Tamingthesru
Grand Rounds Recap 2/3/16
This week we had our annual Critical Care Symposium where we invited our own critical care trained faculty and a special guest to have a day chock full of critical care goodness.
Refractory septic shock with Dr. David norton
Dr. David Norton, Assistant Professor of Medicine and Director of the UCMC Medical Intensive Care Unit
Definition of Refractory Shock:
No clear definition exists, but we are generally describing a state of decreased vascular responsiveness despite high vasopressor infusion.
Grand Rounds Recap 1/27
Morbidity and Mortality Conference with Dr. Toth
- Clinical Decision Unit Usage: We want to keep using our observation protocols for patients that are appropriate for the CDU. These patients must have a priori identifiable endpoints and a plan for care.
- Discharge vital signs: Revisiting a theme from last month, tachycardia at discharge is associated with badness. Abnormal vital signs must be addressed.
- Shift Change: Turnover is fraught with increased risks regarding patient care. Be vigilant that your sign out can anchor the oncoming provider.
Grand Rounds Recap 1/20
Quarterly Simulation and Oral Boards
How do you approach the undifferentiated patient in arrest?
- Your demographics and any initial history can differentiate the hyperkalemic arrest from recent chemo from the rhabdo from prolonged down time from overdose, etc.
Running a code is an art and a science
- Mental modeling is something that causes us angst but it works. Close your loop with your drugs and plan. Being loud with your summary reasserts your control of the situation and can quell the peanut gallery.
- Assign your roles and know your nurses and medics, introducing yourself mid-compressions is poor form and can decrease code efficiency
- We like to keep our fingers on the femoral pulse. It decreases pulse check time, let's you dictate timely next moves.