3 ms·
I diagnosed my first pseudocholinesterase deficiency as a CA-1 (for non-doctors: second-year resident, patient was still paralyzed after a long case from a drug
by devilbunny 2y ago
I diagnosed my first pseudocholinesterase deficiency as a CA-1 (for non-doctors: second-year resident, patient was still paralyzed after a long case from a drug that usually lasts ~5 minutes, had to send him to ICU on ventilator until it finally broke down from all the other enzymes in the body). Had to be an attending for ~10 years before I got a malignant hyperthermia case. Do not want to repeat either of those.
No. Surprises. Ever. Unless it's ROSC (return of spontaneous circulation, aka we succeeded) in a code.
- bookofjoe 2y agoThat's interesting. I never encountered either a pseudocholinesterase deficiency or MH during my 38 years of residency/attending/private practice. However — in my first year of residency, during my rotation at the VA, while performing my first brachial plexus block, I unknowingly injected lidocaine into the axillary artery: as the patient began seizing, the attending calmly said "Joe, take out the needle, I'm going to give him some diazepam." Worked! Never had another intravascular injection (that became symptomatic) doing a regional block.
- devilbunny 2y agoOne of my attendings during residency was Kenyan. In the bush, pediatric anesthesia was lido until they seized. At that point, you knew they could not feel anything.
- bookofjoe 2y agoThis is insanely wonderful and amazing!!!!
- devilbunny 2y agoAs he put it, “cardiac-wise, they were very stable - no arrhythmias.”