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CONTENTS Preface...................................................................................... v AIRWAY AND VENTILATION Basics: 1 NEVER neglect the basics of airway management Adam D. Niesen, MD and Juraj Sprung, MD, PhD .......................................... 2 Always be prepared for a lost airway Adam D. Niesen, MD and Juraj Sprung, MD, PhD.............................................................. 3 Consider PEEP Andrea Y. Tan, MD and Ibtesam A. Hilmi, MB, CHB, FRCA............................................................................. Advanced: 4 A variety of techniques will provide acceptable anesthesia for awake intubation of the airway-ultimately the most important factors are operator experience and adequate time Chauncey T. Jones, MD. 5 An awake intubation should not be a traumatic experience for the patient Chauncey T. Jones, MD ........................................... Special Cases: 6 A high inspired concentration of oxygen is contraindicated in certain circumstances Xianren Wu, MD and David G. Metro, MD........ 7 Understand and take advantage of the unique properties of helium for the management of the compromised airway J. Mauricio Del Rio, MD and Theresa Gelzinis, MD.................................................... 8 Remember that there are special considerations involved with both intubation and chronic airway management of burn patients Marisa H. Ferrera, MD and Shushma Aggarwal, MD .......................... 9 Consider the use of lidocaine in the cuff of the endotracheal tube, but be aware of the risks and alternatives Jamey E. Eklund, MD and Paul M. Kempen, MD, PhD........................................................ Problem solving: 10 Always troubleshoot an increase in airway pressure Adam D. Niesen, MD and Juraj Sprung, MD, PhD .......................................... 11 Avoid the common airway and ventilation errors in morbidly obese patients Francis X. Whalen Jr, MD and Juraj Sprung, MD, PhD 12 Plan for an airway fire with every head and neck case Julie Marshall, MD ................................................................................ 13 Know how to perform a cricothyroidotomy Lisa Marcucci, MD and Hilary Koprowski, MD ....................................................... Don'ts: 14 Don't overinflate the cuff of the endotracheal tube J. Todd Hobelmann, MD ................................................................................ 15 Don't underepresent the risks associated with the use of a laryngeal mask airway Surjya Sen, MD.............................................. 16 Don't be intimidated by the placement and use of double-lumen en- dotracheal tubes Jay K. Levin, MD ..................................... 17 Don't underestimate the difficulty of reintubating a patient who has undergone carotid endarterectomy or cervical spine surgery Heath R. Diel, MD and Randal O. Dull, MD PhD................................. 18 Don't start the airway management of a Ludwig's angina patient until personnel and equipment for a definitive (surgical) airway are assem- bled Anne L. Lemak DMD and Todd M. Oravitz MD .............. LINES AND ACCESS Basics: 19 Remember that the IV start is your first chance to make a favorable impressiononthepatient HassanAhmad,MDandCatherineMarcucci, MD ................................................................................ 20 Neveruseanintravenouslinewithoutpalpatingandvisuallyinspecting it Ryan C. Mc Hugh, MD and Juraj Sprung, MD PhD ............. 21 Use of ultrasound guidance for cannulation of the central veins im- proves success rates, decreases number of attempts, and lowers com- plication rates Michael Aziz, MD........................................ Central Lines: 22 Central line placement: never neglect the basics Hassan Ahmad, MD ................................................................................ 23 Approach the use of a pulmonary artery catheter with caution-it is a powerful monitor but with the potential for significant morbidity and mortality Amy V. Isenberg, MD ........................................... 24 Avoid technique-related central venous catheter complications by us- ing modern tools J. Saxon Gilbert, MD and Karen Hand, MD... Don'ts: 25 Don't overflush lines Julie Marshall, MD and Peter Rock, MD, MBA .............................................................................. 26 Don't use the subclavian vein for central access of any type in a patient planned for dialysis Michael J. Moritz, MD and Catherine Marcucci, MD ................................................................................ Errors: 27 Remember that inadvertent intra-arterial injection is not rare Michael S. N. Hogan, MB, BCh, Surjya Sen, MD and Juraj Sprung, MD, PhD................................................................................ 28 Avoid errors in invasive blood pressure measurement Michael S. N. Hogan, MB, BCh and Juraj Sprung, MD, PhD......................... 29 Remember that loss of a patent hemodialysis fistula in the perioper- ative period is a serious event for the patient and requires immediate communication with the surgeons Anagh Vora, MD and Steven J. Busuttil, MD .................................................................... FLUIDS, RESUSCITATION, AND TRANSFUSION Fluids: 30 Hypertonic saline: the "solution" to the solution problem? Lavinia M. Kolarczyk, MD and Patrick J. Forte, MD........................... 30 Remember that the synthetic colloid solutions have distinct properties and risk/benefits ratios Ivan Colaizzi, MD and Raymond M. Planinsic, MD ................................................................................ Resuscitation: 32 Protect the kidneys, not the "UOP" Michael P. Hutchens, MD, MA ................................................................................ 33 Do not treat lactic acidosis with bicarbonate S. Prasert, MD..... 34 Consider the use of tris-hydroxymethyl aminomethane (THAM) to treat refractory or life-threatening metabolic acidosis Leander L Mon- cur, MD and Elliott R. Haut, MD.......................................... 35 Use the principles of "damage control anesthesia" in the care of the massivelybleedingpatientandaskthesurgeonstoimplement"damage control surgery" if necessary T. Miko Enomoto, MD and Michael P. Hutchens, MD................................................................... 36 Learn from the care of the combat victim: ask the surgeons to consider damage control surgery for the bleeding patient Surjya Sen, MD Transfusion: 37 Know what screening tests are performed on volunteer donor blood Andrew Gross MD.............................................................. 38 Transfusion of packed red blood cells requires a careful risk-benefit analysis Heather Abernethy, MD and Michael P. Hutchens, MD.. 39 Jehovah's Witnesses and transfusion: ethical issues Rose Christopher- son, MD PhD.................................................................... Perioperative issues: 40 Beware of the mechanical bowel prep James C. Opton, MD....... 41 Beware of the antibiotic bowel prep James C. Opton, MD, Catherine Marcucci, MD and Neil B. Sandson, MD................................ 42 Be aware of the drugs that require slow intravenous administration Maggie Jeffries, MD and Laurel E. Moore, MD........................ 43 Rememberthatsmokingcessationandre-initiationareimportantvari- ables in the perioperative period Neil B. Sandson, MD and Catherine Marcucci, MD................................................................... 44 Consider insulin therapy to correct perioperative hyperglycemia in both diabetic AND non-diabetic patients Heather A. Abernethy, MD and Serge Jabbour, MD ....................................................... 45 Stop metformin before elective surgery or intravascular contrast dye study to decrease the risk of lactic acidosis Serge Jabbour, MD and Michael J. Moritz, MD....................................................... 46 Remember that administration of angiotensin system inhibitors within ten hours before surgery is a significant independent risk factor for hypotension in the post-induction period Thomas B.O. Comfere, MD and Juraj Sprung, MD, PhD................................................. 47 Be aware that many drugs commonly given in the perioperative pe- riod have significant P-glycoprotein transport pump activity Neil B. Sandson, MD.................................................................... 48 Acknowledge the complex medical and legal issues surrounding off- label drug use Angela Pennell, MD....................................... 49 Remember that the unthinkable is possible-follow these principles in the evaluation and treatment of patients suffering from nerve agent poisoning Daniel J. Bochicchio, MD, FCCP............................ Specific drugs: 50 Use bicarbonate as a buffer to local anesthetics, especially for skin infiltration Hooman Rastegar Fassaei, MD and Steven L. Orebaugh, MD ................................................................................ 51 Consider perioperative clonidine administration-it has anxiolytic, anti-emetic, and analgesic properties Bryan J. Fritz, MD and Shashank Saxena, MD........................................................ 52 Consider chloroprocaine for regional blockade when appropriate-it is a rapid onset local anesthetic with low systemic toxicity Joshua M. Zimmerman, MD and Randal O. Dull, MD.............................. 53 Consider using ketamine when appropriate- if managed carefully, the benefits will usually outweigh the potential side effects Elizabeth E. Costello, MD................................................................. 54 Dexmedetomidine can be a useful drug, but will it be universally applicable? Evan T. Lukow, DO, Miriam Anixter, MD and Tetsuro Sakai, MD, PhD ............................................................... 55 Check for history of migraine before giving ondansetron, especially in children Michael J. Moritz, MD.......................................... 56 Remember that not all blue-colored compounds are the same Chauncey T. Jones, MD....................................................... 57 Do not forget that linezolid is a monoamine oxidase inhibitor (MAOI) as well as an antibiotic Neil B. Sandson MD........................... 58 Be alert for the signs and symptoms of perioperative digoxin toxicity, especially if the patient is at risk for electrolyte depletion Grace Chen, MD ................................................................................ 59 Exercise care in the use of amiodarone and alternative antiarrhythmics for the treatment of atrial fibrillation Muhammad Durrani MD, Alan Cheng MD, and Edwin G. Avery IV, MD................................ 60 Have extreme caution when using milrinone in renal failure Yingwei Lum, MD and Edward G. Avery IV, MD................................ 61 Use meperidine with caution Neil B. Sandson, MD................. INTRAOPERATIVE AND PERIOPERATIVE Basics: 62 Wash your hands! James W. Ibinson MD, PhD and David G. Metro MD ................................................................................ 63 Never rush through a signout John T. Bryant, MD ................. 64 Preoperative anxiolysis: It's not just "two of midaz" Michael P. Hutchens, MD, MA............................................................ 65 Recognize that transport is one of the most hazardous intervals in the perioperative period and prepare accordingly Mohammed Ojodu, MD and Charles D. Boucek, MD ................................................. 66 The same simple mistakes at induction (and emergence) happen over and over again-so develop a checklist, and make it ironclad Brandon C. Dial, MD and Randal O. Dull, MD ................................... 67 Never fail to report a needlestick injury Vidya K. Rao, MD, and Shawn T. Beaman, MD ................................................................ Perioperative Medicine (or "Periop-tology"): 68 Understand the utility of preoperative stress testing in suspected heart disease Matthew V. DeCaro, MD ......................................... 69 Perioperative beta blocker therapy is indicated for high-risk patients having non- cardiac surgery, but specific questions remain unanswered Esther Sung, MD and Richard F. Davis, MD............................ 70 A positive troponin is not necessarily a myocardial infarction Michael P. Hutchens, MD, MA and Brad Winters, MD, PhD.................. 71 Do not disregard an elevated partial thromboplastin time when the prothrombin time is normal Lisa Marcucci, MD..................... 72 Avoid a 70% mortality rate: do everything you can to prevent periop- erative renal failure Michael P. Hutchens, MD, MA ................. 73 "Renal dose" dopamine must die Todd J. Smaka, MD and Michael P. Hutchens, MD, MA............................................................ 74 Rememberthatthereareatleastsevenmodalitiestotreathyperkalemia in the perioperative period Grace Chen, MD.......................... 75 Manage obstructive sleep apnea patients conservatively Daniela Damian, MD and Ibtesam A. Hilmi, MB CHB FRCA............... 76 Have a high index of suspicion for perioperative pulmonary embolism in patients who have traveled to your hospital by air Abram H. Burgher, MD and Juraj Sprung, MD PhD........................................... 77 Be aware that schizophrenic patients have greater perioperative risks than age- matched controls Neil B. Sandson MD.................... Special Cases: 78 Useextracareinpositioningpatientswhohavehadamputations Carol Bodenheimer, MD and Catherine Marcucci, MD ....................... 79 Positioning patients for spine surgery: how to minimize the risks Ihab Kamel, MD, David Y. Kim, MD and Rodger Barnette, MD, FCCM 80 Be vigilant during placement of the camera in laparoscopic procedures and always watch carefully for the physiological effects of carbon diox- ide (CO2) insufflation Jennifer A. DeCou, MD and Randal O. Dull, MD PhD................................................................................ 81 Do not use urine output as an indicator of volume status in hypother- mic patients Juan N. Pulido, MD and Daniel R. Brown, MD, PhD 82 Anesthesia for eye surgery-The innate culture of "1-N-1" Amit Sharma, MD and Rajeev S. Kathuria, MD.............................. 83 Remember that fires in the operating room can be prevented by mini- mizing just one component of the fire triad Anne B. Haupt, RN, BSN, CNOR and Catherine Marcucci, MD ..................................... 84 Remember that elevated temperature is a late finding in malignant hyperthermia James C. Opton, MD ..................................... 85 Consider methemoglobinemia after ruling out the common causes for a low pulse oximeter reading Leena Mathew, MD, Philip Shin MD and Walter Chang, MD ....................................................... 86 Pulse oximetry: even a simple device requires user understanding Jorge Pineda Jr, MD and Stephen T. Robinson, MD................... 87 The end-tidal CO2 monitor is more than just a "the tube is in the airway" device Brian Woodcock, MBChB, MRCP, FRCA, FCCM 88 Noninvasivebloodpressuremanagement-it'snotjustapieceofnylon around the arm Jorge Pineda Jr, MD and Stephen T. Robinson, MD 89 Don't let the tourniquet time run long Byron D. Fergerson, MD and Randal O. Dull, MD PhD.................................................... 90 Brain function monitors attempt to link an intraoperative measure- ment with postoperative recall - much is known and more is unknown as definitive practice parameters and "best use" guidelines for these monitors evolve Stephen T. Robinson, MD and Catherine Marcucci, MD ................................................................................ Devices: 91 Do not use improvised techniques to warm patients- warming de- vices must be used only as per manufacturers' recommendations Jeff Mueller, MD..................................................................... 92 Remember that the effects of prone positioning are frame-dependent Laura H. Ferguson, MD and Shawn T. Beaman, MD................. 93 Cardiac output measurement: do you really understand the underlying principles? Valerie Sera, DDS, MD and Matthew Caldwell, MD 94 Infusion pumps: great technology when it works Stephen T. Robinson, MD and Richard R. Botney, MD........................................... Behind the scenes: 95 Scavenging waste gases is beneficial for the staff, but potentially harm- ful to the patient Terrence L. Trentman, MD.......................... 96 Carbondioxideabsorberssavegasandmoisturebutcreatethepotential for mechanical hazards, chemical soup, or a thermal disaster Michael Axley, MD and Stephen T. Robinson, MD ............................... 97 Do not use your cellphone in the OR Grant T. Cravens, MD and Juraj Sprung, MD, PhD.............................................................. 98 Remember that the line isolation monitor is based on a simple principle of electrical safety: make sure the patient does not become part of a grounded circuit Jeffrey D. Dillon, MD, Richard R. Botney, MD and Randal O. Dull, MD PhD.................................................... REGIONAL ANESTHESIA Before You Begin: 99 Complications of regional anesthesia: don't touch the needle until you know them David A. Burns, MD ......................................... 100 Know the facts and be ready with an answer when a patient planned for spinal anesthesia asks "Can this paralyze me?" Angela M. Pennell, MD ................................................................................ 101 Remember the low-risk/high-yield blocks Jennifer Vookles, MD, MA ................................................................................ Doing the block: 102 Consider the paramedian approach for spinal anesthetic placement if the patient is in the lateral position Catherine Marcucci, MD..... 103 Consider the paramedian approach for thoracic epidural placement, especially at the mid-thoracic level Amit Sharma, MD............. 104 Incorporate ultrasound guidance for peripheral nerve blockade into your practice Michael Aziz, MD and Jean-Louis Horn, MD...... 105 Do not overlook the "old-fashioned" Bier block, but beware of the speedy surgeon! Surjya Sen, MD and Michael W. Barts, CRNA. 106 Consider an epidural anesthetic as an adjunctive or primary technique for mastectomy patients Jennifer Vookles, MD, MA................. 107 Consider continuous paravertebral block as your primary analgesic technique Bruce Ben-David, MD......................................... After the block: 108 Wet tap? What now? David Y. Kim, MD and Ihab Kamel, MD.. 109 A patient under regional anesthesia who suddenly cannot speak above a whisper is a high block until proven otherwise Ryan J. Bortolon, MD and Juraj Sprung, MD, PhD................................................. 110 Consider lipid emulsion rescue for local anesthetic overdose Heath A. Fallin, MD and David A. Burns, MD..................................... PACU 111 Remember that postoperative pain management should be started pre- operatively J. Todd Hobelmann, MD..................................... 112 Seek out hypercapnea in the PACU and remember that an accept- able pulse oximeter reading is not assurance of adequate ventilation Michael P. Hutchens, MD.................................................... 113 Consider acupuncture as an adjunct for the prophylaxis and treatment of post operative nausea and vomiting Leena Mathew, MD....... 114 Never delay in responding to a call from the PACU about an eye complaint Anagh Vora, MD................................................ 115 Be aware of the issues and criteria pertaining to discharge of the post- spinal patient Erik A. Cooper, DO and Li Meng, MD, MPH...... PEDIATRIC ANESTHESIA Basics: 116 Fasting guidelines for children should be simple but not too simple Justin Hauser, MD............................................................. 117 Do not automatically cancel the case if a child has a runny nose Ann G. Bailey, MD .................................................................. 118 Put some thought into which child and with what drug you premedi- cate M. Concetta DeCaria, MD ........................................... 119 Parents are present in the operating room by invitation of the anesthe- siologist only Juanita P. Edwards, MD and Robert D. Valley, MD 120 Pay scrupulous attention to eliminating air bubbles in pediatric intra- venous (IV) tubing Erica P. Lin, MD.................................... 121 In children, the improper placement, use, and maintenance of vascular access lines can result in serious morbidity and even mortality Angela Kendrick, MD................................................................... 122 Make sure you see the intubation and airway equipment you plan to use AND the equipment you think you might use Eugene E. Lee, MD ................................................................................ 123 Always expect and be prepared to treat hypoxemia during the induc- tion and emergence of a pediatric patient Michael J. Stella, MD 124 The pediatric airway is a scary repository for all kinds of foreign bodies Janey P. McGee, MD and Robert D. Valley, MD....................... 125 Effective epidural anesthesia for children does not always require a catheter Dennis Yun, MD and Robert D. Valley, MD................ 126 Keeping babies warm in the perioperative period is important, chal- lenging, and at times dangerous! Kathleen A. Smith, MD ......... 127 Focus on the prevention of emergence delirium as well as treatment Warren K. Eng, MD and Robert D. Valley, MD........................ 128 Remember that babies really do feel pain Angela Kendrick, MD. 129 Don't let the surgeons discharge every pediatric patient home! Peggy P. Dietrich, MD and Robert D.Valley, MD............................... Special issues: 130 Recognize predictors and patterns of cardiac arrest in the anesthetized child Kirk Lalwani, MD, FRCA.......................................... 131 Clinicians can not rely solely on the legal doctrine of parens patriae when providing care for the Jehovah's Witness minor Anne T. Lunney, MD ................................................................................ NEUROANESTHESIA Basics: 132 The neurophysiology you learned in medical school really does matter during craniotomies Jennifer J. Adams, MD and Laurel E. Moore, MD ................................................................................ 133 Anesthetic goals for cerebral aneurysm are not the same as for routine craniotomy James DeMeester, MD........................................ 134 Evoked potentials: don't approach the surgeon and neurophysiologist until you know these principles Alan Finley, MD, Anthony Passan- nante, MD and Laurel E. Moore, MD..................................... Intraoperative management: 135 Don't treat hypertension in neurosurgery cases before considering the cause(s) and risks and always recognize that an abrupt change in the patient's blood pressure needs to be investigated John Marvel, MD ................................................................................ 136 Awake craniotomy can be done humanely Alexis Bilbo, MD and Laurel E. Moore, MD................................................................... 137 Don't be caught unprepared for a wake-up test Sarah Merritt, MD, Peter Rock, MD, MBA and Laurel E. Moore, MD..................... 138 Remember that loss of vision is one of the most feared and devastating complications of spine surgery Laurel E. Moore, MD .............. CARDIAC ANESTHESIA Basics: 139 Cannulation for cardiopulmonary bypass-be careful where you point that thing! Jason Z. Qu, MD and Edwin G. Avery IV, MD ........ 140 Remember to ask about a history of esophageal disease if trans- esophageal echocardiography is planned (or possible) Thomas R. El- sass, MD and Robert W. Kyle, DO ......................................... 141 Remember that it is not possible to completely avoid myocardial is- chemia associated with cardiopulmonary bypass and the delivery of cardioplegia-the goal is to minimize it Amy Lu MD, MPH and Giora Landesberg, MD, DSc, MBA ................................................ 142 On the cusp of disaster: Distinguish between the anesthetic manage- ment of stenotic and regurgitant cardiac valves George A. Mashour, MD, PhD and Theodore A. Alston, MD, PhD........................... 143 Antifibrinolytic agents: spare the clot but spoil the thrombus Ala Nozari, MD PhD and Theodore A. Alston, MD PhD ................. 144 The downside of anesthesia for the descending thoracic aorta: just about all the anesthetic issues are of paramount importance! Edwin G. Avery IV, MD and David A. Shaff, MD............................. 145 Anesthesiaforascendingaorticdissection:it'slikewalkingoneggshells for the anesthesiologist James F. Dana, MD and Edwin G. Avery IV, MD ................................................................................ Special issues: 146 FREEZE, you're under deep hypothermic circulatory arrest! Stephen R. Barone, MD and Michael G. Fitzsimons, MD....................... 147 Remember that anesthesia for left ventricular assist device surgery is especially challenging: do not neglect these essential principles Mark Chrostowski, MD and Giora Landesberg, MD, DSc, MBA........... 148 Off pump cardiac surgery: What do you mean no pump break for the anesthesiologist? Biswajit Ghosh, MD and Vipin Mehta, MD..... 149 Coagulopathy in the cardiac surgical patient-it's not just about the numbers Joby Chandy, MD and Edwin G. Avery IV, MD ......... 150 Remember there are specific do's and don'ts of anesthesia care for hypertrophic obstructive cardiomyopathy Cosmin Gauran, MD and Edward George, MD, PhD ................................................... OB ANESTHESIA "Routine" labor and delivery: 151 Managing guests on the labor deck requires clear communication con- sistently, firmness when necessary, and calmness always Christopher E. Swide, MD ................................................................... 152 I want my epidural now! The effects of epidural analgesia on progress of labor and delivery Patrick G. Bakke MD and Jennifer Cozzens, MD................................................................................. 153 If carefully selected, patients in labor can ambulate safely-the key is the use of low-dose epidural analgesia Christopher Colville, MD and Christopher E. Swide, MD.................................................... 154 NPO guidelines during labor-"Can I please just have some water?" Patrick G. Bakke MD......................................................... 155 Be prepared for the presence of a doula in the both the labor and delivery room Christopher E. Swide, MD............................... 156 Urgent cesarean section: What's good for baby is good for mommy? Nathan Hess, MD and Karen Hand, MB................................ 157 Pain control after Cesarean section-"how can I take care of my baby if I just had surgery?" Patrick G. Bakke, MD ......................... Special issues: 158 Beawareoftheconsequencesofaortocavalcompressionandthesupine hypotensive syndrome when caring for a pregnant patient Thomas M. Chalifoux, MD and Ryan C. Romeo, MD................................ 159 Headaches and hypertension: management of preeclampsia in the obese patient Patrick G. Bakke, MD..................................... 160 Acupuncture has significant efficacy for the treatment of the pregnant or laboring patient Leena Mathew, MD ................................ 161 Always be prepared for emergent delivery as a consequence of external cephalic version Angela M. Pennell, MD............................... 162 OB anesthesia/analgesia CAN work in a small hospital: the key prin- ciples are commitment, flexibility, and planning James S. Hicks, MD, MMM ............................................................................ 163 Remember that anesthesia for the pregnant patient having non- obstetric surgery is not limited to any particular agents or techniques L. Michele Noles, MD......................................................... PAIN MEDICINE Perioperative management: 164 Do not guess at the equivalent dose when determining an opioid con- version Amit Sharma, MD ................................................. 165 Consider discussing the use of ketorolac (toradol) with your surgical team before the need arises Amit Sharma, MD....................... 166 The basal infusion mode in patient controlled analgesia is both friend and foe Amit Sharma, MD ................................................. 167 Management of perioperative pain in opioid dependent patient-out of the frying pan, into the fire Amit Sharma, MD ................... 168 Do patients with congenital insensitivity to pain need anesthetics and postoperative opioids? Katarina Bojanic, MD, Toby N. Weingarten, MD and Juraj Sprung, MD, PhD .......................................... Chronic pain: 169 Rule out facet arthropathy before initiating expensive and invasive maneuvers for back and spine pain Amit Sharma, MD............. 170 When evaluating back pain, always examine for trigger points before ordering expensive imaging studies Leena Mathew, MD .......... 171 Know the complications of epidural corticosteroid injections Anne E. Ptaszynski, MD and Toby N. Weingarten, MD ......................... 172 Chemical neurolysis has good efficacy in the treatment of intractable and terminal cancer pain, but precise administration of the appropriate anesthetic and lytic agents is imperative Leena Mathew, MD.... HUMAN FACTORS 173 Understanding the human factors F. Jacob Seagull, PhD.......... Do's: 174 Borrow from the pilots in order to minimize errors in anesthesia man- agement: recognition and prevention Stephen J. Gleich, BS and Juraj Sprung, MD, PhD.............................................................. 175 In a noisy OR, use a "spelling alphabet" to communicate the patient's name or check in blood products Catherine Marcucci, MD, Daniel T. Murray, CRNA and F. Jacob Seagull, PhD.............................. 176 Know when to stop F. Jacob Seagull, PhD and Catherine Marcucci, MD ................................................................................ 177 Folklore can be a powerful ally-share stories and don't forget to listen F. Jacob Seagull, PhD, Deborah Dlugose, CRNA and Catherine Marcucci, MD ................................................................................ Don'ts: 178 Don't ignore your intuition F. Jacob Seagull, PhD and Catherine Mar- cucci, MD......................................................................... 179 Donotrelyonrotememorizationofcontraindications ErikS.Eckman, MD, Peter Rock, MD, MBA and F. Jacob Seagull, PhD.............. 180 Be aware of the interface between spirituality and the practice of medicine and NEVER interrupt the chaplain Angela C. Wooditch, MD and Joseph F. Talarico, DO ............................................ LEGAL 181 How not to end up in a closed claims file: lessons learned from the ASA Closed Claims Project Lorri A. Lee, MD and Karen B. Domino, MD, MPH....................................................................... 182 Refusal to do a case on moral or ethical grounds: practical navigation of very troubled waters Kenneth R. Abbey, MD, JD and Marcus C. Stepaniak, CRNA, MS, BSN............................................... 183 Get informed about "informed consent" Lynn A. Fenton, MD.. 184 The anesthesia record IS a legal document Joseph F. Talarico, DO, David G. Metro, MD and Renee A. Metal, JD.......................... 185 Reading in the operating room-is it worth the risk? Michael Axley, MD ................................................................................ 186 Adequate treatment of pain is both an ethical and legal obligation: Treat severe pain scores like unstable vital signs: quickly and decisively Kenneth R. Abbey, MD, JD.................................................. 187 Handle dental injuries like you handle teeth, with care Douglas W. Anderson, DMD and Kenneth R. Abbey, MD JD....................... 188 Do Not Resuscitate orders are not automatically suspended in the operating room Kirk Lalwani, MD FRCA and Vincent K. Lew, BA, (MS II).......................................................................... 189 Invoke Parens Patriae to provide safe medical care to a child when the parents can't or won't consent Anne T. Lunney, MD................ PROFESSIONAL PRACTICE Basics 190 Don'tasktheoperatingroomnursetobeasupplytechnician,secretary, or mediator Catherine Marcucci, MD and Pamela D. Nichols, RN 191 Do not allow your Advanced Cardiac Life Support (ACLS) certifica- tion to lapse Catherine Marcucci, MD and Lisa Marcucci, MD... 192 Do not ask a family member to translate or assist with procedures Randal O. Dull, MD PhD.................................................... 193 Take steps to safeguard yourself when you are pregnant, but try not to worry excessively Angela Zimmerman, MD......................... 194 Know what the basic statistical terms mean Peter F. Cronholm, MD and Joseph B. Straton, MD .................................................. Always Avoid the Bad Jobs 195 Know the advantages and disadvantages of the different types of prac- tices Norman A. Cohen, MD............................................... 196 Know yourself Norman A. Cohen, MD ................................. 197 Know how to assess a practice Norman A. Cohen, MD............. 198 Understanding solo practice and the basics of medical practice finance and legal organization Norman A. Cohen, MD ....................... 199 Specific considerations for a group practice Norman A. Cohen, MD ................................................................................ 200 Make sure you understand the complicance plan Norman A. Cohen, MD ................................................................................ 201 Know the risk management strategies of the practice Norman A. Co- hen, MD .......................................................................... 202 Review the practices special funding sources, obligations and benefit packages Norman A. Cohen, MD......................................... 203 Know what to expect in contracts Norman A. Cohen, MD........ CODING AND PAYMENT - MAKE SURE YOU GET PAID 204 Understanding Medical Coding and The Healthcare Payment System Norman A. Cohen, MD....................................................... 205 The structure of medical codes Norman A. Cohen, MD ........... 206 Detailed look at describing diagnoses using the International Classi- fication of Diseases Norman A. Cohen, MD ........................... 207 Detailed look at procedure coding - Current Procedural Terminology, HCPCS, and ICD Norman A. Cohen, MD ............................ 208 Specific Coding Issues Norman A. Cohen, MD....................... 209 Getting paid for anesthesia services Norman A. Cohen, MD...... 210 Medicare issues Norman A. Cohen, MD................................ 211 What are the coding resources to help me code correctly? Norman A. Cohen, MD....................................................................... 212 Navigating a hazardous road Norman A. Cohen, MD............... 213 Brief look at Medicaid and anesthesia Norman A. Cohen, MD... 214 Brief look at other payers Norman A. Cohen, MD ................... COMMENCEMENT 215 ...................................................................................... 216 Respect in the operating room: be good.... no, be great Grace L. Chien, MD and Tammily R. Carpenter, MD...................................... Index ...................................................................................... 00
Library of Congress Subject Headings for this publication:
Anesthesia.
Medical errors -- Prevention.
Anesthesia -- methods.
Medical Errors -- prevention & control.