Tamingthesru
Grand Rounds Recap - 3/25/15
Mortality & Morbidity Conference with Dr. Bohanske
Remember that sometimes the thing a patient needs most is a specialist (i.e surgeon), especially trauma patients
- Sharps in hectic situations, such as any resuscitation, are dangerous not just for the patient but also for providers as this is one of the most common situations leading to bloodborne pathogen exposures
- Remove sharps from the field anytime you do not need them and always be responsible for your own sharps to keep your team safe
- Keep in mind that early predicators of hemorrhagic shock are pulse and mental status/anxiety as BP changes are later indicators
Grand Rounds Recap - 3/18/15
Evidence-Based Emergency Medicine: Vent Management with Drs. Axelson & Scupp
The term Acute Lung Injury (ALI) is being phased out and instead Acute Respiratory Distress Syndrome (ARDS) is now graded mild, moderate, and severe depending on the PaO2:FiO2 ratio
The median onset of ARDS after presentation to the ED was 2 day but could be anywhere from 5 hours to 5 days
ARDS Net was a foundational trial in ventilator management and was a triall of tidal volume and plateau pressures. The primary end point, mortality, was reduced by >20% when folks were on a low TV (6cc/kg) and lower PP (25-30 mm Hg).
Grand Rounds Recap - 3/11/15
Health Care Disparities with Dr. Ford
There is a well established distrust of the medical system by minorities, especially African Americans. The historic causes of this distrust are widespread and seen in nearly all stages of American Healthcare. A great resource is Medical Apartheid by Harriet Washington. Some key examples of the use of AA in medical advances:
1800s: Slaves referred to as "clinical material" in medical schools and journal publications. Slave bought and used for experiments and experimental surgeries including the first successful vesicovaginal fistula repair (caused by forcep deliveries) which was done without anesthesia.
1900-1930: "malaria therapy" with fatal falciparum used to try and treat syphilis. Tuskeegee experiments- subjects recruited under false pretense of "free testing and medical treatment" for syphilis experiment with no intention to treat despite PCN being widely available. "The future of the negro lies in the research laboratory..." Patients were offered a free burial when they died from the disease so that an autopsy may be performed. "as I see it, we have no further interest in these patients until they die..."