POT'd: suture materials

Good evening buddies, pals, amigos, and everyone who remembers the Dylan episode of the Chappelle’s show

for today I thought I needed to break it down  — >way way down <—- to one of the fundamental procedures of the ED.

You know what I’m talking about.  ; ] 

No, not that.

You consider that fundamental?

Dude, you already guessed foley placement twice.

Nope, what I’m talking about it 

LACERATION REPAIRRSSSSSSSSS

And this time we’re not even pitching it off to the med student. 

Now I’m not gonna provide you with a nice graphic of dotted lines that are supposed to somehow simulate the pathway of each knot (I struggle with computerized depth perception clearly.). Instead I found this nice chart for y’all. 

cred to wikem.

Its got all the different suture types and how long they should be in.  I figure its nice to just touch back on this considering its something we see and do every single day.

As always,

Besitos, love, and the noodles from the hot food bar at j and j’s 

POTD: mechanical capture

P  P  P

O O  O

T T   T

DD   D.

so you just threw in a TVP, dope bro. you did it. high fives all around. welcome to the show, you've made it. might as well end the shift right now, because those incoming 7 stroke codes aren't gonna brighten your day any more than this will

---but wait----

theres still more to do

just because you're getting electrical capture, doesn't quite mean you're getting mechanical capture.

so low and beHOLD        

here .    

are .   

five ways to check for mechanical capture

1. Pulse ox - the crazy thing about a pulse ox is that it can show the pulse. look out for that wave form! this can give you an idea of whether the body is seeing actual pulses 

2. End tidal CO2 - just like in CPR, the end tidal CO2 gives you an idea of if we're getting actual perfusion and exchange. a super low end tidal co2 means we're probably not get the mechanical capture and perfusion/exchange we want.

3. Our sweet baby ultrasound - check for some cardiac movement broseph

4.  An A-line - get those procedures up 

and finally

5. Checking the pulse - I know, bizarre, no machines and putting your hands on the patient? so 1990s, gonna pop into blockbuster after this, then you can catch me on AIM, think i still got a few thousand hours left of that AOL free trial.  PRO TIP: use the femoral pulse instead of the carotid! electrical stimulations can cause muscle contractions that are coonfused for the pulse. dont get caught out there!

in the end, don't assume electrical capture = mechanical capture

don't say i never did anything for you.

besitos

POTD Med ed fellowships

n this edition of potd 

MED ED FELLOWSHIPS

why:

offers a direct pathway to working with medical students, residents and faculty.  Additionally you get some admin experience in the sense of what’s needed to design curriculums and run a program. Additionally although it isn’t absolutely necessary it can expedite your pathway to program leadership.

What can I do during residency: 

Luckily we have med students around almost all the time, whether they prefer it that way or not.  A great way to start is to get involved with teaching them. Additionally, giving talks and mentorship can help show your interest.

Career post fellowship: 

‘’Career options after fellowship are endless!’’ - emra.org

Your Home EMRA

emra.org

The Emergency Medicine Residents' Association EMRA is the voice of emergency medicine physicians-in-training and the future of our specialty and the largest and oldest independent resident organization in the world. EMRA was founded in 1974 and today has a membership over 16,000 residents, medical students, and alumni.

Hopefully you’re as excited about this by this point in the email as they are. Options include but are not limited to program director, faculty development, deans of medical schools.  really theres a ton of things you can do.

the FACTS:

emra says theres 30 programs and more coming. I’d believe theres a substantial bit more than that now. Cornell just opened up a program and of course we have our own lovely program.

Salary:

Varies, some do the pgy pay, some do other things

moonlighting still a thing, even though no one responds to my texts about it. - again.

How to apply; 

Most are on a rolling basis.

Requirements include 2-3 letters of rec, including one from the program director.  

Point people: 

Arlene, sally, Shivani, sumintra and Saloum have a ton to talk about regarding med ed stuff. I’d start there and work your way around