The Xchart Blog

We have to be honest with ourselves. Not a single one of us wants any form of emergency to happen in our office or under our care, but that alone does not shield or even prevent it from happening. Not one of us can say an emergency will never happen to us. We can screen and assess and choose our patients we treat which are all great things, but that has nothing to do with unforeseen issues. We can't prevent someone from walking into our lobbies that we have never seen before and delivering a nicely packaged mega code right to our front door.

Every now and then I come across journal entries that just fascinate me. This case I am sharing with you here is one such case. I love psychology. If you think about it, all of us that perform sedation or especially anesthesia are battling psychology upfront. Fortunately, the drugs we can safely administer usually allow us to control the patient’s state of response among other things. But what about the times we interact with patients that we don’t have any drugs on board? Or should we even care? I’m sure all of you were trained similar to me that setting correct expectations for all treatment is key BEFORE any treatment is performed. We all know how our positive disposition and reassuring words to a patient can have a positive effect, but is it possible that a patient have negative physiologic responses based off of psychological influence? I think you’ll find this interesting.

Recent warnings from the FDA and political leaders have reignited public anxiety about whether acetaminophen (Tylenol) use during pregnancy increases the risk of autism or ADHD in children. By no means is this an attempt to suede or convince anyone of any ideology. Rather, the intention of the following article is to share information that hopefully is helpful. Personally, no matter what is popular on social media, I prefer to get and make my medical decisions from reputable research and texts. Despite the alarm stated and posted publicly, the most comprehensive evidence to date—including a 2024 JAMA study of 2.5 million Swedish births—shows no causal link between prenatal acetaminophen exposure and neurodevelopmental disorders. The FDA’s advisory urged caution, yet it simultaneously acknowledged that a “causal relationship has not been established.” This gap between scientific evidence and public messaging has left both clinicians and expectant parents seeking clarity.

Some emergencies make a dramatic appearance and leave no doubt as to the diagnosis. Others, like methemoglobinemia, creep in quietly, disguised as “maybe she’s just a little cold.” This rare condition turned an otherwise routine dental appointment into a life threatening scenario for Dr. Zack Flint and his team—and gave us all a chance to refresh our understanding of an often-overlooked complication. The following is from an interview with Dr. Flint who has honorably agreed to share his experience with everyone so if any of us were to encounter this situation, we may be even more prepared. After his recount of the situation, there are some follow up questions he has answered coupled with a few images from the incident. I know this is quite a bit longer than we normally do, but I urge you to take the time to read.

Dr. Zack Flint’s Story

I recently made a mistake. Quite honestly, I am still very upset at myself for it and certainly not proud of it. In the name of education and supporting each other, I’m sharing it with you.

As I write this, I can already imagine some of you rolling your eyes for what I'm sharing here. I get it. For many of us, it is easy to get into a routine where not only do we not calculate our anesthetic, but we don't necessarily even slow down to think about how much or when we have given it. And I get it as well, that by in large most of our patients are old enough and large enough and procedures small enough that we can get away with not calculating how much local anesthetic we have administered. I want to challenge you a little today. Before you scroll on and skip over this please think about this for a second.

I’m going to date myself a bit here. For my childhood, there were two players that I admired: “The Ryan Express” Nolan Ryan and “The Mailman” Karl Malone. And no, I’m not referencing when Nolan locked Robin Ventura in a headlock after he rushed the mound and started pounding on him (although sometimes we may feel we need to do that for our patients 😊). One of the elements that made these two greats stand out was their rituals.

In our world of sedation, anesthesia, and pain management, some drugs have a long and complicated legacy, while others offer a glimpse into the future. This month's spotlight features two agents worth your attention: meperidine, a familiar name with evolving relevance, and suzetrigine, a novel non-opioid analgesic that could change the game.

Meperidine: Old Friend, Narrow Path

Inattentional blindness is a fascinating psychological phenomenon that highlights how our focus on one task can make us blind to unexpected occurrences. This concept was introduced by cognitive psychologist Dr. Daniel Simons, whose groundbreaking research has profound implications across various fields, including medicine. One of the most famous demonstrations of this phenomenon is his YouTube video, often referred to as the "invisible gorilla experiment." In this video, viewers concentrating on counting basketball passes frequently fail to notice a person in a gorilla suit walking through the scene.

As providers, we know that precision and accuracy aren’t just virtues—they’re necessities. One seemingly simple tool that transforms our approach to patient safety and procedural success is the checklist. In The Checklist Manifesto, Atul Gawande illuminates how structured checklists improve outcomes across high-stakes fields, from aviation to medicine. For us, the significance of a checklist in sedation and anesthesia is immense, and I'd like to explore why.

The Power of a Checklist