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How to be a Terrible First Date Dating, Pt 1 How to be a Terrible First Date I've been dabbling in the world of online dating for years. Some dates have been more successful than others. But until this point, I've always had pleasant encounters. That all changed with my last couple of dates. I've been shocked to discover how different people can behave in public compared to the persona they project via text. I always imagined people would be more reckless in their text and more personable in real life. Oh, how wrong I was… My first date was a few months after I moved to town. We video chatted a handful of times before we met, and he seemed like a nice normal guy. The first clue should have been when he told me he had a lawsuit against him related to a business deal. I'm too trusting and gave him the benefit of the doubt. So…what went wrong? First, he spent the beginning of the date asking me leading judgmental questions. How many guys have I dated/ slept with, etc, etc. He proceeded to tell me I was promiscuous (really? I've dated like 7 people and I'm 35 years old). Next, he proceeded to discuss pornography and sexual preferences. Then he asked whether I thought people could know each other if they don't live together before getting married, and he told me I was wrong when I said yes. Next, he insinuated that he didn't believe that I'm a surgeon. Weird, but whatever. He went on to Google me in front of me. Like, legit. Probably spent about 10 minutes staring at his phone while I ate my dinner. A couple times I told him he should probably pay attention to the person who took time out of their day to come to meet him… Then he decided to tell me he didn't believe I was Hispanic because Hispanic women wear a lot of makeup. He found a picture from a few years ago when I was applying for a job and told me if I put in some effort, I could look better. I told him I'm so much more than my appearance, and I don't value myself based on looks. After a complete shitshow for the first half, I told him I'd give him a chance to start over and consider a different approach. I gave him the benefit of the doubt that he was just nervous. Unfortunately, he didn't adjust his approach in the second half. He then told me more details about his legal issues. Seriously, he spent a year in a work camp for white-collar criminals. He reminisced about the friends he made and the work he did. I had a hard time keeping a straight face. And the cherry on top of the terrible date? He lied about his height. He wasn't 5'6. I'm 5'3 and he didn't have an inch on me. Note- I'm not against short guys. I AM against guys who lie about their height. Don't be that guy. *Note- Grammarly assessed the tone of this post as "sad" and "disapproving". I'm impressed. Previous Next

< Back Nasogastric Tubes Nasogastric tubes (NGTs) are frequently placed in surgical patients to decompress the stomach and minimize nausea/ vomiting while allowing bowel rest. For intubated ICU patients, this is frequently an orogastric tube, passed from the mouth to the stomach. The anatomy of an NGT Lumen: this is the inner cylindrical hollow conduit that allows gastric contents to be suctioned out and potentially allows medication and nutrition to be given (depending on the clinical situation). Multiple holes to allow gastric contents to be suctioned into the lumen of the tube Side port: if nasogastric tubes were like straws, with only one lumen, they would adhere tightly to the stomach wall when suction was applied. Thankfully, NG tubes have a side port (the blue ventilation port) that allows air to flow into the stomach, preventing the tube from giving the stomach a suction hickey. Markings on the tube indicate how far the tube has been inserted. A white line along the length of the tube (radiopaque). When viewed on an x-ray, the tube position can be confirmed by noting the location of the break in the radio-opaque line, which corresponds with the most proximal hole in the tube. Basic Equipment There is some basic equipment that you need to have at the bedside before inserting an NGT The NG tube and a packet of lubricant A large basin (in case the patient vomits) Suction tubing to connect to a canister with working suction Cup of water with straw (if not contraindicated) Placement Preparation Picking your tube size. Tubes range from 8-18 French. For adults, use 16 or 18. Avoid using a pediatric tube or anything smaller than a 16 Fr. Small tubes will just end up clogged. You can consider having one size smaller just in case you meet a lot of resistance and want to attempt a smaller caliber. Running the tube underwater. Some suggest that warm water helps by making the tube more pliable, others say cold water helps by making the tube softer. I haven't found one to be more helpful than the other. Try and see what works for you. Explain the procedure to the patient. Advise them that they might gag and vomit, and that’s ok. It’s not unexpected when you have a plastic tube through your nose and esophagus. Have the basin ready. Tell the patient their job is to swallow and keep swallowing. Tell them they might feel an urge to cough or gag, but they should try to resist that and focus on swallowing. If not contraindicated (ie aspiration risk, etc), have the patient hold a cup of water (with straw) in the hand opposite from where you're standing. Note- bowel obstruction is not a contraindication- once you place the tube, you will evacuate whatever the patient swallowed. Positioning and insertion Raise the head of the bed and have the patient upright as much as possible and have them put their chin to their chest. Lubricate the end of the tube. Place the tip of the tube just inside the nares and then advance parallel to the floor…not up. You can place your hand on the back of the patient's head to gently keep their head from flying back, which is the natural reaction to a huge piece of plastic in your nose. Keep advancing the tube while encouraging the patient to swallow. The gastroesophageal (GE) junction is usually about 40 cm from the beginning of the esophagus. The tube must get past the GE junction to effectively decompress the stomach. Post-placement Connect your tube to suction. There is a small plastic connector with tapered ends- one end connects to the suction tubing and the other end connects to the clear port. You can place to low intermittent or continuous suction- this is usually provider or institution dependent. You do NOT need a chest x-ray to confirm that an NGT is in the stomach before you place it to suction- if gastric contents are being suctioned, this confirms the position. You DO need a radiograph before instilling medication or enteral feeds. Risks of nasogastric tubes Non-functional tube- an NGT is nothing more than a straw or a garden hose- except for one thing. If you were to place a garden hose into someone's stomach and apply suction, it would just adhere to the stomach wall. This can lead to suction hickeys, which are precursors to ulcers/ bleeding. But most importantly, this will cause the tube to be ineffective. The solution is the blue ventilation port- it allows air to pass into the stomach and keeps the tube from being suctioned against the stomach wall. [this was explained above in the anatomy section- but it's so important that it deserves repetition] Naso-pulmonary tube- accidental insertion into the lung. For an awake interactive patient, this will be evident by your patient's reaction- if they have a tube in their lung, they will cough. This can even cause a pneumothorax (personally never seen it, but it's been described). In an intubated patient, it might not be noticed until x-ray for checking placement. Tube curled and tip directed upward in the esophagus. Two risks- ineffective gastric decompression and misdirected meds and feeds (back up in esophagus instead of into stomach). Aspiration- an NGT essentially stents the lower esophageal sphincter open. So if your patient is lying flat (ie asleep), you MUST ensure that the NGT is functional. Especially in the case of a bowel obstruction (patient can vomit and aspirate) or if your patient has decreased mobility and isn’t able to reposition themselves quickly to avoid aspirating. Clogged tube- risk of aspiration, inability to give meds/ enteral nutrition. The anti-reflux valve You might notice another piece of plastic in the NGT packaging. I didn't mention the anti-reflux valve, that short blue and white plastic piece that suspiciously seems to fit perfectly into the blue ventilation port. According to the manufacturer (CR Bard), this piece of plastic is supposed to be inserted at the end of the blue port and allow air entrainment to prevent the suction hickey on the stomach. It also prevents gastric contents that reflux into the port from spilling onto the sheets. HOWEVER-- the caveat is that when gastric contents are refluxing into the blue ventilation port, it's supposed to be take as an indicator that the valve must be removed and air must be flushed into the blue ventilation port. This is the reason the anti-reflux valves are despised by most surgeons- once the blue ventilation port is coated with gastric contents, if they're not flushed, the NGT is essentially converted to a straw. Yes, the port may spit up some gastric contents. However, the solution is NOT to replace the anti-reflux valve into the blue side port. Instead, the solution is to flush air into the blue port to clear it out . This is the primary task of maintaining a functional tube. You should hear faint sounds of air movement when you listen to the blue port- this means it’s working! [see video] The problem, and the reason we routinely throw these away, is the fact that they aren’t routinely removed and flushed, so they get clogged. When the blue port is clogged, the tube becomes non-functional, which can lead to gastric distension, nausea/ vomiting, and aspiration. “Minimal output” is not always reassuring with an NGT- it might be because the patient is improving, but it’s just as likely that the tube isn’t working because it isn't being maintained correctly. It's not an exaggeration to say this is a life or death issue. An elderly patient with a bowel obstruction and a non-functional tube→ gastric distention + widely patent gastroesophageal junction + laying flat at night→ aspiration, pneumonia, death. Functional tubes are also crucial for patients with foregut procedures. For example, a repair of a stomach or proximal small bowel injury can be protected by a functional nasogastric tube- this minimizes air/ fluid passing by and exerting pressure on the repair. Please note- the blue ventilation port MAY reflux and spill out gastric contents. Two solutions are to place a chux under the end or to place the syringe of a Toomey at the end (see video). Just remember- if this happens, do NOT solve the problem by inserting the anti-reflux valve. Instead, use a Toomey syringe to flush air into the blue ventilation port. CAUTION! There are caveats to this- specifically patients with foregut surgery (anywhere from the mouth through the first part of the small intestine). Patients with these clinical scenarios should have explicit instructions to the nursing staff on how the tubes are to be maintained. But it makes too much noise?! A patient who can complain about a whistling NGT is a patient who is much less likely like to aspirate and need to be intubated than a patient who doesn't have a whistling NGT. But it makes a mess?! See solutions above- chux pad or place a Toomey syringe. How to maintain a functional NGT https://video.wixstatic.com/video/3b6ff6_0ae99743e4244ce6a94c3c6bdd532efd/1080p/mp4/file.mp4 How to use the anti-reflux valve https://video.wixstatic.com/video/3b6ff6_346b85a924454960bd6c4afe6ab037d0/1080p/mp4/file.mp4 So those are the basics. If I didn’t teach you any handy tricks, hold on for one last disclosure… the final secret to my success. I've used this trick many times for patients who are overly anxious or distressed at the process of having an NGT placed. For example, the patient who has had traumatic NGT placements previously (patients have shared so many horror stories with me) or is on edge in general. Two years ago, I was managing a burn patient in the ED. While the ED physician was prepping for a nasal laryngoscopy, he showed me a trick that I still use to this day. Using CTAs (cotton tip applicators, or Q-tips if you insist on a brand name), he anesthetized the patient's nasal passage with viscous lidocaine. He covered the cotton tip of 1-2 CTAs with the clear hair-gel consistency goop (the lidocaine), and then slowly advanced this along the nasal passage. Initially, they sat right inside the opening of the nares, resting for maybe 30-45 seconds. Then the lidocaine was reapplied, and the CTAs were advanced slightly to repeat the process. This continued through the entire length of the nasal passage. In addition to the nasal anesthetic, the patient was given a medicine cup with more viscous lidocaine to swallow. *Note- warn the patient that they MIGHT get the sensation that they can't breathe. They will still be able to breathe fine, but when the upper airway is anesthetized, it alters the sensation of airflow. Previous Next

< Back More Information on Acute Care Surgery The Beginnings of Acute Care Surgery: A Paradigm Shift in Surgical Emergencies. Nelson BV and Talboy GE. Acute Care Surgery: Redefining the General Surgeon. Mo Med. Sep-Oct 2010;107(5):313-315. Acute Care Surgery from the perspective of acute care surgeons. Santry HP et al. A qualitative analysis of acute care surgery in the United States: It’s more than just “a competent surgeon with a sharp knife and a willing attitude.” Surgery. 2014 May;155(5):809–825. A detailed timeline of our history. The AAST History of Acute Care Surgery . Previous Next

< Back A Day in the Life of an Acute Care Surgeon This is a general outline of the daily routine of an Acute Care Surgeon- it does not represent a universal experience, because every facility and every team is unique. Daily schedules vary between the different services. Some facilities have a small enough volume that all three aspects are covered by one surgeon. However, for busy facilities, there can be up to 5-6 surgeons covering the different services. There can be multiple ICU teams to manage, each requiring a surgeon. In-coming trauma might require the full attention of one surgeon, while another surgeon takes care of inpatients and scheduled cases. This is not a guide for how to set up a department- it's just a peek into what we do during the day. The day typically starts with morning report, where overnight events are discussed. This can include trauma and ICU admissions, as well as operative cases. Other significant events such as patients who required transfer to a higher level of care are also discussed. Following morning report, the different services diverge to meet with their teams, either in the OR, in the ICU, or on the inpatient wards. Trauma Service Rounds [the process of evaluating and examining patients currently in the hospital] - Residents typically see the patients first, review their blood work and their x-rays, examine them and ask them pertinent questions to report to their chief resident/ attending. The attending and the chief resident/ senior resident discuss the patients and visit patients in person. There are different practice patterns, and flexibility is required. If the same team is also covering new trauma consults from the emergency department (ED), rounds might be staggered or split based on staffing and patient volume. - Patient evaluation focuses on monitoring patients in the postoperative period, including assessment of bowel function (have you passed gas or had a bowel movement?), nutrition and oral intake (hungry, eating 1/2 of meals, nauseated), pulmonary function (performing breathing exercises), pain control, activity (working with physical therapy, walking laps, breathing exercises), examining wounds, and ruling out surgical complications. Care for patients recovering from trauma also entails communication with subspecialists, such as orthopedics or neurosurgery. Procedures - Emergent operations on new admissions- exploratory laparotomy for intra-abdominal injuries (bowel injury, severe bleeding), thoracotomy for intra-thoracic injuries (severe bleeding, wound to the heart), repair of vascular injuries (bleeding from a blood vessel). - Scheduled operations for patients on the trauma service. Consultations and New Admissions - The majority of patient consults for trauma originate in the ED. Rarely, a patient who is currently admitted to the hospital may be diagnosed with an occult injury (meaning it wasn't found on initial assessment) or a patient may sustain an injury while in the hospital. Surgical Critical Care Rounds - See “What happens during Surgical Critical Care (SICU) Rounds? for details. Procedures - Tracheostomy- creation of a connection directly through the neck to the trachea (airway) to allow removal of the endotracheal tube (breathing tube) from the mouth. - Percutaneous endoscopic gastrostomy tube (PEG)- creation of a connection directly through the anterior abdominal wall into the stomach to allow feeding without requiring a tube in the patient’s nose. - Bronchoscopy- use of a small camera (think of a really skinny colonoscopy) to examine the airways of the lungs, take a specimen for culture or remove obstruction. - Central line placement- placement of a large catheter into a large vein in the neck, under the clavicle (collarbone), or in the groin. The purpose is similar to an IV (intravenous) line, which is commonly placed to provide medication, fluids, or draw blood. A central line is larger- more drips can be connected to it, it can be kept in place longer than a peripheral IV, and it can allow delivery of special medications. - Arterial line placement- similar to an IV, this is a skinny catheter, but instead of being in a vein, it’s placed in an artery. This allows continuous monitoring of blood pressure and allows repeat labs, specifically arterial blood gas to assess respiratory status Consultations and New Admissions - Scheduled or semi-scheduled surgical cases such as complex vascular procedures (aortic surgery, carotid surgery), transplant surgery (patients receive a new liver or kidney), resection of head and neck cancer with a need for management of tracheostomy, and monitoring of muscle flap. - Emergent surgical cases such as a ruptured abdominal aortic aneurysm (thinning of the wall with eventual rupture with bleeding), bowel perforation (hole in the intestine), or any of a variety of surgical catastrophes. - Severely injured trauma patients, including patients who require close monitoring of hemodynamics (low blood pressure, high heart rate) or pulmonary status (ability to take deep breaths with severe trauma to the chest), or patients with head injuries requiring intubation. - Non-ICU patients in lower acuity units that require ICU admission for deterioration in clinical status (respiratory distress, altered mental status, hemodynamic instability). Emergency General Surgery Rounds - Similar to trauma patients as above. For patients who haven’t had surgery (uncomplicated diverticulitis or small bowel obstructions secondary to adhesive disease), close monitoring for changes in clinical status is vital. Procedures - Emergent operations on new admissions- laparotomy for bowel ischemia/ perforation (decreased blood flow to the bowel or a hole in the bowel). - Scheduled operations for patients on the emergency general surgery service, for example, reversal of an ostomy. Patients who undergo emergent surgery for trauma or bowel ischemia/ perforation sometimes require creation of an opening on the skin to allow stool to pass outside into a bag. These can be “reversed”, meaning the bowel is reconnected (so the patient will now pass stool normally) and the skin opening is closed. Consultations and New Admissions - Patient consults typically originate in the ED. Everything from abdominal pain to rectal pain to massive intestinal bleeding can prompt a phone call/ page/ text message to the Emergency General Surgery service. - Patients admitted for non-surgical diseases can develop a surgical emergency during their hospital admission. This includes diagnoses that typically prompt a visit to the ED (appendicitis, cholecystitis), but there are a host of other diagnoses that are more frequent in the hospital setting, such as C. difficle colitis. In addition to daily responsibilities, there are weekly or monthly department-wide events. - Staff Meetings - Trauma Morbidity and Mortality- discuss outcomes from trauma cases. - General Surgery Morbidity and Mortality- discuss outcomes from general surgery cases. - Grand Rounds- lectures from subject matter experts on various surgical topics. Previous Next

2 Critical Care Lectures Vents .pdf Download PDF • 7.24MB Respiratory Failure .pdf Download PDF • 4.85MB Electrolyte Imbalance .pdf Download PDF • 3.88MB Acid Base Basics .pdf Download PDF • 1.14MB Kidney Injury .pdf Download PDF • 8.05MB Hemodynamics .pdf Download PDF • 9.86MB Heart POCUS .pdf Download PDF • 55.03MB Nutrition .pdf Download PDF • 3.52MB Ultrasound .pdf Download PDF • 84.19MB Blood .pdf Download PDF • 4.92MB Pain Delirium Agitation .pdf Download PDF • 16.05MB

12 Barking Up The Wrong Tree The Surprising Science Behind Why Everything You Know About Success Is (Mostly) Wrong - Good grades in school- likely to be a "rule follower", and less likely to be innovative, think outside the box. - Introverts are more likely to be experts, extroverts tend to make more money (socializing, "networking"). We should look at "networking" as "making friends". This disputes the "nice guys finish last"... - Match your strengths/ passion/ skill to the right context. - Flattery (sucking up to the boss) can work in the short term, but in the end, when people see their colleagues/ neighbors/ etc cutting corners and reaping benefits, this leads to a general collapse into distrust and rule-breaking. - IQ only matters up to a certain point, but then it yields diminishing returns. After that, hard work is what makes the difference. - Tradeoffs- every hour that you spend working is an hour spent away from other things (family, hobbies). In this age of constant accessibility, you have to decide to leave work behind (ignore your emails when you're at your kid's ball game). - Gratitude in relationships- on their deathbed, people regret working too much and not saying thanks to the people in their life. - Some helpful things I learned...please note that tact and delivery matter and these are not appropriate in every scenario. - When someone is getting upset or frustrated and starts yelling, "Please speak more slowly, I want to help." Or try, "What would you like me to do?" - When someone is upset, validate/ name their feeling. "Sounds like you’re angry/ hurt/ frustrated." If you're wrong, give them the chance to correct you. - Gratitude to relationships. Previous Next

How not to lose everything < Back Organizational Hacks How not to lose everything All my life, I've been forgetful and easily distractible. I joke that I'd lose my head if it wasn't attached. This challenge is part of my ADHD, and I can't overcome it with sheer willpower. The list of things that I've lost over the years is staggering- homework (oh so much homework…it was usually stuffed somewhere in my locker), clothing, books, charging cables, water bottles, earrings (what am I supposed to do with the remaining single earrings?) and a white polar bear stuffed animal (he was left in a hotel room on a road trip as a child). I'm looking forward to learning where all my things went when I die and go to heaven. So if this can’t be overcome with sheer willpower, how can you adapt? Check out these techniques or tools to see if you find something that would be useful for yourself. Information * Create a tool for yourself for storing the data you need to be able to access reliably. This website is full of high-yield medical information that is rapidly accessible, but a website is a labor-intensive option. You don’t have to invest time and money into a website. Here are some other options (check out this post for more details ): - Invest in a planner . Electronic options that sync are useful because they minimize the need to re-write things in multiple places. Another option that I prefer is one notebook that keeps all my events in one place, along with my collection of lists and reminders. - Write everything down. My planner is my note repository. The Apple Notes application is also useful because it can sync across multiple Apple devices. At home or work, dry-erase poster paper can be used to take notes, keep track of schedules and provide reminders for long-term tasks and due dates. - Trello is a user-friendly free application with multiple functions, including the creation of lists, storage of documents, and the ability to share notes or documents among team members/ family members. Items * Magnet strips . Using magnetic sheets the size of business cards, cut pieces and strips to put on various items and stick them to the fridge or other magnetic surface of your choice. For example, if you use dry-erase poster paper on the refrigerator, thin strips of magnet can be cut to fit along the length of several dry eraser markers, so they're always on hand when you have something to jot on the whiteboard * Keys on a hook by the front door. 3M hooks work well, but the hook design isn’t as important as placement, ideally not in direct sight of the door. You can also hang your work ID badge or any other small items you need when you leave the house. * Keep track of all your cords with these tie wraps . Inexpensive and sturdy. I didn’t think there was any way I’d use 50- I figured maybe a couple, just for a handful of my charging cables that always end up in a jumble. But trust me, you'll find plenty of uses for them! Finances and Important Documents * Save receipts for anything valuable. If it was purchased online, download the digital receipt. Use the "Create PDF" function to combine receipts. For paper receipts, an envelope in a drawer is a simple option. Every so often, review the receipts, and if there is anything you don't need anymore, toss it. * Paper shredder . Anything with personal information should be destroyed before being thrown away. This is technically not about avoiding losing something, but it’s an important task so it is included here. * Taxes. Instead of waiting until tax season, keep track of key documents and expenses throughout the year. A running spreadsheet of business expenses, donations, etc, can avoid the frantic search in March. * Metal rack of hanging file folders. Each folder has a different label, including taxes (donation receipts, investment statements, etc), moves (signed leases, welcome packet with key information, etc), and business (bank paperwork, original EIN and registration forms, deposited checks). Previous Next

11 Made to Stick Why Some Ideas Survive and Others Die 6 Principles of Sticky Ideas - Simple - Unexpected- crash at the end of the car commercial. - Concrete - Credibility- the ability to test. Before you vote ask yourself if you are better off today than you were 4 years ago- Reagan. - Emotions - Stories Curse of knowledge- we find it hard to imagine not knowing what we have learned. Can’t imagine what it’s like not to understand a certain concept that we accept as fact Previous Next

Medical Literature Evidence-Based Medicine After you have established a firm foundation of the basics of your chosen specialty, you're ready to develop regular habits to stay up to date on the newest research. Evidence-based medicine is the basis of high-quality patient care, but it can seem overwhelming to try to keep up with the ever-growing body of research. There are countless journals, and it would be time-consuming to search them regularly. So how does one go about navigating the vast ocean of available data? Registering for email alerts is a simple way to get notified when there are new publications. With a quick skim through the article titles to see if anything is relevant, followed by a review of the abstract/ article itself, you can be on the cutting edge of the latest information in your field. Several require individual registration, but it's a very simple and quick process. Many journals require a subscription, often available through your medical school or hospital library. If you are military, you have access to AMEDD Virtual Library (abundant medical resource collection). Thankfully, three publishers (LWW Wolters Kluwer , Springer and Elsevier ) have centralized their journals, so you can quickly subscribe to several journals [these journals are designated by L, S or E]. Medicine and Critical Care Journal of the Ameri can Medical Association New England Journal of Medicine Intensive Care Medicine Critical Care Medicine (L) Current Opinions in Critical Care (L) Journal of Intensive Care (S) Critical Care (S) Journal of Critical Care (E) Critical Care Clinics (E) Surgery World Journal of Surgery World Journal of GI Surgery JAMA Surgery J Gastrointestinal Surg Advances in Surgery Annals of Surgery (L) Annals of Surgery Open (L) BMC Surgery (S) Surgery (E) American Journal of Surgery (E) Journal of the American College of Surgeons (E) Surgical Clinics of North America (E) Advances in Surgery (E) Trauma and Emergency Surgery European J Trauma and Emergency Surgery Trauma Surgery and Acute Care Open Journal of Trauma and Acute Care Surgery (L) World Journal of Emergency Surgery (S) World Neurosurgery (E) Other Specialities Journal of Neurotrauma World Journal of Cardiology JAMA Cardiology JAMA Neurology JAMA Network Open Anesthesia and Analgesia (L) Current Opinion in Anesthesiology (L) Current Opinion in Clinical Nutrition (L) Current Opinion in Infectious Diseases (L) Current Opinion in Neurology (L) Diseases of the Colon and Rectum (L) Journal of the American College of Cardiology (E)

Surgery trainee education. Trauma surgeon. Acute Care Surgery. Collaboration Interested in being a guest contributor? Any suggestions and contributions will be promptly reviewed and added to the appropriate page/ subpage. The contributor will be noted on the website- you can choose if you want your name or Twitter handle or whatever other identification you would like (or none at all if you would like to be anonymous). Content currently under development. Note- this list is NOT all-inclusive. Database of clinical vignettes in key topics of trauma, critical care and emergency general surgery. Focused on more complex scenarios (ie not run-of-the-mill appendicitis)! Please check out the vignettes I currently have to get an idea of what I’m trying to create- and reach out with any suggestions or cases. Literature reviews - deep dives, high-yield articles, etc Procedural or skill tutorials (pre-peritoneal packing, using the ultrasound in critical care, reading a chest x-ray). Each tutorial is followed by a list of primary sources, encouraging readers to pull information from multiple references. If there is any particular procedure or skill that you would like to create a tutorial for, or something that is currently on the website that you would like to enhance (for example, more advanced ultrasound techniques or ventilator settings), please feel free to reach out with suggestions! There is a wide array of other content that you can add to as well. Note templates Recommendations on networking opportunities Recommendations on social media accounts to follow Educational resources (textbooks, journal articles, training courses, web based open access medical education) Please send me an email (form at the bottom of the page) or contact me on Twitter @doc_on_the_run if you have any questions or want to submit something.

Surgery trainee education. Trauma surgeon. Acute Care Surgery. FAQs Why did you make this website? Over these years of learning about the practice of surgery, I've also learned a lot about myself. I am not an expert, and I did not follow a typical pathway- but I have some knowledge and resources to share. As I transition into my new Acute Care Surgeon role after 17 years in training, I'm pausing to share my experience, tips for success, and random nuggets of wisdom. This will be a work in progress, and I look forward to seeing how it evolves. My goal is to share my experience and knowledge in the hopes of helping those who desire to follow this path. But why do we need another medical education website? There are so many good resources already... There are endless ways to explain clinical concepts- pictures, text, analogies, clinical cases, podcast discussions of cases or principles, review articles, etc. There are also different learning styles. When I was trying to grasp advanced ventilator management, I read basic critical care textbooks, a book dedicated solely to ventilator management, and various websites and journal articles. This website is another way to interact with the information. Hopefully you will understand some of the concepts in a new way that helps you remember and apply them in clinical scenarios. In addition, I have also tried to create a comprehensive collection of all the useful resources I know, like apps and open access medical education resources (websites, clinical guidelines, etc) in one place for trainees to What does Doc on the Run mean? The summer before my last year of medical school was the start of my running career. My focus was enjoying the outdoors, not pace or distance. During my residency, I met someone who helped me refine my running. I started timing myself, training, and racing. Within a year or two, I pushed through personal barriers to become a "runner." My first half marathon was on Thanksgiving in my third year of surgical residency. I am at the end of my formal training, I am now an Acute Care Surgeon. As a surgeon, there are numerous factors that I can't control. It's fast-paced, demanding, and dynamic. I enjoy the organized chaos and high-stakes cases. Running is key to my work-life balance. Unlike in the operating room or the trauma bay, I have control over most aspects of my runs- pace, distance, route, and thoughts. It's not chaotic- it's basically the polar opposite of my work. During the day, my mind is going a million miles an hour. When I run, everything becomes clearer- I can solve problems, mull over ideas, or process dilemmas. And perhaps the most concrete impact is the runner's high that I enjoy after finishing. I have continued to run 10Ks, 10 milers, and the occasional 5K or 15K. I have learned more about the science of running (HR training zones, different paces for tempo/ interval/ long runs/ short runs) and I've learned how to adapt training schedules to fit my life. Unfortunately, I have suffered my share of injuries, including most recently nerve impingement in my foot. While I may have scaled back, running will always be part of my identity. Did you really build this website yourself? Yes, I did. No, I didn't do all the intricate coding by myself. But I did design, format, and create the content. So are you a computer/ technology guru? Whatever I know about technology, I learned from my brother and from spending many hours researching problems online. While my parents might consider me an expert, I literally just search online to solve most issues. When I get to the end of the internet and still haven't found the solution, my next step is Apple tech support (obviously only if the problem is with my iPhone or Mac). What did you learn while making this website? - Formatting the working space on a website - URL redirect - Domains and subdomains - Search engine optimization (SEO) - Establishing custom domains - Which text/ background colors are easiest to read - Anchors If you weren't an Acute Care Surgeon, what would you do? I'd be a chef. I love cooking! Is there anything that is overwhelmingly gross in your job? I have had almost every body fluid on me- stool, urine, blood, etc. So very little grosses me out. But I can't stand oral or nasal secretions (aka saliva, slobber, snot, etc.).

< Back Ultrasound: Cardiac Exam Purpose: identify possible causes of hemodynamic instability, respiratory distress, assessment of volume status. Probe The phased array can be used for the entire exam. The curvilinear can also be used for the subxiphoid and IVC views. Views There are 4 basic views, including the parasternal long axis, parasternal short axis, the apical four chamber and the subcostal view. Additionally, the inferior vena cava can be visualized. Cardiac ultrasound is more challenging to learn than most other ultrasound studies, because probe usage (position, angle, rotation, translation, etc) have drastic impact on visualization. It’s necessary to understand what is shown in each view, so take time reviewing these so you can have a better appreciation for what you are seeing when you perform a study on a real patient. One recommendation, if it is difficult to visualize the heart, moving the patient into the lateral decubitus with their left side down can significantly improve visualization as the heart is closer to the chest wall in this position. For video and pictorial explanations of the views, please refer to these sites. Basic Cardiac Views, #1 Basic Cardiac Views, #2 Findings Gross abnormalities- decreased ventricular function, arrhythmias Profound hypovolemia Small hyperdynamic left ventricle with end-systolic collapse Inferior vena cava- assess volume status, either static measurement of diameter or calculation of collapsibility (>50% correlates with volume responsiveness). Respiratory variation (collapsibility/distensibility index). Takotsubo cardiomyopathy Akinesia of the apical and mid-ventricular segment, hypercontractile basal segments. Apical sparing (dilated). Acute cor pulmonale Respiratory disorder→ pulmonary hypertension→ right heart failure. Dilated right heart. Cardiac tamponade Effusion with end-diastolic collapse of the right atrium, effusion in front of the aorta Pulmonary embolism Free-floating thrombus in the right ventricle or pulmonary artery; right ventricular dilation/ systolic dysfunction; septal bowing into the left ventricle; dilated IVC without inspiratory collapse. Most sensitive/ specific indirect sign- right ventricular apical sparing (McConnell's sign). References Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography Previous Next