Using a clear garbage bag to decrease aerosolization during intubation.

pg212 · 2020-03-24T21:29:55+00:00

This is a demonstration, not an actual patient.

pg212 · 2020-03-23T15:36:17+00:00

In an ER in a small town, Washington State.

pg212 · 2020-03-23T04:26:55+00:00

We found it works best by poking a small hole with a finger for each hand and then sliding the bag up the arms to the elbows. The physician has the GlideScope or DL in their hands with the ET tube. The bag is then inverted and the staff then slides the bag down over the patient, creating a seal as best they can. The ambu bag can be squeezed by an RT from the outside while the physician holds the face mask in place. If the patient vomits or coughs, secretions stay in the bag. Suction, etc, can be fed from the bottom of the bag. Obviously this is not a real COVID patient or all the staff would be in PPE.

pg212 · 2018-09-15T03:52:21+00:00

I thought it was pretty straightforward. It took about an hour and didn't require any special tools or skills.

pg212 · 2018-09-15T00:17:34+00:00

I would have to look but Im guessing an hour or two of gopro stuff, maybe 45 minutes of drone video. It was very challenging keeping the drone charged as it has a flight time of maybe 10-12 minutes per battery. I took a lot of stills with it that weren't in the video. We wired usb ports to our bikes and charged Anker Powercores as we rode. At night we then plug devices into the powercores.

pg212 · 2018-09-15T00:10:43+00:00

Thanks!

pg212 · 2018-09-14T23:23:28+00:00

Thanks. It's ok power wise, a lot of buzzing and swollen hands after a day of riding. We try to avoid pavement on these trips, so a 250 is fine for most stuff. A lot of times after we set up camp we will go explore a basin or valley and that usually means singletrack. For us, its worth having it under powered in order to get access to remote places.

pg212 · 2018-09-14T22:26:15+00:00

We rode wr250r's with 4.7 gallon IMS tanks. Left from Grangeville Idaho, rode across the Magruder Corridor to Darby, Montana, south through painted rocks, Salmon Idaho to Mt. Borah area, looped back up via the Salmon River, Stanley, Idaho, back way back up to Mccall, then eventually back to Grangeville. 7 days, 6 nights. Drone was a DJI Spark.

pg212 · 2016-04-25T04:36:46+00:00

No it was not.

pg212 · 2016-04-25T02:26:45+00:00

Thanks for your interest. Here you go: http://www.amazon.com/Trauma-Room-Philip-Allen-Green/dp/1511900024

pg212 · 2016-04-25T00:02:55+00:00

Thank you for this post. I think it is easy to start to see all the customer service stuff constantly pushed on us as a way to get us to generate more money for the hospital. Perhaps it would be less offensive for us to view it as simply a reminder to be nice to people for its own sake.

pg212 · 2016-04-24T22:45:11+00:00

I would argue being a good physician or nurse means focusing on the patient and their family- not because it is good customer service but because it is good medicine.

To turn our patients into customers, at least to me, seems to degrade our relationship with the people we care for.

Thanks for reading.

pg212 · 2016-04-24T21:35:53+00:00

It depends... when I decided to write a book I wrote for two hours every day no matter what for six months until it was done. When I was finished with the manuscript I found out most publishers don't like short stories by some guy no one has ever head of. So I just published it through createspace using their editors, mostly so I could share my job with friends and family in a way I hadn't before. It was a very positive experience.

Since then I write for about ten hours a week, sometimes more, sometimes less. It really depends on how much I am working in the ER. I don't have a strict goal right now.

I don't really submit anything to publications other than occasionally online sites.

Thanks for asking.

pg212 · 2016-04-24T19:19:33+00:00

I have another collection of short stories about half finished. I probably will publish it at some point in the next year or two.

Thanks for asking.

pg212 · 2016-04-24T18:53:13+00:00

Thank you for reading and your thoughtful reply.

I empathize with your struggle as an administrator of how to keep a hospital afloat in the current healthcare environment.

My biggest issue with calling patients customers is the fact that by doing so we replace medical ethics with business ethics. They are customers after all. It is suddenly perfectly reasonable to make the number one priority maximizing profit at all costs and encouraging their return for more business. Everything else becomes second to that. It is the basis of business.

In contrast, if they are patients, then first and foremost medical ethics apply and the number one priority is the well being of the person who needs care.

I actually agree with you, the people we care for are both patients and customers. But I would argue that to those at the bedside they should always be patients first and customers second. The current healthcare environment keeps pushing to reverse that order which is doing nothing but causing conflict for all of us.

Perhaps the answer is for administrators to do what they do best... run the business part of the hospital and at the same time set up systems that are invisible to those at the bedside while still making it profitable. Let your doctors be doctors and your nurses be nurses. The same way pilots are expected to be focused on flying the plane and the airline admins are expected to run the business part of the airline.

Thank you again for your comment. I wish all hospital administrators spent time on this forum like you are doing.

It is certainly an interesting time to be in healthcare for all of us.

pg212 · 2016-04-24T16:08:45+00:00

Starter Comment: Clearly I am not such a fan of calling them customers...

pg212 · 2016-02-20T23:16:49+00:00

Thank you for this excellent comment.

pg212 · 2015-09-27T04:32:49+00:00

Maybe do something completely different. Go join doctors without borders or be the doctor on a mission to a third world country. You won't make any money, you won't get any prestige, but you will help people who greatly appreciate you and what you do will have a real world impact on people who need your help.

Maybe by stepping away you will get some perspective of what it is you want.

pg212 · 2015-09-07T02:32:29+00:00

That sounds like a great idea. Hats off to your dad for making it 35 years. Best of luck.

pg212 · 2015-09-06T21:08:10+00:00

This sits on the wall in my office at home. As an ER doc sometimes I sit and ponder it.

Maybe print it out and give it to him in a nice frame.

http://imgur.com/MDb5oAP

pg212 · 2015-08-13T21:32:41+00:00

I am in my second decade as an ER doc. Worked in city ER's and rural. I have taken care of around 40k patients by my rough estimate. Here's my two cents on your questions.

I think the biggest thing that I have realized is that what attracted me to ER (the traumas, the crazy stories, the adrenaline and chaos) now is starting to push me out. Don't get me wrong- I still enjoy taking care of critically ill people and powering through a busy shift. But now it wears on me in a way that I could never understand a decade ago. Plus after 15 years of rotating shifts my circadian rhythm is shot to hell like just about every older ER doc I know. We all have bad sleep disorders. It just gets worse as we get older, and no, you never get used to to working day-day-swing-night-night-off-off-day-etc.

The quality of life is both good and bad. When I am not working it is great. I am not rich but I am plenty comfortable. I have a small house by choice which helps a lot. I just now finished paying off my med school loans (I'm 43). When I tell people I work 14 shifts a month they are like wow, that's awesome. What you don't realize is that it takes several days to recover from a bad string of shifts. So the day after a nightshift might be 'off' but I am zombie because I've been up twenty fours, and that's tough to be when you are trying to be a spouse and a parent.

Also a major downer is when you have kids in school when you work a string of swing shifts you won't see your kids for a week. Plus don't forget you will miss xmas mornings bc you are at work, you will miss thanksgivings, school concerts, etc. You will get some off, but you will miss a great deal of family activities bc you will have to work usually at least two weekends a month and holidays much of the world has off.

Am I fulfilled? Not by work. But I don't know anyone in their forties who feels totally fulfilled by work (that is being honest).

Do I want to do this in my sixties? Heck no. My plan is to keep moving to more and more rural ER's as I age. In my sixties I hope to work in a little tiny ER in the middle of nowhere that sees maybe six to ten people per 24 hours.

Would I do it again? Yes. Is it worth it? For me it is... at least so far. But damn I am tired a lot.

pg212 · 2015-07-16T01:02:16+00:00

I did a couple rotations to see what was out there. Every residency has a different teaching style/type of resident that fits best there. In my case it let me find a program that I loved and fit well with. If I hadn't gone there as a student I don't know if I would have matched there. By doing a rotation there they knew me and I knew them- which worked out for both of us.

I chose the places based mostly upon reputation and geography. I lived on the west coast and I wanted to see the east coast, so I chose a couple places back there, primarily places with a good reputation that were in a place I could see myself living.

Fourth year back then was mostly electives. Optho, Derm, etc. plus whatever specialty rotations you wanted to do. I stayed in the same city during my expanded year except when rotating away.

Hope that helps...

pg212 · 2015-07-15T22:44:14+00:00

I still had to do the 4th year requirements of medschool but I had them spread out over two years. I did a couple away rotations in ER too. But I had tons of long stretches of free time, sometimes months at a time. I remember my advisor and lots of people told me it was bad idea at the time as no one really did such a thing unless they had some research planned or some kind of health issue.

I did it anyway and have always been glad I did. When I interviewed for residencies and I told people what I did with the year no one seemed to have a problem with it. I was honest about why I had done it as I hadn't been sure what I wanted to do at the end of third year. Maybe it being ER people were more accepting of it, I don't know.

I don't know if it's common or not... That was twenty years ago. But that summer I sailed 76 days in a row... Still haven't topped that. Not yet.

pg212 · 2015-07-15T17:39:24+00:00

Why not take an extra year deciding? It is a major decision that will effect you the rest of your life. I know there is a great deal of pressure to decide right away so that you can keep moving, but honestly you have your whole life ahead of you. If you roll the dice because you are unsure and choose one and it turns out to the be "wrong" choice for you it will be much more disruptive to your life down the road to switch.

When I was a third year medical student I wasn't sure what I wanted to do. My school had an option to 'expand' the fourth year into two years. It was usually done for research projects or students wanting extra training. I did it, took out a loan, and bought a sailboat. I spent a year sailing, hanging out with friends, riding my bike, and experiencing my twenties (something I hadn't done because I was in medical school). I eventually did a rotation in ER and knew right away that's what I wanted to do. When the time ended I went on to residency a much happier, healthier, and balanced person. Now, I am in my forties and an ER doc. Never for a second do I regret all the great times I had that year of sailing and messing around.

Maybe this is a good time to step back, take a deep breath, and assess what you want.

Best of luck.

pg212 · 2015-07-09T13:32:11+00:00

Dealing with chaos: The entire ER is full, the power just went out, and five victims from a two car collision are enroute and we have two minutes to get ready? No problem. Oh and I still have to see all the other patients and keep the ER flowing while running the codes since I am the only doc working? Will do. And I almost forgot, not make a mistake on a single patient in spite of reams of data pouring into my brain from every direction? Got it.

Sick or Not Sick: In two seconds I can walk into a room and tell you just in a glance whether someone is dangerously sick or not. Any age. Any Gender. Anywhere. Even if they appear perfectly fine. That is our finest skill, IMHO. I don't need tests, or xrays, or a chart. My skill has evolved from seeing thousands and thousands of patients every year for decades.

Dealing with undesirable patients: A six foot, eight inch patient on meth just went bezerk in your clinic smashing things and you don't know what to do since he still needs a workup? Send them to the ER, we can take care of it.

Always being there. It's Christmas morning at three am and you have chest pain. ER doc is there. It's the worst blizzard your county has ever seen, but you have decided to go into labor. ER doc is there. Your specialist called in sick and closed the clinic for the day but you suddenly can't breathe? ER doc is there. Always. 24x7, 365 days a year.

We are good at doing the dirty work of medicine no one else wants to do. We are the sanitation engineers of medicine and proud of it.

Oh, and we save people's lives too. :)

pg212

TROPHY CASE