POTD, come and get it

DAANNNNNGGGGGGG THATS A FAT FINGER 

Today or tonight, depends on how you look at it tbqh we’re gonna take a look at a surgical EMERGENCY (now I bet you’re paying attention)

> FLEXOR TENOSYNOVITIS<

Infection of the digital flexor tendon sheath 

Flexor sheaths are continguous w/ deep spaces of the hand 

BE ON THE LOOK OUT FOR PENETRATING TRAUMA HISTORY

Man, this stuff sounds serious. If only there was a set of signs I could look out for.. wait, who is that knocking at the door? 

OH SNAP IS KANAVEL

What’s that? Someones drowning down by the well? What? Huh? Thats a dated reference? Fair play 

Back to the signs 

KANAVEL SIGNS are what you should be looking for this generally clinical diagnosis 

And, 

Here

They

Are

1. PAIN WITH PASSIVE EXTENSION

2. PERCUSSION TENDERNESS OVER THE ENTIRE LENGTH OF THE FLEXOR TENDON SHEATH

3. UNNNIIIFFOORRRMMM SWELLING  ALONG THE LENGTH OF THE TENDON SHEATH 

4. FLEX-FLEX-FLEX-FLEX-FLEXION POSTURE (THEY KEEP IT FLEXED TO MINIMIZE PAIN)

So fi you think you found one get an emergent hand surgery or ortho consult and start some anTIbiOTics broseph.

Its been a lovely chat with you all, 

Besitos 

potd baby

we’re entering my last week of doing this (I know, shed your tears now, get them out of your system) and I figure we should talk about some electrolytes gosh darnit 

But which one? Theres oh so many? 

Hey what’s with the groans from the audience? Is it my fonts (comic sans italic)? Is it my colors (i know you like that fuschia)? Is it my COMPLETELY REASONABLE TIMING when it comes to sending emails? 

hey! Stop that, theres no need to throw stones at me!

Wait a second, 

you’ve inspired me!!

HYPERCALCEMIA!!!!!

I’m talking stones (renal calculi)

I’m talking bones (bone pain)

I’m talking groans (and pain, dehydration, pancreatitis)

I’m talking thrones (polyuria and constipation)

And not but not least

I’m talking psychiatric overtones (lethargy, confusion, hallucinations)

And you better 'member to check the EKG for all the findings 

Prolonged PR/QRS

Widened T’s 

Brady’s and heart blocks 

Even ST changes

What are we gonna do about it?

<12 —> home 

doesn’t need immediate treatment but you best believe you’re gonna give that baby some follow up 

12-14 —> the grey zone

if they’re symptomatic better start treating it

but, but, but how? 

throw some normal saline at that chump. bolus or until urinary output is 100-150ml per hr

want some more?

calcitonin works w/ in 2-4 hrs (woah) think 4 units/kg SC or IV

theres some data to show that zoledronic acid works well with calcitonin in dropping the calcium too

>14 —> admission, look at that EKG first. These pups are at risk for severe dysrhythmias and cardiac collapse

Keep in mind if things are looking rough enough you can pull the trigger on dialysis 

think patients w/ renal failure

patients that have calcium over 18 

patients w/ neuro sx 

and of course those that fail other therapy 

Well anyways thats all from me 

Besitos

#justiceforhan #Fast9

POTD: sim fellowships

as we reach another weekend which we're all surely schedule for both saturday and sunday overnight 

- how'd they even pull that off? i mean all of us on both nights? is anyone working the days? and i got the same schedule next month too! idk man, i think whoevers doing the schedule is out to get me. wow these internal dialogues are getting long - 

its time for fellowship friday. 

this week we're talking: 

S I M 

FELLOWSHIPS

why:

Teaching opportunities that can expand further than the world of the ED.  Sim is everywhere now, we’re sorta living in the future, and this provides an abundance of applications to the skills you can learn.  The field allows you to take part in the intersection of patient care, medical education, systems improvement, and tech.  Additionally it offers a cross of education and administration, as you plan budgets and maintain a sim center.

What can I do during residency: 

 don’t know if you’ve realized but we have sim scheduled almost every day. First and second years, ask to get involved with planning or whatever is available. Then by the time third year rolls around you can/should do a sim selective. 

Career post fellowship: 

Expanding sim centers all over need faculty for admin, education and research.  Some even go into private industry at educational companies or tech/insurance companies as sim directors. Generally, however, you should expect to be involved in direct education and training. 

the FACTS:

As of 2016 there’s at least 30 programs of varying length (1-2 yrs) Most 2 year programs try to get you a master’s degree.

Theres no board certification process for sim but the Sim Society in Healthcare offers accrediting standards for sim centers and exams for basic and advanced levels.

Salary:

Varies year to year/place to place but generally not on the regular PGYx set up

How to apply; 

No universal match process

No specific standardized requirements, you’ll have to look program to program. 

Generally suggested to take an elective.

Deadlines are lal over the place - range from September 1st to may 1st so you’ll have to check the program you want 

Apply to at least  3-5 programs

Point people: 

attending level: ann marie, lamberta, aghera 

resident level: tome, who is impressively literally accessible everywhere,  or humaira. likely in room 20 or whatever isolation room she finds herself in post international 

enjoy your friday homeboys and homegirls and as always

besitos

bob