The post-it says “the other side of the coin with the need? For an abg right before incision and the crush that follows, including ologist handing off the specimen with NO label to someone in black scrubs.’
The universe saw the post-it from 2/27/22 and decided to up the ante.
The CRNA, the scrub tech, the surgeon, and the anesthesiologist needed something at the exact busiest time of the case.
The incision.
This one pushed my skills to the test.
The ologist and the surgeon agreed they needed a baseline ABG.
And decided that the time to request it was right then.
Immediately before incision.
There is much to do immediately before the incision.
The pre-incision pause has been done.
Lines including suction and bovie are being handed off.
The surgeon’s step is being put in place.
You remind the room at large that you are the only person in the room that is free and they will have to wait their turn.
The bovie and the suction are the immediate concerns.
Once the incision has been made, which is happening right now, the need for electrocautery and for suction is high.
Especially on a big belly case.
Where you don’t know exactly what you are getting into.
Of course there is no one in the department.
It’s a call case.
Why would there be?
The ologist bleats again, while you are tending to the possibility of bleeding, about the ABG.
You tell him to put the order in himself.
And you will print the sticker after the suction and the cautery are connected and starting to suck up blood and control the blood because the incision has been made.
And once the pressure of the skin is released the intestinal contents spill out like a trick can of snakes.
Which leads to more immediate requests from the table.
Once those are taken care of, you sign in, again, to the EHR.
While you are doing that you call the supervisor and ask for the respiratory therapist to come to the PACU to pick up the ABG.
You go in search of the blood tube for the ABG, which is not in the room.
Why?
This is the critical case room.
The ologist is sitting there frustrated.
You have no time to re-sign into the electronic health record and print the labels.
It has been 3 minutes.
Haven’t you finished getting the case started yet?
What are you doing?
The CRNA finds the blood tube and draws the ABG blood from the central line.
The phone alerts that the respiratory therapist is in PACU to get the blood sample.
The EHR has timed out AGAIN.
In a moment of calm, when the field and the CRNA are both content, you sign back into the EHR and try to print the labels.
Which do not populate to your to-do list.
You check the ologist’s work.
The order is not in correctly.
You correct that, and go get the printed label.
It has now been 5 minutes.
When you ask where the blood tube is, the ologist calmly tells you that he gave it to someone who knocked on the sub-sterile door.
Someone he didn’t know.
In black scrubs.
Wall, meet head.
The ologist allowed a specimen to go out of the room.
Hell, out of the department, without a specimen sticker.
There are so many ways that could go wrong.
You don’t have time to yell at the ologist.
Much.
But, wait, the sterile field needs you before you can cause bodily harm to the ologist.
Don’t tell me Murphy doesn’t live in the OR.
Dispatches from the Evening Shift 