Cardiac arrest in the OR: The anesthesiologist's role

[@passion5554]

Hi Max, I am a CVICU nurse who you inspired to become a CRNA. Currently applied to CRNA school and hopes to join the anesthesia community in the future. Thank you for these educational and entertaining videos!

[@scrumptious9673]

👏

[@darriontunstall3708]

I tried to go to college to be a anesthesiologist but it was gonna be too hard because of my cerebral palsy, so now I donate to the anesthesiologist Foundation

[@spoerer567]

Me too! Good luck on your applications!

[@Jen_K]

Best wishes to both of you I see have pushed yourselves to go farther!

[@macmedic892]

7:55 “…it can seem like anesthesiologists are just sitting in a chair not doing anything…” Not true. I learned from Dr. Glaucomflecken that you do sudoku puzzles.

[@denniseaton3215]

I am an anesthesiologist who was saved by a CRNA. Forever grateful.!

[@pennilegget7305]

Max due to your videos, when I met the Anesthesiologist prior to surgery I knew what questions I needed to ask ( even though I just retired as a kidney care nurse. Thank you

[@CheesyHotDogPuff]

This was a great vid, as a paramedic I love seeing how things are handled inside the hospital.

[@macmedic892]

It must nice for them to have practically unlimited professional partners.

[@sadib4782]

sameeee, i love being able to see the quality of care continue once they’re off the ambulance. it makes me feel good to hand off a patient and truly know that they’ll still be taken care of.

[@dixieinstrumental805]

After seeing some of the lines they put in I defiantly know who to go to of I can't get a medic or a phlebotomist.

[@TomKimmerer]

Thank you so much for this, Dr. Feinstein. I was a cardiothoracic surgical tech at Hopkins for a number of years. I don't recall more than two CVAs during that time, except for patients who were already moribund or otherwise expected not to survive, and for the surgeries where arrest was planned. Restarting those patients, a collaboration between the surgeon and the anesthesiologis, was thrilling (OK, I was a teenager).

[@rontiemens2553]

A teenager, yes, but also an empathetic human being. Kudos to you. Restarting a patient is amazing and thrilling.

[@starfishgurl1984]

Great video! My brother-in-law is a clinical engineer who works with the mapping equipment used in ablation surgeries for patients with heart problems and he helps to direct the surgeons where to go during surgery so it’s fascinating to see things from the anesthesiologists role in procedures like that.

[@AmbarSharif-d3l]

Am anesthesia technology student from India , your vid have helped me a lot for my studies 😊Thank you

[@genepatterson4375]

Dr Max is the greatest! When you look at the vast amount of knowledge he is required to have and the ability to multi, multi-task, how could you not feel comfortable in his hands? With him at the head of the table I know I would have no surgery fears.

[@Gamblers_Ashandarei]

Love watching your videos in the off-time of studying for my bsc in nursing. Cheers from austria.

[@ilovetotri23]

Not surprised to hear a new level of the expertise your field has! I love the work you do! And the care you give with little thanks! Thank You!

[@kellyanne7225]

Interesting. 🤔 It made me think about what went on during my gall bladder removal, when the surgeon had trouble getting it out, and had accidentally cut a very large, hidden vein beneath it. He told my husband about it, and me too I guess, although I don’t remember as I was still coming out of anesthesia. I was told that he said that “You had me worried for a while, there”. 😊 You guys ARE amazing and God is in control! 👍🏼

[@milestogo394]

Dr. Feinstien, thank you so much for the vidoes. I notice so many disclaimers... It is so admirable that even though you might get backlash or negativity, you continue to take the time to make these videos of your work and the work of your colleagues. I can only imagine jow relentlessly you work and still have the dedication to making videos and sharing knowledge. My spouse is a ct anesth md, and your videos help me be a better wife, listener and supporter by having more understanding of the work. (I always listened 😂😂 I just didnt understand the words or situations). I can't thank you enough!!

[@edu.M.A.0077]

Your great sense of humor is unique and wonderful! It helps in your presentations.

[@lohikarhu734]

Really refining a lot of what I knew, at a fairly basic level... I had 4 surgeries on an elbow, in about two weeks, and found that I felt stress on the 3rd and 4th times, and needed quite a 'bump' of pain med, even with a good brachial block...

[@dennypollard8004]

I have a 3rd-degree heart block and have thyroid surgery in three days. I should mention I am 100% paced. During my pre-op meeting, no mention of my heart pacer was made so I asked the question. The Pre-Opt doctor was a bit put off when I asked, the resident doctor in training started to answer and was cut off. I have written a one-page question sheet that the pre-opt doctor did not address. On surgery day I plan to give my anesthesiologist the same page of questions as I am really concerned now. How would you address a patient's questions just before surgery?

[@Miss_Attitude_70]

Christmas day 2020. I had 5 cardiac arrests. How I lived I will never know. I now have a defibrillator in my chest.

[@jar101047]

Good quick review, but in my 47 years at the head of the table, anaphylaxis was probably one of the leading causes of cardiac arrest that I saw, the worst being an aortic Y graft allergy that when unclamped led to V-tach, V-Fib, immediate DIC, and total body exsanguination from every cut surface, puncture site, and orifice within 3-4 minutes...nothing worked...perhaps the serious nature of the event could be stressed just a little more...

[@darriontunstall3708]

Great info! I learned so much! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be an anesthesiologist physician! That was an amazing! Anesthesiologist is the best!!

[@peachmelba9333]

Oh Max , You brought up a sad memory. My Cousin June-Ellen, after bouncing from low to medium to Cleveland Clinic, being Poo-Pooed all the way that all She had some indigestion. Turned out to Be Barretts Esophagus that had progressed to Gastro/Esophageal carcinoma, coded on the Table and they werent able to bring Her back. 68 years old- 5 1/2 years ago & i mss her and I had already had diagnosis of GERD, i had Bariatric surgery so i would lessen my likelihood of followng Her. She was my 1st cousin and once my playmate!😢😢

[@mollysullivan6414]

rest in power june-ellen

[@danbrodsky57]

This is great video from such a dedicated complex team. Wondering if EPIC or other EMRs have a check list you need to fill out before the case gets started? Also perhaps a video on the team that operates the heart lung machine one day..

[@5954ldydi]

Thank you Dr Fienstein for another educational and interesting video.

[@Ms.Opinionated]

Thanks for continuing to educate us meer mortals Max!!! 😂

[@Nunofurdambiznez]

LOL!! Doctor, you have a GREAT sense of humor, I love it!

[@sherrydawson6253]

This was very interesting. Even your sense of humor is always a delight 😊 may I ask a question? When u first started as a resident , was it scary? As a former nurse my belief was , yes the surgeon of course is very important. How ever the anesthesiologist is more important. Our life is in your hands.you are the high priority. Wondering how as a beginning student did u handel or deal with all the scary things? 😊❤❤

[@Eman1900O]

I’d say it’s equally important. Bad surgeons are anesthesia’s worst nightmare

[@dylanatkinson9916]

I am a third year medical student applying to Anesthesia. Yes these critical roles can be scary but that’s why we have the choice to go into any medical specialty. For some people the emotional toll of outpatient medicine- think child abuse, mental health crises, opioid seeking patients over time is more than being prepared for true medical emergencies at the hospital. I can only hope I am making the best decision for myself.

[@DevilChild6100]

That zoll needs a defibrillator test done, thats what the red x means

[@mollysullivan6414]

awesome video as always max!! i am a sinai RN and love your representation of what we do! i especially think it's so important to talk about in-hospital management of cardiac arrest. even as an ICU nurse i have seen arrest frequently mismanaged, mostly from a team perspective but often from a medical one. i would love it if you could make a video describing your thoughts on what distinguishes a well-managed cardiac arrest from a mismanaged one. thank you again for awesome content and focusing on quality/education as opposed to "influencer" life!

[@comcastjohn]

So it can be delivered in a heartbeat! 😱😂🤣😁😅🧐🧐🧐🧐🧐🧐🧐🧐🧐🧐 Love your vids Doctor. Been with ya from the near beginning! 😎👊

[@rontiemens2553]

Fantastic presentation. THANK YOU!!!

[@davidadams9391]

Hi Dr Max, we’ve missed you!

[@Markyroson]

7:30 that got a chuckle out of me

[@gaurav.sajlan]

Long waiting for new video

[@Slik-Rik-V]

Max, how long did it take you to master those ACLS algorithms?

[@craigpater6278]

I think that it's worth mentioning that an electric shock is not always a bad thing. What I mean by that is an accidental high voltage electric shock can trigger a cardiac arrest and be immediately life threatening, however a properly controlled electric shock delivered by a defibrillator could potentially save the life of a patient if they are already in cardiac arrest before the defibrillator shock is applied

[@PaulBishop-v1o]

Correct!

[@randomfootage8440]

What is the equivalent to chest compressions for cardiac arrest that occurs during surgeries on the chest region itself? Just curious.

[@PaulBishop-v1o]

Internal cardiac massage. The chest is opened (either by splitting the sternum, or opening the left chest), and the heart is manually squeezed at 100 times a minute in lieu of standard external chest compressions

[@kcpoodlesofpa]

A friend of ours went into cardiac arrest during a tubal ligation days ago. Her heart rate climbed before it plummeted. They could not revive her. She was 43 and left 9 kids without a mother and her husband a widower. It just blows my mind that they were unable to save her. What could cause this?

[@PaulBishop-v1o]

That’s a question without an answer short of an autopsy. Could have been underlying heart disease, blood clot, arrhythmia, it’s really impossible to say. This is where medical examiners are able to provide more answers than anyone.

[@dmitryschafebook2443]

Are the intentional cardiac arrests included in the 5.1 per 10,000 rate of cardiac arrests?

[@michaelwhitaker6553]

Hey max am Mike from SC your videos very interesting

[@lohikarhu734]

You made me think that this intraoperative pain/stress is quite critical for patients with things like four previous MIs, and so on...if a patient has a genetic tolerance to opiods, it's probably important for the anaesthesia doc to know that, when a patient can easily tolerate 1mg fentanyl IV, that's a bit more than average? How does one communicate this to you? It seems that it's very difficult to 'convince' the doctors, and even more difficult to get adequate post-op pain relief, when one's baseline, every day, is 2.4 mg fentanyl (transdermal), so post-op ain relief requires the baseline, plus, from what I have read, about 20% of baseline, every 4 hours, for the immediate post-op period... Not easy to sort out with "ward doctors"...is it feasible to get the anaesthesiologist into the loop?

[@Spartacus.D]

what is the most common complications that occurs for a anesthesiologist to deal with?

[@Eman1900O]

My guess would be difficult airways

[@PaulBishop-v1o]

Bronchospasm, hypotension, and keeping up with blood loss are the biggest ones.

[@acdfg56]

Hi Max, what kindve medication or group of medications would you say would be a challenge to have someone be put under for surgery?

[@paulkoza8652]

Thanks, very informative.

[@ApparitionFVT]

Question: why is it that you can use an electric shock to restart an arrested heart during surgery, but using a defibrillator on someone in asystole in the wild/streets is considered pointless and that only chest compressions works?

[@MaxFeinsteinMD]

It’s not pointless- that’s why there are AEDs in public places like airports.

[@ApparitionFVT]

@@MaxFeinsteinMD oh, for sure, but I thought it was only applicable during certain rhythms like v fib, etc but the doctors always get mad at health TV shows because they dramatize and use AED on an asystole/flatline patient because they say asystole is not a shockable rhythm and it's essentially cooking the heart. It seems like that's different than what you're using during surgery then?

[@ApparitionFVT]

@@MaxFeinsteinMD maybe you could make a video about shocking rhythms, etc. Please? ☺️

[@MaxFeinsteinMD]

You’re correct that only certain abdominal rhythms (vfib, pulseless vtach) are amenable to electrotherapy. You’re also correct that it’s dramatic and wrong to deliver a shock during asystole, and this bothers me on TV shows.

[@ApparitionFVT]

@@MaxFeinsteinMD haha I thought so tysm. So then what type of rhythm are you shocking a patient out of when they are arrested during surgery please? 😊

[@brendancorcoran245]

Scary stuff.

[@tomdeweese9547]

Thank you. I now understand why elective surgery is sometimes denied. The likelihood of a coronary event during surgery isn't worth the desired, but not necessary, result.

[@fletchti5984]

What about cardic arrest in trauma patients?? I am sure that number is higher

[@Liliana_Lili_]

What year did you graduate medical school?

[@jerrylim6722]

"...anesthesiologist just sit around, doing nothing..." security guards for major government facilities do essentially just that, yet you don't see people complaining about them, do we now? you'd think having an extra guy in the OP room to say something in the even that shit hits fan, is better than NOT having that "do nothing" guy around... for all I care, I'd prefer having someone sitting there in the corner playing mobile games next to the beeping machines, over just the machines on max volume so the surgeon can MAYBE hear it beep every 5 minutes between them constantly asking for different stuff to be handed to them.

[@3ormore887]

Do you keep your ACLS up to date?

[@MaxFeinsteinMD]

Yes

[@lms2391]

​@@MaxFeinsteinMDYou should do a reaction video to medical shows!

[@Eman1900O]

He is required to

[@sigvald11]

What if the surgeon arrests, are you in charge then? lol :) great videos.

[@Boodieman72]

I would think it would be more likely to happen in a trauma surgery rather than a scheduled surgery.

[@jackforshaw4439]

have you ever met Doctor Mike?

[@kerbalt692]

I think they both work in nyc it would be a cool colab lol

[@dariansaid3657]

Hi max

[@lindaspradlin1436]

If you were my anesthesiologist, I’d surely have a cardiac arrest because you’re SO STINKING CUTE! (I liked your joke!)

[@joescarpelliiii8637]

Looks like that Zoll needs a QC test!

[@memohedlbee1587]

Or rare in trauma cases

[@MrOrthodox13]

7:24 It's ok

[@SilentRoses]

what's funny is, it was the opioid painkiller that nearly killed me after surgery! Turns out I'm deathly allergic! Only found out from surgery lol

[@rumscarum]

Nice hat

[@hollymcknight8581]

Some thing I would advise you to be very careful of, you like to say things, such as as you can see, well, I can’t. I, along with other of your fevers may be blind or low vision, it would really sound much better if you just left that phrase out. Just explains things without assuming anything.

[@dklein2008]

Everyone knows that surgeons NEVER have more than "minimal" blood loss during surgery... 🤣

[@marwanitani4269]

A big Salut to your efforts 🫡