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The Future of Knee Repair - February 2016 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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1 6 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 6 Cutting Remarks John D. Kelly IV, MD Just Play It Cool Like The Fonz You gots to chill when things go wrong in the OR. U ntoward events are part of the deal in sur- gery. When the unexpected arrives, surgeons and staff alike gots to chill. Some examples: • Cardiovascular stuff. Administering anesthesia is usually a routine and often mundane exercise. However, fluc- tuations in blood pressure, heart rate and oxygenation regularly occur. Thankfully, we can readily identify and quickly remedy most causes of cardiovascular lability. When a patient's pulse drops, usually there is an identifiable cause — such as too much sedation, reaction to meds or unknown cardiac conduction issues. Mere bradycardia does not constitute a Code. I've witnessed well-meaning but hyperac- tive staff behave like the patient flatlined when the pulse dropped a mere several beats. For our bradycardic patient, one bolus of fluid and a meager amount of atropine later, the heart rate returned to 90 bpm with the ultimate discovery that there was an unusual sensitivity to fentanyl. • Self-reproaching fellow. I am blessed to train fellows in shoulder/sports surgery and find it extremely fulfilling. Yet many never recover from a single surgical misadventure Whether from aberrant portal placement or improper anchor insertion, many fellows react as if they transected the aorta. Head hanging, perspiration, endless mea culpas and some- times flat-out despair may ensue. I quickly entreat the fellow to appre- ciate the notion that fellowships are for learning and no one ever said you would get it all right this year. We learn best from our mistakes. Time to breathe, get back in the saddle and welcome other opportuni- ties for learning (as long as they are not too costly). As Zig Ziglar says,

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