Circulation 75,648 • Volume 20, No. 1 • Spring 2005   Issue PDF

Do Not Break Contact With the Patient

Terring W. Herionimus III, MD, FACA, FCCP

To the Editor

I read with interest, and sadness of course, of the 3 examples of anesthetic accidents in the article “Turn Your Alarms On” in the winter issue of the APSF Newsletter.

I have been retired for almost 15 years, but was forcibly reminded by the article of my constant admonition to residents and students: “Do not break contact with the patient.”

A precordial stethoscope for all conscious patients and an esophageal one for all under general anesthesia was a constant routine for all my patients. My spiel was,

“You are either hearing the heart beat or you are feeling it beat at all times. This way, you can turn your back to the patient to draw up meds or write on the chart. You can carry on a conversation with the surgeon, but you never lose input from the heart. The beeping EKG helps, but is not a substitute. The oximeter and capnograph are great, too, but nothing takes the place of listening to or touching the patient.”

There is no excuse, of which I am aware, for the anesthesiologist to leave the head of the patient; he or she has no obligation to help anybody do anything; his only obligation is to the patient’s safety. This sounds mundane, but I pounded it into my residents.

Monitors are fine, but these 3 accidents would not have happened if my rules had been followed.

Terring W. Herionimus III, MD, FACA, FCCP
Professor of Anesthesiology, Retired
University of Virginia Medical Center
West Virginia University Health Sciences Center