fies ventilation. Not true. A pulse oximeter measures oxygenation. A
patient hooked to oxygen can have passive oxygenation without venti-
lation. The pulse oximeter will likely let you know that a patient has
stopped breathing, but not necessarily in a timely manner. "That's
where the capnography machine comes in," says Dr. Jopling. "It pro-
vides a much earlier indication."
11. A simple cough can help. When a half-awake patient in recov-
ery experiences a laryngeal spasm due to secretions on the vocal
cords, this causes the patient to breathe rapidly in a panic, which can
make things worse. "Tell them to take a slow breath in and to cough
— because a cough can clear those secretions away — to avoid hav-
ing to intubate them again," says Dr. Jopling.
12. Your pride gets in the way of quality care. Sometimes, ego
can prevent anesthesia providers from calling for help should things
get tricky. It may also prompt them to keep trying — and failing — at
the same technique without making any adjustments, like changing a
patient's positioning, the type of laryngoscope blade or the curve of
the stylet in the endotracheal tube. Sometimes in medicine, there's a
misconception that asking for help is a sign of weakness. "You don't
want to force anything," says Dr. Cazier. "You have to know when you
need assistance. You can't be so prideful that you refuse to call for
help, or wake a patient up and cancel the case." In other words,
there's no shame in trying again another day. Just make sure to cata-
logue these difficulties for the patient's future anesthesia providers, so
they know exactly what they're up against.
OSM
A P R I L 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 1 0 3
"You have to know when you need assistance.
You can't be so prideful that you refuse to
call for help, or wake a patient up and
cancel the case."
— Jeffrey Cazier, MD
