Trick of the Trade: Ultrasound-guided supraclavicular central line
Subclavian central lines are commonly touted as the central line site least prone to infection and thrombosis. The problem is that they are traditionally performed without ultrasound guidance. They are done blindly because of the transducer’s difficulty in getting a good view with the clavicle in the way. [+]
Patwari Academy videos: ACLS (parts 4-6)
Below are the next 3 video installments of Dr. Rahul Patwari’s digital whiteboard talks on ACLS. These videos cover: Cardiac arrest (Vfib and Vtach) Cardiac arrest (More of Vfib and Vtach) Cardiac arrest (Asystole and PEA) I love that each video is less than 15 minutes long. Also, even if you aren’t a medical student, these are great refreshers. For instance, don’t forget that atropine is no longer on the 2010 ACLS algorithm for asystole. [+]
The secret to patient presentations
“So there’s a patient, and umm… they are in the hallway, they came to the ED today for breathing problems, I mean dyspnea. They also don’t speak any English. So, uh the respiratory rate is normal, and they had a blood clot, er… I mean PE, in the past, but not on coumadin anymore. Shoot, I forgot to tell you my exam…they had pitting edema for 3 months. By the way, the labs came back on that other anemic patient in the other hallway, and they are really anemic…” – Anonymous medical student Sounds familiar? Imagine working in a hectic ED [+]
Andragogy: How adults learn best
Andragogy refers to learning strategies which help adults to learn more effectively. It is a term that was first used by Alexander Kapp in 1833 and later expanded by Malcolm Knowles to fit the needs of adult education. The concept is contrasted with pedagogy in which the child is lead through the learning process by the teacher. In andragogy most of the learning is self-directed and the teacher is a facilitator in the learning process. [+]
Article review: Macrocognition in novices and experts in the ED
Expert physicians: These are the ones who effortlessly handle a busy Emergency Department while juggling patient load, learners and consultants. How do they make decisions? How do they get there? This article 1 studied macrocognition differences between novices and experts in the Emergency Department. [+]
Trick of the Trade: Sterile cover for linear ultrasound probe
You decide to use ultrasonography to help you establish peripheral IV access for and obtain blood cultures from your patient. How can you ensure that you get a sterile sampling to avoid blood culture contamination? Do you need to open a full central-line ultrasound probe cover? [+]
Losing faith in evidence-based medicine: Etomidate and sepsis
In an era where evidence-based medicine is the goal, it is vitally important for practitioners to understand how to prioritize and interpret the onslaught of data coming at us. This fact was driven home for me with a recent publication. Several weeks ago an article was published in Critical Care Medicine entitled “Etomidate is associated with mortality and adrenal insufficiency in sepsis: A meta-analysis.”The point of this post is not to debate if etomidate should be used to intubate septic patients. Etomidate very well may kill people with sepsis. I just don’t know from the data currently available. Using this meta-analysis [+]
Patwari Academy videos: ACLS and the Airway
This videos below include a 2-minute introductory video on the ACLS video and the first 2 (Airway) of 11 video discussions on different components of ACLS. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation [+]
PV card: PE Severity Index (PESI) score
Do you send some of your low-risk patients with pulmonary embolism home? This is a controversial issue which warrants a look at risk stratification tools. The primary one used is the validated Pulmonary Embolism Severity Index (PESI) score. In Lancet 2011, the authors looked at whether PESI class I and II (low risk) patients could be managed safely as outpatients. It turns out in their study, regardless of whether their PESI class I and II patients were treated as outpatients and inpatients, all fared equally well from a complications standpoint (recurrent clot, bleeding from anticoagulation). I like the validated PESI [+]
What is debriefing in simulation education?
Medical education high-fidelity simulation allows for deliberate practice in a safe environment. We are able to miss the intubation repeatedly or botch up the management of aspirin overdose without the demise of the patient. At the end of each session, we gather in a pow wow and debrief…. I have been involved with debriefings, and often wonder what residents are thinking: Do they understand what debriefing means? Do they think this is the time where they are scolded for mistakes? Do they think it is a valuable part of the simulation? What does debriefing even mean? [+]