You see a patient with a large V-shaped laceration under tension requiring suture repair. Resist the temptation to simply pull the edges together and close the laceration with simple interrupted or running sutures. Excessive tension on a flap edge during the healing process can compromise its blood supply. This causes ischemia to the healing tissue, which in turn makes that flap edge more likely to dehisce, necrose, and become infected.
Debriefings in medical simulation are meant to be the bow on top of the gift that is medical simulation. It is the ultimate delicious dessert, served after a grueling dinner course. All analogies aside, debriefings are meant to drive home the teaching points, to gain a deeper understanding of medical resuscitation as a group, and create mental frameworks of the approach to various patients. But this is often easier described than actually done. We here at ALiEM paired with Dr. Henry Curtis to come up with a creative way of developing debriefing skills and gain deeper understanding of mental frameworks.
DNR/DNI, Code Blue, Cardiac Arrest, Traumatic Brain Injury, Exsanguination, Septic Shock, Respiratory Arrest… and the list goes on. As healthcare providers, we are well versed in the medical and emergency resuscitations that can spiral into these dangerous arenas. Even if we don’t always know the exact cause, we know the mantra of ABCs and we stick to it until the end. The very last end… But the end of what? Where is the dignity in resuscitating a body that has already died? Ultimately the question becomes, are we as practitioners as well versed in letting go, in letting the body die, and then ultimately explaining that process to the family?
Every person involved in teaching and learning has a philosophy on how people learn. Implicitly, explicitly, legitimate or not this mental construct of learning affects the way they impart instruction and assess learning. One of the oldest and most
commonly used educational theory of learning is
In this fifth and final installment of the Evidence Based Medicine series, Dr. Rahul Patwari reviews the concepts of: distribution of the means (with case examples), confidence intervals, accuracy, precision, and the student t-test (with an example).
You have a patient with an anion gap of 30 and bicarbonate of 10 mEq/L. You also determine on VBG that the patient’s pCO2 is 25 mmHg. What trick of the trade can you use to quickly determine whether this low pCO2 is an appropriate compensation of the primary metabolic acidosis? Dr. Jeremy Faust and Dr. Corey Slovis explains the quick “Rule of 15”.
Dr. Rahul Patwari is a one-man statistics teaching machine. In part 4 of this Evidence Based Medicine series, he reviews advance concepts in statistics and calculations including: case-fatality rates, crude mortality rates, specific-mortality rates, years of potential life lost, and direct and indirect age adjustments.