科技:是敌是友?电子健康记录会增加麻醉师的职业倦怠吗?

P. Ghodki
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摘要

全麻下正在进行的三维腹腔镜全子宫切除术;低着头,每个人都高兴地看到屏幕上的3D画面,包括麻醉住院医生。我进入了OT(不用说,作为一名高级人员必须同时监督多个OT)。高端麻醉机高高地矗立在手术室里,配备着各种精密的监控设备。我看了看监视器上的通气模式:etCO2图上升,值为42mm Hg,气道压力为26mm Hg,而且还在上升!我问我的住院医生一个关于他的注意力在哪里的问题,令我沮丧的是,他表达了他的不满,因为监测器既没有给我们警告二氧化碳浓度或气道压力上升,也没有警告我们二氧化碳浓度斜率的变化!!我很震惊。回顾-不久以前,当我们还是住院医生时,我们用我们“受过教育的手”来监测人工通气的气道压力。紧袋的鉴别诊断曾经是高年级学生在桌上教学时最喜欢问我们的问题之一。当时我们没有etCO2监测仪(强制性最低监测标准);别管高科技的通风设备和相关的气道气体监测。受过教育的手很快被呼吸机所取代,争论将继续是否宣布这是临床技能的丧失;由于缺乏证据而未解之谜。至少我能说的是,手放在脉搏上,手里拿着包,我们过去常常与病人“保持联系”;随着技术的进步,这种联系消失了。这是否使得呼吸机和监控技术的进步变得邪恶??显然不是。科学技术的进步不仅仅是为了我们的舒适,而且在提高患者的安全性和提供更好的患者护理方面也发挥着关键作用。多年来,外科手术取得了巨大的进步,这些发展大多归功于麻醉领域的进步,麻醉领域从石器时代发展而来
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Technology: A Friend or Foe? Do Electronic Health Records Increase Burn Out Amongst Anaesthesiologists?
3D total laparoscopic hysterectomy in progress under general anaesthesia; steep head low, everyone delighted to see the 3D picture on screen with the goggles including the anaesthesia resident. I enter the OT (needless to say that as a senior one has to supervise more than one OT at a time). The high-end Anaesthesia machine standing tall inside the OT with all the sophisticated monitoring gadgets. I look at the ventilatory pattern on monitor: etCO2 graph upsloping with a value of 42mm of Hg, airway pressure 26mm of Hg and rising! I ask a rhetoric question to my resident as to where his attention is and to my dismay, he expresses his dissatisfaction that the monitors neither give us alarms against rising etCO2 or airway pressure nor do they warn us about changing capnograph slopes!! I am appalled. THROWBACK- Not long time ago when we were residents, we used our ‘educated hands’ to monitor the airway pressure with manual ventilation. Differential diagnosis of tight bag used to be one of the favourite questions seniors used to ask us during on-table teaching. We had no etCO2 monitor then (the mandatory minimum monitoring standard); leave alone the hi-tech ventilatory gadgets and associated airway gas monitoring. Sooner the educated hand was replaced by ventilator and arguments will continue whether to declare this as a loss of clinical skill; an unresolved riddle due to paucity of evidence. The least that I can say is with the hand on pulse and bag in hand, we used to ‘stay connected’ to the patient; with the technical advances this connection got lost. Does this make the ventilator and the advances in monitoring evil?? Obviously not. The advances in science and technology are not only for our comfort but they also play a pivotal role in improving patient’s safety and offering better patient care. Over years surgery has advanced enormously and most of these developments are attributed to advances in the field of anaesthesia which has evolved itself from the Stone Age t
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