The Crashing Patient

Podcast from a few years ago you cant get on iTunes anymore that I think is worth listening to. Hope you find it useful. Thanks for listening. JY

Reality Check Simulations

Discussion of using simulation to prepare your people for those situations which are not what they initially appear to be. Massive hemorrhage, sepsis, and respiratory arrest in the seemingly innocuous situation are discussed. Thanks for listening.

JY

Play

Command

Discussion of command in medical situations and its relation to other command disciplines. Also part of a live recording of Jeepers Creepers by Dotsero from the band Nightbreeze I was in with Tom Jolly in NC for several years. Hope you enjoy both. JY

Update

Sorry all. As many may know I had a 2 level ACDF of my cervical spine a month ago and have just gone back on service and its been busy. I will get a podcast out this weekend when I’m on call. Thanks for sticking with the site.

JY

Preventing Airway Catastrophies

Discussion on how to keep out of trouble. Thanks for listening. JY

Airway

While I continue to recover from my neck surgery, a podcast from early 2012 on airway issues. A little bit of an original song I wrote and recorded at home called “Leigh” for my daughter. Thanks for listening. JY

Not accurately detecting the true state of the patient

I talk about misperception of the patient’s true clinical state and how that is a significant cause of medical error. Also discussed are some strategies to avoid this problem.
JY.

Discussion with Ken Lipshy MD on Crisis Management

Ken Lipshy, MD, author of the book “Crisis Management Leadership” discusses the book and the concepts to control performance during a crisis. Thanks for listening. JY

Presentations

When presenting complex patients, especially as a medical student, you really need to either tape the presentation and listen (which you may not have time for) or run through what you are going to say in your head or out loud to make certain what youre saying makes sense.

For the past few months I’ve heard very good presentation and some very poor ones. The good ones show a bit of thinking on the part of the presenter in the following way: problem-system-status-countermeasure- follow-up

Example of bad: Presenting a elderly patient s/p surgery whose urine output has dropped then presents all the rest of the things that happened in the past 24 hours, then presents all of the organ systems in their entirety, then presents all of the lab data as a monologue and all of the x-ray data and then stops talking and looks up at you.

The problem with this presentation is that you are not synthesizing any of the information, and you’re presenting so much information without emphasis that it is very difficult for anyone who is listening to put together what’s going on patient. In addition, the attending’s mind begins to wander, at least mine does, and the dangerous aspect of that is that they won’t be able to pick up on the cues that may be important in caring for the patient.

 

Example of good: Mr. Johnson had a total urine output of 240 mL over 24 hours yesterday his weight is down 2 kg, his inputs were 3.5 L and his outputs were 500 mL. His BUN went from 22 to 30 and his creatinine went from 1.6 to 1.8.

As another example: Mrs. Smith got started on five dobutamine her blood pressure at the time was 90/60 her pulse was 95 and she is on beta blockers.  Her lactate was 2.6 and urine output droppped to .3 mL per kilo per hour. Her bicarb was down from 24 to 19 and her BUN had risen from 35-42 and her creatinine from 1.5 to 1.8

You can see from the examples that presenting the event with the context of the data from the system that the event relates to:  1. it proves that you’re thinking, 2. it allows the other people on the team to have a better chance of putting the information together to come up with a viable treatment option and it will also help you learn what data relates to what organ system.

 

While there may be an attending that will discourage you from presenting this way first of all I think it that’s crazy but second of all even if you have to present in a different fashion you need to use this advice for you to present to yourself or to present others to show that you’re simplified synthesizing the information and putting things together to get a real picture of the patient thanks

Why 10 years of Quality Effort in Medicine Have So Little To Show…

My take on why quality and patient safety improvements in medicine have been so hard to demonstrate, and why. I also present my belief in how we can move more effectively in quality and patient safety if we give up on competition. Also Brian Hughley and I playing “James” by Pat Metheny from a few years ago. Thanks.