Episode 34: Oral Board Prep with Drs. Tran and Beaudry

In this episode, episode 34, I welcome Dr. Tina Tran and Dr. Steve Beaudry to the show to give you two run throughs of an oral board stem.  First Dr. Tran demonstrates some common errors and then Dr. Beaudry demonstrates an example of the “right way” to do it.  We then mention some learning points from the stem itself, a pregnant woman at term with HOCM.

7 Replies to “Episode 34: Oral Board Prep with Drs. Tran and Beaudry”

  1. Woah! I totally FORGOT that an ECG is part of the standard ASA monitors! I’m sure it was just momentary nervousness 🙂

  2. Hi Dr. Wolpaw. I really enjoyed listening to this episode. I am currently a PGY2 in pediatrics, though I am transferring to anesthesiology. I noted a few of the neonatal resuscitation steps that Dr. Beaudry recommends in the “right way” portion of this episode do not reflect the recommendations of the most recent set of guidelines from the Neonatal Resuscitation Program (NRP). In particular, it is no longer recommended to routinely suction the trachea of babies with concern for meconium aspiration. Additionally, the recommendations are to perform at least 30 seconds of effective PPV (typically via BVM) as the initial resuscitation step before attempting suctioning, intubation, or compressions. Dr. Beaudry does mention giving oxygen via blow-by or CPAP prior to suctioning/intubating, but I thought it was important to emphasize attempted effective PPV prior to additional resuscitation steps. Below I’ve included a link to the 2015 AAP article summarizing the most recent recommendations and have quoted below the portion pertinent to this scenario. Thank you!

    http://pediatrics.aappublications.org/content/136/Supplement_2/S196

    “However, if the infant born through meconium-stained amniotic fluid presents with poor muscle tone and inadequate breathing efforts, the initial steps of resuscitation should be completed under the radiant warmer. PPV should be initiated if the infant is not breathing or the heart rate is less than 100/min after the initial steps are completed.

    Routine intubation for tracheal suction in this setting is not suggested, because there is insufficient evidence to continue recommending this practice (Class IIb, LOE C-LD). In making this suggested change, greater value has been placed on harm avoidance (ie, delays in providing bag-mask ventilation, potential harm of the procedure) over the unknown benefit of the intervention of routine tracheal intubation and suctioning. Therefore, emphasis should be made on initiating ventilation within the first minute of life in nonbreathing or ineffectively breathing infants.”

    1. Meghan,

      Thanks so much for the excellent comments and for correcting our mistake! Best of luck with the rest of your pediatric training and your transition to anesthesia.

      Best,
      Jed

    1. I agree! Really enjoyed the episode and helpful that you showed the right and wrong way to approach oral boards especially with them coming up soon!

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