Tuesday, October 19, 2010
Hey, remember that patient you saw?
It's one of the most panic-triggering phase during our day-to-day work...
Reference: http://thecentralline.org/?p=568
Reference: http://thecentralline.org/?p=568
Sunday, October 10, 2010
Rules
- First of all, "Anything can go wrong WILL go wrong, at the WORST POSSIBLE TIME."
- Always recheck marking of ET tube for desaturating patients
- Rising pCO2 in spontaneously breathing patients/pt on PSV => decrease sedation first
- USG is your best friend for procedures (e.g. lines, pleural tap...)
- Remember bougie for endotracheal intubations, check mouth opening and ROM of neck beforehand, position well beforehand, insert the tube deep enough, always check breath sound yourself after intubation, protect patient's teeth during DL
- Stick higher for IJ lines at level of thyroid cartilages to avoid pneumothorax, manipulate to increase diameter of IJ vein (head down, limited head turning/extension, light palpation of carotid pulse)
- Do not blindly correct INR, platelet. Think before given pack cell/FFP/platelet concentrate
- Always check ionized Ca2+ level for post-TOTAL thyroidectomy patient
- O2 flow rate of NRM should > 6L/min
- No need to stop NG feeding just because of coffee ground aspirate
- Always check the patient's position while reading a CXR
- Offer comfort care (e.g. morphine infusion) earlier if indicated
- Use sulperazone as emprical abx for nosocomial infections in "The Unit"
- Know when to wait and when to start antibiotics
- Bronchospasm..."treat medically"...remember "second-line agents" e.g. MgSo4, IV salbutamol, adrenaline infusion, ketamine infusion...
- Remember Difficult Airway Algorithm: Awake Vs GA, Spontaneous ventilation Vs paralysis, Superglottic Vs Infraglottic. (always remember awake intubation under topical anesthesia +/- sedation for expected difficult airway)
- Filp Technique of airtraq insertion (like 180-degree turn while inserting oral airway)
Topics
- PPH (massive transfusion)
- Typhoid fever, CNS involvement
- Neuroleptic malignant syndrome
- Rhabdomyolysis with AKI
- ARDS/ALI
- Brain stem tests/Organ donor support
- Management of increased ICP
- ACS
- Heart block/temp. pacemaker management
- DKA/HONK
- Thyrotoxicosis
- Bronchoscopy
- Adrenal insufficiency
- GBS
- Thrombolysis for ischemic stroke
- Plasma exchange
- Becker myopathy/Inherited myopathy
- Pulmonary embolism
- Major burns/inhalational injury
- VF
- Reperfusion syndrome
- Contrast nephropathy
- Insulin overdose
- Rickettsial infection
- Metformin induced lactic acidosis/other causes of lactic acidosis/metabolic acidosis
- Therapeutic hypothermia
- TB meningitis (with associated hydrocephalus)
- Deep neck space infection and associated complications (e.g. mediastinits)
- Therapeutics of anti-heart failure medications
- "Severe" acute pancreatitis, including hypertriglyceridemia-induced case
- Citrate toxicity during anticoagulation for CRRT
- Venlafaxine toxicity
- Infection of resistant bugs e.g. Acinetobacter, Stenotrophomonas, ESBL, ICBL strain, MRSA...
- Severe/near-fatal asthmatic attack
- Agents for bronchospasm, ventilator management for severe obstructive lung disease
- Difficult-to-control seizures, second-line anticonvulsants
- SLE with multi-organ involvement
- Intubation/extubation strategy for tracheomalacia
- Empyema thoracis
- Dislodged/blocked tracheostomy drill
AIRTRAQ intructional videos
BVM Ventilation for "tooth-less" patient
emupdates.com
BVM should be replaced with LMA ventilation. Aside from that, if this technique is half as effective as they suggest, we need to know about it because we bag a lot of edentulous patients.
aVR - Gets No Respect!
emrap.tv
EMRAP - Emergency Medicine Reviews and Perspectives
Rocuronium Vs. Succinylcholine
vimeo.com
For 8 minute Pecha Kucha competition at Scott Weingart's ED Critical Care Conference, January 13 2010.
Advanced Airway Management for the Emergency Physician
vimeo.com
Audio, slides, and the Emergency Department Intubation Checklist are available at http://emupdates.com/
日夜輪班的生活睡眠作息
decode-medicine.blogspot.com
實驗發現日夜作息顛倒的動物比較短命。在日本，已經有因為值夜班造成過勞死而賠償的判決先例。實驗證實，人體內存在一個以25.1小時為週期的生理時鐘，因此一般年輕人比較傾向於晚睡。這項發現，對於日夜輪班者的生理時鐘調節亦有重要的影響。雖然很多排班輪值上班族相信，隨著時間及技能的熟練，他們將能適應這樣的輪值工作。但是證據顯示，年紀的增長使得輪值工作的適應變得更加困難。美國曾經做過調查，發現有25%的急診專科醫師(平均工作年資10.3年)需要靠藥物來幫助睡眠或保持工作清醒；相對之下，已經結束急診輪調的住院醫師，只有15%有服用藥物的習慣。睡眠時間有一大部分是由日夜週期決定，這可部分解釋為何夜班輪值工作者...
Airway World
Welcome to Airway World! If this is your first visit, please click on “Register.” After answering a few questions and creating a password, you are ready to enter this one-of-a-kind airway management knowledge center. ...
123sonography.com
Hi there! This is the 123sonography blog on echocardiography. We provide you with innovative teaching materials on echocardiography. We will regularly post videos on basic and advanced echo skills. The videos you will see on this site were produced by echocardiographers – for echocardiographers. ...
Presentations on intensive care by Andrew Ferguson
Presentations on intensive care
Videos on anatomy and physiology
Videos on anatomy and physiology by a student from U of Toronto major in human physiology
Bread and Butter info on physio and pharmacology
"Bread and butter" info on anesthetic practice eg. videos on physiology and pharmacology
SurgicalCriticalCare.net
Surgicalcriticalcare.net is an interactive website containing evidence-based medicine guidelines, lectures, resources, and educational case presentations pertaining to the practice of Surgical Critical Care.
Thoracic USG for pneumothorax
instructional video discussing the use of thoracic ultrasound for pneumothorax
Understanding Capnography
E-mails also suggested that the use of multimedia programs, digital images, and clip arts, and real-time animations, that convey the complex physical, physiological and clinical principles underlying capnography, had a great impact on viewers in facilitating easy understanding. ...
Cardiovascular Pharmacology
Click here for information on Cardiovascular Physiology Concepts, a textbook published by Lippincott Williams & Wilkins (2005)
Cardiovascular Physiology
Click here for information on Cardiovascular Physiology Concepts, a textbook published by Lippincott Williams & Wilkins (2005)
Ultrasound Guide for Emergency Physicians
Ultrasound Guide for Emergency Physicians, from American College of Emergency Physicians
This online website was a creation of members of the American College of Emergency Physicians (ACEP) Section on Emergency Ultrasound under the direction of Beatrice Hoffmann, MD, PhD, RDMS and the coauthors ...
OpenAnesthesia.org
Wikipedia-type anesthesia and critical care resource from "Anesthesia & Analgesia"
Anaesthesiamcq.com
Use the board for your comments or messages about any topic related to anaesthesia. (See adjacent notes about log-on requirements).
World Federation of Societies of Anaesthesiologists
The World Federation of Societies of Anaesthesiologists (WFSA) wasfirst formally constituted at the World Congress of Anaesthesiologistsin Scheveningen, the Netherlands in 1955. There were 28 founder membersocieties.
Practical Plastic Surgery
Free handbook on plastic surgery (also covering burn care/hand surgery) written by Dr Semer, an US plastic surgeon
Practical Plastic Surgery for Nonsurgeons was written to bring plastic surgical expertise to areas with little access to plastic surgeons. Please feel free to download/print as much of the book as you desire. And please, tell others about this site!
MicroTextbook of Clinical Airway Management
airwaymicrotext.homestead.com
Difficult Airway Book
A unique feature of this book is the inclusion of slides and video clips on the Oxford Region Airway Group (ORAG) website - www.orag.co.uk. This is intended to complement the material in the book. It is therefore important that the reader has read the chapter(s) before logging on to view the slides.
Echo in Context
Echo in Context is the longest standing and most watched recurring telemedicine event in the world. Site supports all phases of Echo training.
Videos on airway management
The videos uploaded here are a variety of educational videos obtained from our training series, cadaver lab or various patient contacts. www.airwaycam.com
Videos on emergency ultrasound and more
Instructional videos related to emergency medicine produced in the Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota. Associated with hqmeded.com, your source for high quality medical education media.
