Sunday, May 24, 2009
I'm taking a course from the Society of Critical Care Medicine. I did not take an elective in the ICU during medical school, so my first TRUE experience will be on the PICU in July. This course was actually pretty helpful in reviewing the basics of ICU. Some tips I learned:
Always start with the ABCs.
Tachypnea is an omnious sign of sickness. Evaluate thoroughly
When a nurse calls you on call and tells you about a patient with dyspnea, get up, standup.
Rocuronium (a non-depolarizing agent) has an antidote - Sugammadex! I don't thinks it's been approved by the FDA yet.
Intubate starting from pt's right mouth and sweep the tongue. Have someone give you Sellick and the fish hook. Then use BURP myself and have another person hold it when i visualize cords.
Use the bougie as a tube exchanger.
Winter's formula: 1.5*HCO3 + 8 +/- 2
For every 10mmHg change in PCO2, there is a 0.8 change in pH.
Propofol can cause falsely elevated Pulse oximetry saturations.
After finishing up the Day 1 of the course, I went and hung out with surgical interns. Yes, they are normal people too. Good times.
p.s. Who knows how to calculate the delta-delta? Care to share?
Monday, May 4, 2009
“Given one well-trained physician of the highest type, he will do better work for a thousand people than ten specialists.”
~ William James Mayo, M.D.
Emergency medicine is the youngest and most diverse medical specialty. We can reassure patients about H1N1 virus and their home BP measurement of 160/90, while detecting a pneumothorax on ultrasound and placing a chest tube on the trauma patient. If we choose to, we can become certified experts in pediatrics, toxicology, sports medicine, high altitude, & deep sea diving.
Because of this broad training, we have the ability to speak the language of every specialty: Monteggia’s fracture, Stanford Type A dissections, retinal detachments, retrograde urethrogram, Brugada syndrome, and ectopic pregnancy are words that even our astrocytes retain. Moreover, the ED is truly the front door to the hospital. Putting these factors together, I believe emergency physicians are uniquely poised to transform from the newbie to the "big dog" at the head of the medical community.
Our field has numerous strengths, yet there are many challenges. For example, we are legally responsible to see every patient regardless of ability to pay. Ironically, there is no funding set aside to pay for these visits. Upon graduation, some residents will work at an hourly wage for a healthcare corporation, while administrators skim heavy “management” fees off the top. Naturally, we need leaders who can represent Emergency Medicine in the political, medical, and business world.
My calling is to be the doctor with a business toolbox to represent physicians in these crucial areas. Today, I ask for your vote to begin my path towards making a difference not only for our patients, but also for you. Thank you. http://dr.samko.googlepages.com/