ultrasound edition

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me: knock knock

novak: didnt you do this yesterday?

me: SHUT IT INTERN, ITS TIME TO TALK FELLOWSHIPS

i remember as a budding youth, i was interested in the abstract contract of life post residency.  so i think it might be useful to go through some of these. I'll try to do one a week, but you know... the winter.

why: ultrasound is everywhere and it really expedites your dispos. This could be useful even if you’re going into community medicine and/or plan on being a nocturnist. Also allows for you to apply/teach this skill globally.

What can I do during residency: 

Luckily you get all the blocks of ultrasound, but we’re also lucky enough to have a ton of ultrasound staff. You can literally throw a stone from any spot in the ED and hit an ultrasound trained or someone that is going to be ultrasound trained.  Reach out for research opps. 

Career post fellowship: 

Not limited to academics. Its great for those planning to be nocturnists or those who may want to go slightly more remote places.  But those that wanna do academics boy oh boy are there options right now.  Think ultrasound director, or ultrasound fellowship director.

the FACTS:

>121 programs, some have specific global/international tracks

1-2 yrs 

Learn to perform and interpret ultrasounds

Admin aspects of running/maintaining ultrasound programs

Integration w/ emr 

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.

How to apply; 

You’ll generally need at least one rec from ultrasound staff/chair possibly. 3 recommendations total is fairly common. 

Apply to 7-8 programs, but run it by other staff who might have point people or ideas for what you need. 

This year it was through the match, rank lists were due early November

Start thinking about an applying in august or earlier. 

Point people: 

Everyone

Joking

Not really though

Kay, Judy, haines, dickman, so on so forth. Theres more, I’m not listing them all 

Resident wise: Taryn, suman, siri, tina and Aaron. Probably ask Aaron first, he’s a big fan of questions.

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lets get shruggy

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me: what’d the subclavian line say to the face? 

You: IDK man, its late **shrug**

me: GREAT BECAUSE THATS EXACTLY WHAT WE’RE GONNA TALK ABOUT!

THE. 

SHRUG.

TECH.

NIQUE. 

(for subclavian lines) 

First question:  why oh why choose a subclavian 

  1. Easier to keep clean and dry than a neck or groin (obvi)

  2. Lower risk of catheter associated  DVT 

  3. Avoids trach ties/collars - super useful now that those are all the rage

  4. Does impede venous drainage from the brain in Neuro patients

Second question: yeah you’re right and I get to get a chest tube from that pneumo I’m gonna cause!

WRONGITO!

Guys its 2020, I saw a robot type machine doodad named Marty roam a grocery store the other day. Times. Have. Changed. 

Lets talk ultrasound 

So here’s some technique, but don’t you worry your pretty little heart, I’ll include some videos at the end.  

So for this I’m going to describe short axis, but you can also do this long axis. 

You start lateral looking for that axillary vein 

Trace that bad boy medially and you’ll see it join up to a larger vessel. *spoiler alert -thats the subclavian* BOOM!

Here’s a view you might get 

1.png

Note: long axis can be done but there have been studies shown that short axis actually has a higher success rate, go figs. But here’s a long axis ultrasound measure for good measure

2.png

Additional note: Ribs run between the subclavian and the pleura  and can be used strategical to prevent pneumothorax.

You: This is all great stuff, but its back day and you sold me this email on the shrugs. I’ve been real concerned about my traps so. 

Me: Shut it. Heres your shrugs.

So one thing is the subclavian tends to dive below that pesky clavicle, but you know what? 

You tell those patients to shrug or maybe you do a little creative arts and crafts, suddenly that clavicle  jumps up and that subclavian view comes right back. 

3.jpg
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POTD AIRWAY CARTS

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Howdy buddies and pals,

This is a great time of year because the there's a ton of role changes. Interns man the wall overnight. Second years get trauma tubes. All of this happens in the back drop of the flu touching any and everyone.

In light of that today's POTD is brief, but sweet.

LETS FOCUS ON THE AIRWAY CART

EVEN BETTER, LETS JUST FOCUS ON THE TOP  LAYER

So I know that we have the check lists there and I know its been sent out a couple of times, but ultimately a picture is worth a thousand words.  So let me bless you with at the very least 1000 words. 

I'll frame the picture though

you walk into the ED, you're checking your carts as you do on any day you're lucky enough to wander through our lovely department.  BOOM! this is what you see.

PICTURE 1:

ZOINKS!






Luckily the systems gods have thought this through and theres a sign of guidance.








You think to yourself, how did I get so lucky. Who loves me enough to make sure I have this lovely piece. AND ITS LAMINATED?!?!?! I DON'T EVEN KNOW IF MY PARENTS LOVE ME THIS MUCH. 

BUT...

What do you do with all this love? How do I organize it? Don't worry, I got you fam. 









Now this is just a sample, a taste so to speak. Is there a filter on these pictures? Perhaps.   Some people like the top of their carts less cluttered. Some people like it a little more cluttered. 



The major keys (alert) is making sure you know where it all is and making sure your quick items are working.  This means testing the balloons, keeping syringes attached, having some blades set up, having at least one, ideally two means of capnography and your back ups on top.  



Occasionally, these supplies may run low and I encourage you to go over where the main supply of these items are. Often in the more distant cabinets and/or clean utilities. 

And of course I also encourage everyone to check suction, glides and bvm's prior to your 14th fallen old woman on blood thinners who will undoubtedly need a tube. 



Happy tubin' yall. 

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