Quote:
Originally Posted by Red Flag 1
BIS has been around for some time. I have used it in surgery and found a bit of a time lag as I have said before. Patients on and off BIS have had recall...it is not an absolute indicator or predicter of awarness. A bit of a delima happens when you have 10 ORs running with general anesthesia, and only 6 BIS monitors. Who gets the BIS? Do I think I need one for me when I am under general anesthesia? Do I want my MD/CRNA looking at me or the monitor?
I have two fears with BIS monitors. One is that ICU /OR staff will run their eyes around the room at the monitors without really using a "clinical eye" for the patient...believing the monitors only and writting down the numbers. The second is that some day a case will be brought to trial and a provider ICU/OR will have to explain why a BIS was not used.
At one time every patient under anesthesia care, general, regional,MAC, had a precordial stethascope on their chest for their entire anesthetic. How often are they used today? Reliance is on PulseOX & EKG for pulse rate.
A monitor will likely be produced to give us a solid look at the awarness issue. BIS is on the track, just not totally there yet.
RF 1
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RF 1,
you are right on......BIS is a tool and tools fail. Always have a back up that is as good as the original, be it monitoring of vitals, response to stimulation, other techno boxes with numbers/waves/info. I can't remeber if it was TS or TR that said always be prepared with your backup, build in redundancy since tools fail (paraphrasing one of these fine gentlemen). Great lesson to take to heart.
ss
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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