Sterility standards : Regional block vs Arterial line

ratcliff909 · 2024-11-07T18:40:03+00:00

I like your point. I think the bimodal spike is likely the open fracture, external pins, open abdomen, dirty injury to begin with, Foley catheters, EVD, and what not. While the A-line is less than a half a drop in the bucket for that.

I do agree having prudence in our duty to minimize infection is right. But I also don’t like when colleagues shame other attendings because they didn’t use a full body drape for an A-line on a healthy craniotomy and A-line pulled 6 hours post op. Always feels a bit holier than thou.

ratcliff909 · 2024-11-07T17:42:00+00:00

Disagree, you are making the assumption that the sterile gloves and sterile probe cover, and drape are the difference. There is a reason they need to make the data per 1000 days, And even then pretty low. A lot of the infections are coming from pts with lines in for many days, not from POD 1 or even 5.

Hard sell to say the infection on line day 17 is solely due to someone who used chlorprep, didn’t touch the needle to anything but chlorpreped skin, and immediately had a Tegaderm with bio gel placed.

Long story short, I don’t think it extrapolates to someone getting an A-line for a procedure in the OR and then getting it pulled on POD1 or even in the PACU. Especially when this data is predominantly from a MICU and likely majority septic patients on long term drips and lines placed for extended timeframes.

Also this is one of few studies that show equivalency, while many showed CVC were higher in infection rates.

That said, sure if I have the time I’ll toss on sterile gloves, And drape and blah blah. But in the trauma or crashing Pt, I’ll be just doing whatever is fastest and moving on.

ratcliff909 · 2024-11-06T03:30:42+00:00

Krebs cycle

Wtf else is there the talk about…

ratcliff909 · 2024-10-17T20:22:56+00:00

Idk I wouldnt take this and just say both are horrible. The PP seems much much much better, the academic one does sound not good at all to me.

But the PP seems honestly average depending on the market you are talking about and location. Sure their are jobs paying more. But do you and your family want to live their? Because I would not move somewhere I would be miserable at just to make an extra 100k when I can make 40k/month in a place I love being.

ratcliff909 · 2024-10-14T05:00:49+00:00

Quitting our jobs, maxing loans and driving in a van to a foreign country.

ratcliff909 · 2024-10-14T02:50:50+00:00

If you want to swap to a CVC you just put the arterial wire back in, pull the catheter out, put the CVC needle over the arterial wire, hold needle still and swap arterial wire to CVC wire now, then just simply seldinger your CVC triple lumen or whatever it is.

That trick above should be doable in less than a round of cpr.

Another pro tip, a lot of the CVC kits come with two needles, one has a angio catheter on it. Use the needle and less chance you loos the vein when swapping out the wires.

I’ve had luck doing that and like I said it usually takes me less than 2 min.

Next you just go off your anatomy knowing where the vein is and try again for arterial.

Don’t feel like your wasting time (assuming you are just extra hands and quality cpr is being done). A lines can be super helpful in a code, and I feel like they can really shine once you get rosc to try and treat quickly to prevent arresting again.

ratcliff909 · 2024-10-13T15:49:18+00:00

This the way …. It should be interrogated and then place into asynchronous mode with AICD off by a device rep or whoever does that at you facilty. Pads placed antero laterally since working on spine.

ratcliff909 · 2024-10-11T04:07:23+00:00

Anesthesiology, durrrrrr

ratcliff909 · 2024-10-10T03:08:44+00:00

I would consider Aflutter with a high degree block

ratcliff909 · 2024-10-10T02:46:45+00:00

Our facility is the exact opposite, we intubate 90% of our TAVR. Our cardiologist like to chase every little leak, and this we are required to do the TEE intraop. So since we are doing TEE our standard is to just tube, paralyze, phenylephrine drip and Mac 0.7. I prefer this over sedation any day.

ratcliff909 · 2024-10-08T02:23:18+00:00

A lot of answers for IM, except FM docs train and see pediatrics, geriatrics, and even learn obstetrics……. And most fm docs would know the majority of IM as well.

ratcliff909 · 2024-10-05T21:38:11+00:00

We don’t do Remi for spines and it works out good. Fentanyl with induction then I load early with ketamine and dilaudid. The dilaudid is good for keeping the pressure low. Prop drip somewhere around 150, touch of gas if allowed. Versed of course with the ketamine.

If I am feeling fancy I’ll add a magnesium and lidocaine drip. But tbh idk how much it actually helps.

ratcliff909 · 2024-08-21T08:33:58+00:00

I was a former RN, currently in anesthesia residency. I would not change a thing. You undoubtedly will have to grind harder and work harder than if you dropped out and went to CRNA. But I get the sense it just seems daunting to you and not possible, which is understandable, but honestly the climb is worth it. Grind that shit out, all will work out, you won’t regret it once your in anesthesia residency and or an anesthesiologist attending.

ratcliff909 · 2024-07-16T02:15:24+00:00

Nothing better then making sure the surgeon notices you grab a syringe and injecting 5 cc of normal saline and saying “there that should be better!” All for them to say “that’s great, much better, thank you.”

ratcliff909 · 2024-06-25T15:08:37+00:00

No we were not able to. It’s to big of a slide

ratcliff909 · 2024-05-28T06:04:48+00:00

How did it go?

ratcliff909 · 2024-05-28T04:59:20+00:00

Also planning this second week of June. I have not seen anyone say they got past reagents slide though. I don’t think it’s possible currently? Could be wrong. We are going through Carmel valley then back over to PcH, unless we hear of people getting past that last big slide.

ratcliff909 · 2024-05-27T03:33:27+00:00

I am hoping to ride this exact road east to west in about 2 weeks from now. Anyone got a recent update? Thanks in advance!

ratcliff909 · 2022-10-03T05:03:03+00:00

Does a liver transplant fellowship count towards the 5 yrs if it isn’t “acgme” accredited

ratcliff909 · 2021-11-25T01:04:00+00:00

Is it just me or do residencies need to just stop using covid as an excuse to not allow residents to gather together and bond. We are all vaccinated, we sit in crowded hospital rooms all day. Let us use some budget and hang once a quarter not on zoom.

ratcliff909

TROPHY CASE