Grand Rounds Recap 1.17.24

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Leadership curriculum: recruiting & building a team WITH Drs. fermann and lAfollette

  • The best leaders understand that the critical component to their success as a leader is building a great team around them

    • This involves getting the right people involved in your organization and empowering them to do their job well

  • Recruitment is not a one person job and should involve the entire team recruiting other members

    • If you want your organization to be better, you need to be an active participant in recruitment

  • Recruitment is more than just filling holes in a roster

    • Rather you need to identify the type of individual who will help you fulfill your organization’s mission and help create a unified team with in a common goal in mind

  • To be successful at recruiting, you must recognize the type of person who would embrace your organization’s mission

    • Think about what characteristics and background that person should have

    • Then figure out what resonates with the person you are trying to recruit

  • This starts with first identifying what the organization needs

    • Must know your organization’s mission

    • What is the goal of your organization?

    • Then find who will help you deliver that mission

  • Teams that function well typically have a good sense of their mission and priorities

    • To know your purpose, you must know your goals

    • Having a sense of what the goal of your group is and its primary mission will allow people to rally around it

  • Recruitment successes

    • The institution must portray an investment in the recruit

    • Think to yourself, would you want to join this team if you were being recruited?

    • People want to envision themselves in an organization, so show them what their life will look like

  • Recruitment failures

    • Recruiting is about the individual recruit, rather than the organization

    • So a common failure is overstating how great the organization is and not focusing on the individual

  • Diversity in recruitment

    • Diverse teams tend to be smarter, more creative, and examine facts more thoroughly

    • Also allows organization to focus on the actual population that it serves

    • Both the individual and the collective are important

  • Building a team:

    • First need to know your global mission

    • Then, define roles that are each focused on achieving that mission and empower team members to do so, while providing honest, constructive feedback along the way

    • Create an arena of psychological safety and listen as team members voice their ideas/solutions

  • Being a successful team leader involves:

    • Respecting, protecting, and inspiring your team members

  • Being a successful team member involves:

    • Understanding your organizational mission

    • Working hard to achieve those goals

    • Employing good communication with other members of your team

r4 case follow-up WITH Dr. finney

Dr. Finney reflects on an impactful case that ultimately ignited her passion for critical care. The case highlights how we as providers can grieve the loss of our patients, as well as the profound relationships with can make with their family members. Below are Dr. Finney’s pearls about how to cope with the most difficult cases you may encounter during your training and beyond.

  • Keep the memory alive​

  • Allow yourself the time and space to grieve​

  • Talk to your people & let it all out​

  • Remember why you chose this field to begin with​

  • Identify some wins to remind yourself it isn’t all bad​

  • Be patient with yourself​

  • Stay humble

R3 Small groups WITH drs. chhabria, davis, & gobble

  • Pediatric Resuscitation Quick Hits

    • Fluid bolus volume is 20ml/kg and may be repeated up to three times if needed

    • Treatment for hypoglycemia: D50: 1ml/kg, D25: 2ml/kg, D10 5ml/kg

    • Step for an umbilical line cannulation

      • Prepare and flush catheter

      • Add 3-way stopcock to catheter

      • Sterilize cord and tie with trach tie and/or umbilical tape

      • Cut cord with scalpel/scissors 1-2 cm from skin

      • Insert catheter to 5 cm and aspirate

      • Advance to predetermined depth

      • Secure w/ anchoring suture

    • Formulas that are useful during a resuscitation

      • uncuffed ETT size = age/4 + 4

      • cuffed ETT size = age/4 + 3.5

      • ETT Depth = ETT size x3

      • initial defibrillation: 2J/kg (next shock is 4J/kg)

  • Toxicology Quick Hits

    • Fomepizole is the treatment for both polyethylene glycol and methanol toxicity.

      • It inhibits alcohol dehydrogenase and blocks the formation of the ultimate byproducts of oxalic acid and formic acid respectively.  

    • Hyperammonic encephalopathy is an important cause of altered mental status in a person who regularly takes Valproic acid.

      • Check an ammonia level, it can present even with normal AED levels and normal LFTs.  

    • Gasoline is a hydrocarbon. It has a increased risk of aspiration due to its low viscosity and volatility. It is toxic as an asphyxiant if inhaled and an irritant when aspirated.

      • Patients should be observed for 6 hours following ingestion to watch for development of pneumonitis.  

  • Orthopedic Injuries Quick Hits

    • Upper Extremity Injuries

      • Galeazzi Fracture

        • How? FOOSH

        • What? fracture of distal 1/3 of radial shaft w/ distal radioulnar joint injury

        • Management? reduction, elbow cast, +/- ORIF

      • Monteggia Fracture

        • How? FOOSH

        • What? fracture of proximal 1/3 of ulna w/ radial head dislocation

        • Management? reduction, elbow cast, +/- ORIF

    • Lower Extremity Injuries

      • Masionneuve Fracture

        • How? pronation-external rotation

        • What? proximal fibula fracture w/ ligamentous injury/widening of distal tibiofibular syndesmosis/medial malleolus fracture

        • Management? reduction, short leg split, + ORIG

      • Segond Fracture

        • How? internal rotation and varus stress

        • What? avulsion fracture of the lateral aspect of the tibial plateau usually with ACL disruption (about 3/4 of cases)

        • Management? RICE, knee brace delated surgical intervention/MRI