All in a Day’s Work in Brazil by Flavia Machado
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Transcript of All in a Day’s Work in Brazil by Flavia Machado
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@FlaviaSepsis
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Our public hospitals
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Our very nice private
hospitals
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Cadastro Nacional dos Estabelecimentos de Saúde (CNES) – 2013, Agência Nacional de Saúde Suplementar (ANS) e Instituto Brasileiro de Geografia e Estatística (IBGE).
7.6 public ICU beds for 100,000 habitants
Middle-West7.4
Northeast5.0
North3.2
South9.4
Southest 10.4
25.5 private ICU beds for 100,000 habitants
Middle-West38.5
Northeast28.4
North28.8
South22.2
Southest 24.2
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This means that your
chances of dying are greater!
This means that your cancer surgery has already been suspended because
we didn’t give you an ICU bed!
AND THERE ARE MORE LIKE YOU
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In this afternoon the ED has 168
adult patients for 41 beds and 9 children for 9 pediatric bed.
Subtitles
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Boeing B-17 Flying Fortress
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A DAILY CONSEQUENCE
The pilot
The co-
pilot
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I only disagree with this innovative method: speakers like TED using the same t-shirt and sitting in a chair as sessions’ moderators. We
lost the solemnity and respect for the professionals , especially the physician. Something similar with what the current Brazilian
government has made to the physicians.
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Our own experience
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Subtitles
ATTENTION
Desfibrilator is out-of-work!!!
ATENTION PATIENTS
PLEASE, IF YOU ARE GOING TO HAVE A CARDIAC ARREST, DO IT IN NON-
SHOCKABLE RHITMS
WE THANK YOU FOR YOUR UNDERSTANDING
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TOP THINGS THAT SUCK
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Procrastination from the last guy in charge
Procrastination from surgeons – “another CT scan…”, “he is too unstable…”
Paper work
Be all by yourself because your buddy fudged up
Work with bad nurses – good nurses are everything we want!
Deal with assistant physicians that don't wash their hands
Weekend shift
Team misinformation and family misinterpretation
Surgeons asking for transfusions
THE TOP IN ANY HOSPITAL
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Battling for medicines
Being threatened by judicial warrant
Deciding who will get the only ICU bed
Battling for a bed in the wards
Cancelling elective surgery because you lost the battle
Begging the radiology resident for a CT scan
Getting the assistant physicians to come and see their patients
THE TOP IN PUBLIC HOSPITALS
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Dealing with assistant physicians
Admitting patients in the early hours of the morning without ANY ICU INDICATION
Waiting for health insurance company approval for exams and procedures
Answering audit from the heath insurance companies
THE TOP IN PRIVATE HOSPITALS
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think they are intensivists
think they are god
don’t want patients under EOL care
put the patient in the ICU because he is unable to discuss EOL with the family
decide in a holiday that patients is not ready for discharge
tell family everything is all right
wants to talk about amenities when you shift is a battle camp
Deal with assistant physicians who:
THE TOP IN PRIVATE HOSPITALS
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ECMO!!????
OR1,250 g meropenem = 416 treatment-days?
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OUR FIRST ECMO!!!
1,250 g meropenem in less then 24 hours...
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Some times it is just too
much...
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Futility?
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