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

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