Since the death of comedian and talk-show host Joan Rivers, more information has surfaced about the events on the morning of August 28 at Yorkville Endoscopy. But key questions remain unanswered.
News accounts agree that Ms. Rivers sought medical advice because her famous voice was becoming increasingly raspy. This could be caused by a polyp or tumor on the vocal cords, or by acid reflux irritating the throat, among other possible causes.
So Ms. Rivers underwent an endoscopy by Dr. Lawrence B. Cohen, a prominent gastroenterologist, to evaluate her esophagus and stomach for signs of acid reflux. At the same time, a specialist in diseases of the ear, nose, and throat (ENT) reportedly examined her vocal cords (also known as vocal folds).
We don’t know exactly how much or what type of sedation Ms. Rivers’ may have received, though several news sources have reported that she was given propofol, the sedative associated with the death of Michael Jackson. No physician who specializes in anesthesiology has been identified on the team taking care of Ms. Rivers, and we don’t know who was in charge of giving her propofol.
It seems clear that at some point during Ms. Rivers’ endoscopy and vocal cord examination, there was a critical lack of oxygen in her bloodstream.
Was laryngospasm the cause?
Giving sedation for upper endoscopy is tricky, as any anesthesia practitioner will tell you. A large black endoscope takes up space in the mouth and may obstruct breathing. Any sedative will tend to blunt the patient’s normal drive to breathe. But most patients breathe well enough during the procedure, and go home with no complaints other than a mild sore throat.
News reports have speculated that the root cause of Ms. Rivers’ rapid deterioration during the procedure could have been laryngospasm. This term means literally that the larynx, or voice box, goes into spasm, and the vocal cords snap completely shut. No air can enter, and of course the oxygen in the bloodstream is rapidly used up.
The most common situation that leads to laryngospasm is irritation of the vocal cords. Everyone knows that when a drop of liquid or a crumb of food goes down the wrong way, it’s highly irritating and provokes a fit of coughing. When the vocal cords are stimulated or even lightly touched, their natural protective response is to close up.
Every anesthesiologist is taught how to manage laryngospasm, because it can be a life-threatening emergency leading to brain damage or death if the patient is deprived of oxygen for too long. Sometimes the vocal cords relax and open up on their own, but often they don’t.
The appropriate treatment depends on the exact type of airway problem that is happening. Partial airway closure (inspiratory stridor) should improve after gentle positive pressure ventilation with a bag and mask.
True laryngospasm, though, won’t respond to simple bag-mask ventilation. In fact, positive pressure may make it worse. Positive pressure actually increases the anatomic ball-valve obstruction in the patient’s throat during laryngospasm. This scientific fact has been known for decades, though I fear that it’s often forgotten or underestimated.
The quickest and most reliable way to treat true laryngospasm is to give a medication called succinylcholine. This immediately paralyzes all muscles and relaxes the larynx, so that the patient’s vocal cords open and the lungs can be ventilated.
“Our anesthesiologists monitor the patient continuously”
The public statement issued by Yorkville Endoscopy claims that an anesthesiologist evaluates each patient before any procedure, gives only light to moderate sedation, and stays with each patient throughout the procedure and into recovery.
If this statement is true, and a physician anesthesiologist was with Ms. Rivers, it seems hard to believe that laryngospasm wouldn’t have been promptly recognized and treated.
It may be, though, that the appropriate drugs and equipment to manage the situation weren’t immediately at hand. Some endoscopy suites decide not to buy an actual anesthesia machine for every location. Some ambulatory centers no longer stock succinylcholine because they rarely use it. And if you keep succinylcholine in stock, you also need a supply of the medications needed to treat malignant hyperthermia, a rare and potentially fatal condition that can result from receiving succinylcholine.
Some news sources have speculated that it may have been difficult to insert a breathing tube for Ms. Rivers after she stopped breathing on her own. That seems unlikely if anesthesiology and ENT physicians were present, as both are expert at airway intubation. In addition, Ms. Rivers had undergone multiple surgical procedures and anesthetics before. Jokes about all her plastic surgery operations were part of her stock-in-trade. If she had unusual anatomy that made her airway difficult to manage, this would surely have been known to her doctors.
ABC’s of life support: Airway, breathing, circulation
My best guess—and it is only a guess—about what happened to Ms. Rivers is a hypothetical scenario along these lines. She was undergoing an endoscopy and evaluation of her vocal cords under a light to moderate level of sedation. Irritation of her vocal cords caused coughing, and the level of oxygen in her bloodstream started to drop. More sedation might have been given to stop the coughing, and she might have stopped breathing completely. Or, if the vocal cord irritation got worse, she might have gone into complete laryngospasm.
The realization that a high-profile patient was in trouble would certainly have added to the stress of the team. We can easily imagine that staff members rushed to bring a crash cart with drugs and equipment to rescue her. But as the minutes ticked by, the oxygen level in Ms. Rivers’ bloodstream would have deteriorated quickly.
Eventually, if a patient’s oxygen level drops low enough, the heart can’t function properly. Abnormal heart beats start to occur, followed by ventricular fibrillation and cardiac arrest. Ms. Rivers was known to have suffered from arrhythmias in the past, and at the age of 81 she could easily have had underlying heart problems such as coronary artery disease or aortic stenosis. These would have made resuscitation even more difficult.
At some point, the rescue attempts succeeded and a breathing tube was placed. However, it was too late to prevent irreversible damage.
Dr. Cohen steps down
It was a surprise to learn that Dr. Cohen no longer heads Yorkville Endoscopy, and it would be easy to interpret his departure as a tacit admission of error. Dr. Cohen has been outspoken in his opinion that nurses may administer propofol sedation safely for endoscopy, and that anesthesiologists aren’t usually necessary.
Many anesthesiologists expected that it would be only a matter of time until gastroenterologists learned how easy it can be to run into serious complications with propofol.
My overwhelming feeling, though, is sympathy. A complication or a death in the operating room is a tragedy for everyone concerned. Physicians and staff members will feel the emotional after-effects for months, comparable to the post-traumatic shock of a major accident or combat experience.
Some good may come out of a full report on the August 28 events at Yorkville Endoscopy. We can learn how risky even simple procedures can be. It’s important to understand that the bare-bones supplies of drugs and equipment in many ambulatory centers won’t be enough sometimes, and that no anesthesia is minor. Sadly, nothing can bring Ms. Rivers back to her family and her legion of fans.
Dr. Karen Sibert practices anesthesiology in Los Angeles. She is a frequent contributor for THCB. She can be reached at ed****@***************og.com She blogs at apennedpoint.com.
Categories: Uncategorized
THCB has published a response to the thread here
https://thehealthcareblog.com/blog/2015/02/25/why-cant-we-just-all-get-along/
WOW! GETTING READY TO HAVE SURGERY, I WANTED TO KNOW ABOUT PROPOFOL. CAME ACROS THIS CONVERSATION, AND IT MAKE ME SCARED. YOU GUYS ARE MEDICALAND YOU CAN NOT AGREE. NOW I AM SCARED TO BE PUT TO SLEEP.
Where do you bring CRNA’s into this discussion, other than to make a political point. There is no evidence a CRNA was present. Stick to the facts an anesthesiologist was present. There was a bad outcome. Facts stick to the facts instead of trying to make political hay of something.
((((clapping))))
Exactly!
Yes Rick Holmes. Make sure you have an anesthesiologist present by all means. Just like the one Ms. Rivers had. Educate yourself. CRNAs have been safely administering anesthesia in this country over 100 years. You are so very naive with your “doctors are at the top of their class their whole lives” comment. In med school Pass = MD
So tyred dock, now that we know it was an anethesiologist at the helm it appears you have more donuts than dollars.
Well FCRNA your obvious disdain for nurse anesthetists leaves me wondering what we as a profession have done to warrant such a disparaging attack. Your rants demonstrate a complete lack of understanding of the world of medicine in general, but your disjointed ramblings about nurse anesthesia runs the gamut from an aloof flight of ideas to outright fabrication and heresy. You apparenlty are not secure enough in your criticisms to publish your statement with a legal name. I happen to be one of those 30% CRNAs grandfathered into practice, and I have no plans to pursue a doctorate. I would like to clarify a few things for you. Nursing education is not now and never has been considered a “medical education.” There are many paths to become a nurse. Your opinion of nurses not withstanding, the nursing profession has a long history of dedicated but thankless service to mankind. Physicians in general have no understanding of the nursing profession but are often the first in line to heap criticism and blame on the nurses caring for their patients.
The average patient does not have a clue about the credentials of the person providing their anesthesia. They do not know the difference between a physican anesthesiologist and a nurse anesthetist. The question of who was first to practice anesthesia is widely documented in the history of the practice. It was dentists. As far as the safety of the practice I afraid much of the improvement in that area again falls to nonanesthesia providers. Safety improved as modes of monitoring the patient were developed and better drugs were developed. I am afraid to report that neither CRNAs nor anesthesiologists can claim much contribution to the development of either. It is hard to believe your report of nurse anesthetist “killing 90%” of their patients. I doubt nurse anesthetists would enjoy a 150 year history of respected service while killing off 90% of the patients under their care. They would have gone the way of the barbers as medical providers. As far as being arrogant and cocky I think we can both agree that the world of medicine is full of arrogant and cocky care givers. As for dirty politics and buying politicians, I am not sure either CRNAs nor MDs is in any position to point fingers. You are either not a member of either profession, or you are VERY new and perhaps in training. The fight between CRNAs and Anesthesiologists is basically about money and security. I have always believe there was enough of both for all of us. Neither profession benefits from these attacks, but if you are going to buy into them please by all means do it with some integrity. Get your facts straight or shut the fuck up. Your disjointed rantings and poor execution of basic english grammar and writing skills leave me wondering which nursing school rejected your application.
Judy, Right on the button. When lecturing to student nurses regarding safe anesthesia always told them to NEVER go to sleep in a dental office. Know any dentist that could open a chest and massage a heart as a last resort? Even more doubtful. Reasons for having the dental procedure done in a dental office were always insurance coverage.
What cost a life lost? Have horror stories regarding dentists giving anesthesia after my 30 years at the head of the table.
Good point Judy.
The incident brings to light the inherent dangers of sedation outside the hospital setting. An upper GI series should only be performed in a hospital where adequate resources would have been available.
Over 30 years ago, as a teenager, I opted to have all 4 impacted wisdom teeth removed in the hospital. I did not feel the dentist nor his staff were experts at airway management, even though they insisted it would not be a problem to be sedated in a dentist’s office. Could any of those staff members perform an emergency tracheotomy? Doubtful.
Well said Ron CRNA. Where does fCRNA ‘Superior’ Anesthesiologist practices anesthesia? Let’s don’t work there! 🙂
The point remains:
Any anesthesia provider doing procedures at endoscopy centers ensure yourselves that the place is well equip and it follows acceptable standards…
Let’s keep our patients safe and let’s keep it cordial:)
Comments from fCRNA are only reinforcing what CRNA’s have been talking about for years. Hurling insults at Nurse ANESTHETISTS only adds to how MDA’s try to justify their so-called superior knowledge over CRNA’s, again unfounded, and always BS when study after study proves otherwise.
Your insults prove your inferior intellect and as usual if you don’t know what else to do just hurl insults.
Your neighbor who got into an ONLINE nursing school indicates that he/she COULDN’T get into an APPROVED school of nursing. He/She will NEVER get approved for any anesthesia program.
Sorry you have such a problem with Doctor CRNA’s. But hold onto your ass my friend. It’s coming!!!
Don’t even know why I reply to your asinine comments. Your ignorance speaks for itself!!
Why did one conversation turn this into MD vs. CRnA? I love to read about CRNAs and their superior education to doctors and other practitioners. Did you know 30% of CRNAs have been grandfathered in and only hold a bachelors degree or less and practice anesthesia? I say we just stop every medical school in the country and just let nurses take over all of medicine. I realize that Putting in Foley catheters and wiping butts is a tough semester in nursing school, so I understand why you guys are the best option for anesthesia. Nursing school is so one of the easiest and most basic medical education there is. You guys feel that by going to a PhD program that everyone is going to want you. We’ll wake up dr. Nurses, a PhD doesn’t make you better anesthetists, because it’s still nursing school. You saturate the market with thousands of incompetent practitioners every year. If it wasn’t your dirty politics and buying politicians, you would not have the power you do. I never understand how you guys say you were the first to practicie anesthesia from the beginning of time while killing 90% of the patients. It wasn’t until MDs came into the picture and actually made it a science. Your going to love this.. My neighbor just got into an online nursing school. The best part is that he didn’t graduate high school. They accept anyone and everyone who applies. He wants to be a CRNA too. This Joan rivers debacle got way off track, but as you already know from your comments you guys are arrogant and cocky. As a profession you guys need to be humbled by an outsider who knows a lot about anesthesia and training. good night and let the replies begin! Ready ,set ,go…..
Agree!
gas passer is even better
Ha! Anesthesiologists are THREATENED by CRNAs b/c CRNAs take their jobs! An AA must be supervised by an anesthesiologist. This all started when the anesthesiologists got lazy and someone got greedy. Same thing with primary care docs and NPs…now the NPs are opening clinics and taking their patients with them. IT’S ALL ABOUT GREED AND FEAR OF COMPETITION!
Well, does it surprise you that an ANESTHESIOLOGIST was in charge of sedation? Who knows, she might still be alive if a CRNA had been in charge.
ABSOLUTELY NO POINT IN BLAMING A CRNA AT ALL. CUZ IT WAS A BOARD CERTIFIED PHYSICIAN /MDA/Ollie…
when seconds count I want a CRNA THANK YOU VERY MUCH
Please see today’s column for an update–it’s published both in The Health Care Blog and on my website:
apennedpoint.com
There’s no point in further discussion about who gave the sedation–that individual has been identified as Renuka Bankulla, MD.
Dollars to donuts (sic) huh? So now from further reports it was an anesthesiologist there, guess your doughnuts were wrong, or maybe your dollars? Where’s your apology for professional slander? I would never wish this situation and outcome on ANY anesthesia provider, and I’m not in any way implying that this anesthesiologist was not competent. Unfortunately you, tyred dock, didn’t feel any qualms about accusing a CRNA of incompetency without even knowing who the provider was.
Anesthesiologists are NOT liable for CRNAs’ mistakes, that is a matter of settled case precedent after case after case. Perhaps you are confused and thinking of Anesthesiologist Assistants? You ARE liable for any mistake they make, because they work only under YOUR license. But it’s understandable that you could be confused, after all, the A$A insists it is the same. But perhaps you will do your own investigation of evidence and case law, you sound like a smart enough person.
No you are wrong. No CRNA was present. Just an md anesthesiologist. Don’t tell me she must have been ‘a difficult airway’ at least 50 providers had been there before. This isn’t CRNA vs MD. This is incompetence. In my mixed CRNA and MD practice all the MD’s were speculating this was CRNA. They talked very loudly for about 5 minutes. Now they say nothing. Shit happens. This is a dangerous profession with the only thing between life and death is training and judgement.
very good
How did you segue from this horrible tragedy to a diatribe about nurse anesthetists. Multiple studies on multiple anesthesia practice models have repeatedly come to the same conclusion. The anesthesia care team practice model is much safer than either anesthesia professional practicing alone. Imagine this tyred dock, and I do not expect an honest response. I’m assuming you are a general surgeon, but it if not the message is still the same. You have a case you want to do tomorrow afternoon. We’ll keep it simple, and say that it is a laparoscopic cholecystectomy. You want to know when you can do your case, so you called the holding area to ask for an estimated start time. The charge nurse tells you that you are number five on the list of add on cases, and it will be a few hours before an anesthesiologist is available to put your patient to sleep. However, we have a CRNA that can start your case immediately. You, me and every CRNA and anesthesiologist in practice knows how you will most likely respond. “Hell yeah send for the patient; I’m leaving my office right now.” Here is how it proceeds. Your history and physical which is on the chart documents a patient assessment by system. Every system is negative until you get to the GI system whereby you extensively detail your workup of the patient’s cholecystitis. In the preanesthesia assessment performed by the CRNA it turns out that the patient has a documented history of CAD having suffered two MIs that were treated with multiple PCI stent placements and an angioplasty a month ago. The patient is still on plavix and ASA, but has missed the past five days due to his nausea and vomiting and you never ordered it for him on your admission orders. All of which you discover during a phone conversation with the CRNA who is concerned that the patient is in very real danger of developing an instent stenosis and suffering another MI. Your response to the CRNA on the phone is something like this. I don’t give a damn he has to have his gallbladder out now. Take him to the room, and I’ll be there in 5 minutes. Upon arrival to the holding area the patient is anxious and in pain. Suddenly he complains of incredible chest tightness just like he had with his heart attacks. You see where I’m headed with this all too familiar scenario. The nurse anesthetists that you so thoughtlessly disparaged with impunity is now helping you fix your fuck up. You call cardiology to come see the patient immediately. The patient gets Reopro immediately which stops his chest pain. He goes to the CCU for two days. He returns to operating room on day three to undergo an uneventful lap cholecystectomy which you now insist must be done by an anesthesiologist. You never thank the CRNA for his/her efforts to help you care for YOUR patient. Then you decide to respond to a blog about the tragic intraopertive death of comedic icon, Joan Rivers’. In a GOD LIKE declaration from a surgeon no less you publicly bash an entire medical specialty with particular attention and effort to place blame on those wicked nurse anesthetists. With absolutely not a shread of evidence and no public discussion of a CRNA participating in the care of Joan Rivers’, you can sum it up for America. “The CRNA did it, and the lazy ass anesthesiologist was no where to be found.” Of course in your universe, the surgeon saves the day.
Pseudocholinesterase deficiency is more prevalent in segments of the Jewish population most notably in the Persian and Iraqi origins. I would hope that the administration of succinylcholine would be closely followed by efforts to secure an airway or at the very least some kind of ventilatory support. When I hear hoofbeats, I usally think of horses not zebras. I suppose anything is possible.
Hey Doc who are you kidding here. These corporations are usually owned by anesthesiologists. I am certain that your corporation would gladly pay you the salary they offer to their nurse anesthetists and allow you to have your own room sans supervisory responsibilities. The number of rooms you are permitted to supervise is regulated by multiple stakeholders. We both know your “uber-group” has no say about the maximum number of anesthetizing locations you can legally supervise and bill for your services. You really do sound miserable. May I suggest you take a trip to Thailand and get that vagina created since you’ve obviously already suffered an apparent orchiectomy. Stop whining!!
Mr Holmes the facts in this case do not support your assertion that being anesthetized by a nurse anesthetist implies an inferior level of anesthetic care. There is only ONE standard of care regardless if you are being cared for by a nurse anesthetist, and anesthesiologist or both. Chances are pretty good that if you’ve been anesthetized in the United States in the past 100 years it is quite likely that you were cared for by a nurse anesthetist. Kel surprise you survived. Your knowledge and understanding of nurse anesthesia education not withstanding the provider in Ms Rivers’ case was infact a board certified anesthesiologist. Like you it was her wish that only a doctor provide her anesthesia. Do not take my word for it just read the report released by the New York state agency reviewing the facility following this tragedy. You may not understand all the jargon, but the message is clear.
Nadia I think you’re missing the point. No amount of preparation would have prevented this tragedy. This level of arrogance, ignorance and incompetence will always prove to be a lethal cocktail. These clowns could not respond to something they did not recognize as a problem. Finally when they did recognize the arrythmia, ventricular tachycardia with a pulse per the state’s report, it was so grossly mismanaged that it further delayed a return to spontanous circulation. She and her heart had to have been in fairly good health for her to endure and successfully stave off so many attempts to kill her. It was not simply a failure to prepare that proved lethal to Joan. It was according to New York’s definition, murder. The unlawful killing of another human being with malice aforethought. Malice aforethought in this instance refers to a level of intent or RECKLESSNESS.
Dittos Robert!!!
After thirty years at the head of the table myself, great to see another ball bearing CRNA not afraid to say it like it is. Seems like Joan Rivers tragic death has turned into a forum to let folks know that CRNAs are here to stay and that the MDA’s don’t have the market cornered on providing competent care to patients.Wonder how their attitudes will change after 2025 when all CRNA programs will be at Doctorate level.
Now retired blame the AANA for not letting people know we exist. The most closely guarded secret in the medical world. They need to do a much better job at coming out of the closet with who we are. Less meetings and more action.
Kudos to you Robert.
You guys I’ve been a CRNA for 26 years. I”ve saved an anesthesiologist’s ass about as many times as one has had to save mine in all these years. The ones I’ve been fortunate enough to work with were sincerely greatful to have me in the operating room with them. It was about the patient not our egos. This sounds like a star struck bunch of idiots who happen to be physicians that could not find their own asses with both hands. Problem number one is as physicians you guys have this miss guided notion that the rules do not apply to you. There has NEVER been any mention of a nurse anesthetist being involved in the debacle that resulted in the death of Ms. Rivers’. I am sure this was exceptionally disappointing news for the American Society of Anesthesiologist’s membership. About as disappointing as the fact that it has also reported that an anesthesiologist working for pop star Michael Jackson was the first to administer bedtime propofol infusions as a medical treatment for his chronic insomnia. I guess that is one use of propofol they only teach you anesthesiologists in anesthesia residency.
As anesthesia professionals we all know that the lack of a time out, the lack of a surgical consent, the lack of weighing Ms. Rivers’ that morning, the snapping of a selfie during the procedure,the lack of documented credentials for the visiting physician staff, nor lack of labeling on a specimen had much to do with what caused Joan Rivers’ death. For all intents and purposes there was no preanesthetic assessment. I believe the propofol dosages are more than likely correct as documented. The story of a propofol documentation error was likely concocted to deflect attention away from what was undoubtedly a fatal oversedation and a desire avoid professional opprobrium. Which we all know anesthesiologists possess in abundance. If no other sedatives were administered namely midazolam and/or fentanyl, and the anesthetic was propofol alone as reported. It very unlikely Ms. Rivers’ would have tolerated the introduction of a laryngoscope blade into her airway after the administration of just 50mg of propofol. She would have coughed and gagged violently. She also very likely physically resisted by reaching or moving around on the table. The documented vital signs do not support a light level of sedation anesthesia. The documented vital signs, if they are to be believed at all, are more much more consistent with an anesthetic overdose scenario. The first dose,propofol 100mg, while being a relatively large dose for age and weight particularly if other agents had been administered would be adequate to induce a state of general anesthesia. This would explain the lack blood pressure and pulse rate response. Direct laryngoscopy which is plainly described in the detailed report of the facility is classically considered to be a potent physiologic stressor for any patient. It results in elevated levels for blood pressure, heart rate, as well as workload on the heart at a time when it may be experiencing lower oxygen delivery. The body responds to this intense physiologic stress by releasing potent stress hormones and catecholamines. Despite this relative anesthetic overdose it is likely that the patient would still have a cough reflex and possibly gag. The vocal cords would spasm in response to being manipulated resulting in a closed airway known as a laryngospam. This is particularly plausible since we know that Joan Rivers’ came to the clinic complaining of hoarseness that was thought to be secondary to chronic acid aspiration. It is also conceivable that she regurgitated some residual stomach contents and suffered a pulmonary aspiration which should have been a particular concern in this particular situation. So we have given this 81 year old lady that weighs about 50 kilograms and induction dose of propofol. The ENT physician attempts to do a laryngoscopy but is met with a resistant patient who is moving around and coughing. The anesthesiologists quickly administers a second 100mg dose of propofol at a time when there is an abrupt decrease in the procedural stimulation. Many patients tolerate a simple EGD with topical anesthetic alone or in combination with minimal levels of sedation. Now you have a profoundly oversedated patient who is not able to maintain her own bodily functions which goes unrecognized and therefore unaided. The result is a patient which has limited breathing ability and is oxgenating poorly. Her cardiovascular system which has been severely depressed by the anesthetic agent. She suffers further assault as her bodies oxygen levels drop. Her carbon dioxide levels would climb to higher levels also due to the depressant effects of the anesthetic drugs on her ventilartory capability. This would have caused an acid/base disturbance from two differenct sources resulting in a serum acidosis. All this is going on and she is given yet another two doses of propofol. Finally her heart is overwhelmed resulting in the development of an arrythmia in this case ventricular tachycardia albeit reportedly with a detectable pulse. A very treatable, if recognized, arrythmia which to great surprise is treated inappropriately. Ms Rivers’ arrythmia is grossly mismanaged by the administration of medications which would actually worsen the arrythmia. She should have been cardioverted immediately with synchronized cardioverson. Manually ventilated to correct her acid/base and ensuing electrolyte disturbance. And you guys have the unmidigated effrontery to turn this medical debacle into a discussion about your selfish, self serving interprofessional battles with CRNAs. Can you even see the irony in this mess? In a blog which essentially presents a case of a comedic icon dying at the hands of one of your anesthesiologist peers. A surgical procedure and anesthetic so poorly executed that calling it negligence belies the incredible dereliction of your sworn oath of primum non nocere. I would go so far as to describe this as second degree murder. Joan Rivers’ would have been the first to say, “fuck you all.”
Dr Drew just answered questions pertaining River’s case with diplomacy…
His #1 above is really the question to ask and then add: Really people, really?!!!
Drew #3 Sux has to be available… I think most of us MDA or CRNAs agree on that…
Thanks Ronald! And i like your comment:)
I am an MDA, and have worked along side CRNA’s for close to 30 years.
The team approach has been shown to have the best outcomes.
That being said, regarding this case, I cannot imagine a decent CRNA or MDA even breaking a sweat dealing with laryngospasm.
Having read through the posts, I think anyone who provides anesthesia for a living must be asking the same questions:
1) Why on God’s green earth would anyone do anything to a vocal cord more invasive that just looking at it without an ET tube?
2) Was there an anesthesia provider ever really present – despite the reports?
3) Isn’t anyone who presides over this type of airway manipulation w/o sux in their pocket is in the wrong business.
4) Is Yorkville hiring?
Plus there’s no C student getting into nursing programs You really need to get informed if you’re going to comment on this kind of website.
Last reply was to Rick Holmes not Nardia.
Like most uniformed you left out part of our title. We are nurse ANESTHETISTS. If you or anyone you know has had an anesthetic in the past it was 60% chance given by a CRNA Our training is in par with MD.s
Do the math. If you take the amount of surgeries given in this country and divide it by MD.s your going to have your surgery WITHOUT any anesthesia except local by your surgeon Try that with a chest or belly operation my friend. Wake up!!
Ditto Gasser. Retired CRNA after thirty years. 1 death in Vietnam in 1967. He had all limbs and genitals blown off by land mine.
Would have intubated Joan in fifteen seconds when O2 sat started to dive. Her death we all know was incompetence by whomever was watching her airway. .She was performing on stage in good health the night before for Christ’s sake. If she wasn’t in good health what the hell was she doing in a store front endoscopy facility?
Hope her daughter sues the bastards!! They killed her!!
Here we go again with the CRNA VS MDA BS!!
Too bad that MD.s can’t accept the fact that in many, many cases a CRNA will outperform MDA’s
After thirty years of practicing as a CRNA could describe volumes of times having to bail out incompetent MDA’s.
Would love to be around after 2025 when all CRNA’s will have PhD programs.
As usual any chance to downgrade CRNA by MDA’s with the inability to admit CRNA’s are extremely capable anesthesia providers. We really don’t have to take a back seat to any MDA’s.
Studies by ASA to try and downgrade CRNA’s as second rate providers have ALWAYS failed.
Apparently, Joan Rivers specifically asked for a MDA (Physician Anesthesiologist) and she is dead now. I like this analogy better. My brother’s second surgey anesthesia was provided by a Doctorate level CRNA, better outcome than the first surgery which was provided by a MDA.
You are such a scumbag for spreading your non-sense propaganda. The wrongful death of Joan Rivers is simply the failure of the Medical Team and the MDA to take action and to provide a simple airway by any means. As far as anesthesia outcomes, the appalling disaster that led to the death of a person is and will be in the MDA’s hall of shame. Go and practice medicine and let anesthesia providers do what they have been doing without your needless supervision for over 100 years. Please………..
Hi Rick Holmes: Let me clarify, we are not regular nurses! We are nurse anesthetists and we attend a master’s program in anesthesia… Most of us were top of the class students in our other degrees… I love my anesthesiologists and CRNA friends… I have worked independently and also under a Physician Anesthesiologist… I love both ways!
To all: Let’s continue to strive to provide safe anesthesia for all of our patients. We do this by continuing to study and research cases and also by being cordial to one another in the OR.
Why an anesthesiologist would allow an ENT doctor to do two very stimulating direct laryngoscopies on a sedated, un-paralyzed patient, without protecting the airway with an endotracheal tube is beyond me. But what do I know, I’m just a highly trained Nurse Anesthetist. The ENT doctor may be an airway expert on awake patients, but anesthesia providers are the airway experts on patients who are asleep. She should have known better. That’s too bad
Why an anesthesiologist would allow an ENT doctor to do two very stimulating direct laryngoscopies on a se