What to do with the trauma patient who requires rapid, critical decisions and actions.
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Jun 2
Posted by Jeff Young, MD in Clinical Pearls, Clinical Teaching, Hospital, Podcast | No Comments
What to do with the trauma patient who requires rapid, critical decisions and actions.
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Apr 18
Posted by Jeff Young, MD in Clinical Pearls, Clinical Teaching, Hospital, Podcast | No Comments
Discussion of the trial and tribulations of moving from intern to team leader and consultant.
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Jan 28
Posted by Jeff Young, MD in Clinical Pearls, Clinical Teaching, Hospital, Podcast | No Comments
A further discussion of the trials and tribulations you will face as a PGY-1 with more focus on procedures and surgical technique.
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I am starting a series of podcasts on the stages of residency and how to succeed during those years. Hope you find it useful.
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Nov 1
Posted by Jeff Young, MD in Clinical Pearls, Clinical Teaching, Hospital, Information | No Comments
It can be very difficult for third year medical students, and NP/PAs new to critical care to learn how to present patients. I have done several podcasts on this and I direct you to the “critical care podcasts” page of this site and the “ICU presentations” podcasts. But I think a written primer can be helpful.
Presentations in general are done to bring people up to speed on new or current patients. The purpose is to advise the team coming on shift of the patients current condition and warn them of potential problems. I have always had a problem with the totally scripted presentation, in that it does not highlight what is important for the new team to know which is:
I realize that novices cant present exactly like this, because they don’t have the ability to synthesize a large amount of data and turn it into a coherent presentation. Therefore they are taught to go through either a data-based or a system-based presentation format. What usually happens is that the experience people on the team have to take this scripted format and turn them into something useful. I often find it very hard to pick out those critical pieces of information from a system based presentation because all data is presented similarly and it is difficult to know what is absolutely essential for the next shift. For instance in a typical system based presentation you will talk about what happened in the past 24 hours hopefully after talking about why the patient is in the intensive care unit, and then go through neuro, cardiovascular, pulmonary, renal, infectious disease, endocrine, and musculoskeletal. Usually the laboratory data is sprinkled in amongst this system presentation or non-laboratory data is presented amongst the systems and then the data is presented in one bolus at the end.
It is difficult to find common ground between a presentation that two attending physicians would make to each other, and a presentation that two medical students would make to each other. If it is the only presentation the team is getting, then critical information has to be relayed. In my opinion the critical information is:
The other concept I’ve tried to get across (with minimum success) is the inter-relation between organ systems. If the patient’s respiratory status is worse, what’s their renal status? If they’re septic, what going on with their kidneys and lungs? Will treating one system hurt another system?
This is why its essential to think through your proposed actions. Do you wean the vent on a patient who’s renal function is plummeting? Maybe, but you need to consider if they’ll need dialysis to maintain extubation.
There are also several things that I do, more religion than science, that has served me well over the years:
All I have for now.
Jun 21
Posted by Jeff Young, MD in Clinical Pearls, Clinical Teaching, Discussion, Hospital, Information | No Comments
As July 1 approaches I went ahead and put a group of useful critical care related podcasts on their own page. Go to top of this page under picture and click on “Critical Care Podcasts”. Hope you find them useful. JY.
If youre a surgery resident and haven’t read the book “Top Knife” You need to. I’m a little embarrassed I haven’t read it prior to now.
It is an amazing “textbook”. Its especially amazing to me in that it describes my thought processes when dealing with major trauma almost exactly. It supports my theory that while making surgeons may resemble making sausage, it’s amazing what a consistent product we turn out. The crucible of patient care and surgical training does a great job of creating safe thought processes and actions.
Feb 24
Posted by Jeff Young, MD in Clinical Pearls, Clinical Teaching, Discussion, Hospital, Podcast | No Comments
Discussion of ileus and SBO. More general surgery topics coming
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Dec 22
Posted by Jeff Young, MD in Clinical Pearls, Clinical Teaching, Discussion, EMS, Hospital, Podcast | No Comments
Further discussion of handling MCIs and preparation for disasters. Happy Holidays. JY
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Aug 17
Posted by Jeff Young, MD in Clinical Pearls, Clinical Teaching, Discussion, EMS, Hospital, Podcast | No Comments
My first hand description of our preparation and process that helped us manage the MCI this past Saturday. I want to thank everyone for their professionalism, knowledge, and skills that helped us manage this incident. JY
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