In this 292nd episode I play the audio from the live episode we did at the Northeast Anesthesia Resident Conference in Boston on 9/14/24. I interviewed Aalok Agarwala, Associate CMO at MGH, Joanne Conroy, President and CEO of Dartmouth Health, and Sunil “Sunny” Eappen, CEO of UVM Health. We discuss their careers, and their tips for aspiring leaders in healthcare.
In this 290th episode I welcome Drs. Finan and Ehrenkranz to the show to discuss the data on using psilocybin and other psychedelics for treating chronic pain and depression as well as their ongoing study on the topic.
CME: Link
Random Recs:
In this 290th episode I welcome Dr. Mike Grant back to the show to discuss post-op care for patients having cardiac surgery.
CME: Link
Random Recs:
In this new series on master clinicians I will be interviewing people who have been identified by their colleagues and trainees as “master clinicians”, people who others go to for advice and clinical guidance, people who are masters of their craft. In this episode I welcome Dr. Dave Berman back to the show to discuss how he has, in a relatively short time, become one of these master clinicians and what advice he has for all of you.
CME: Link
Random Recs:
Trader Joes Cinnamon Dragons
In this 288th episode I welcome Dr. Tym Kajstura to the show to do an ABA keyword episode. We discuss considerations for electroconvulsive therapy (ECT) and transfusion reactions.
Big thanks to Dr. Pranav Shah, a cardiac anesthesiologist/intensivist at VCU and one of their physician informaticists. He provided some great detail on how blood preparation works:
Cross-matching isn’t a physical process majority of time, and hasn’t been for about 20 years per our Blood Bank. “Electronic Crossmatch” is the norm.
Details:
*A patient needs “two” samples within a certain time-period.
-time-period is institutional, but commonly (for inpatients) about 3 days.
-one sample is “historical” for ABO/Rh status
-one sample is “current” for ABO/Rh Status “confirmation” (to reduce the likelihood of a single clerical error for leading to harm)
Current specimens are “Type and Screen” where one part is above (ABO/Rh)..
Second part is screening … for a large library of common antibodies. (Kell, Duffy etc.)
*Scenario A (common):
Conditions:
patient has two samples,
antibody screen is negative (current and PAST)
patient isn’t “special” (e.g. sickle cell where special blood rules exist)
In this very common scenario (majority of patients), the cross-match is VIRTUAL.
When you request a unit of pRBC, Blood Bank “says” the patient
“has two samples” + “samples give same ABO / Rh” + “no antibodies ever” + “not quirky Blood Bank subpopulation”…
.. then they run an “Electronic” crossmatch. Fundamentally just hands you a blood off the shelf that meets the criteria. There is no vial mixing.
Therefore, in this scenario, Blood is available VERY quickly!
*Scenario B:
1) patient has two samples
2) patient has antibody screen that is positive.
Now, blood bank doesn’t just do an electronic screen. They do use that to identify a high-probability match unit (in my words). But they need to do a physical cross-match (my understanding).
Depending on the frequency of the antigen that the antibody is to (e.g. say Anti-Starwars antibody. But StarWars antigen is present in 96% of folks in US), the cross-match may take DAYS.
CME: Link
Random Recs:
References:
Anesthesiahub.com
OpenAnesthesia.org
Barash, P. Clinical Anesthesia 8th edition. Walters Kluwer.
In this 287th episode I welcome Drs. Kyle Sanchez and Dan Ellis to the show to discuss the perioperative care of transgender and gender-diverse Patients. We discuss terminology, different medications and surgeries that you may see, preop, intraop and postop considerations.
CME: Link
Random Recs:
In this 286th episode I welcome Dr. Elisa Walsh to the show to discuss Central Venous Catheters. We discuss where they can be placed, what can go wrong, how to teach people how to place them safely and how to confirm placement.
CME: Link
Dr. Walsh is on X @ElisaCWalsh
Random Recs:
In this 284th episode I welcome Drs. Sparling and Agarwala to the show to discuss the importance of, and evidence for, perioperative hand-offs. We discuss what hand-offs are, what kinds of handoffs occur during the perioperative period, why they matter, how they can cause harm when poorly done, and how implementing good hand-offs can reduce harm.
CME: Link
Dr. Sparling is on X @jamiesparling and her email is JLSparling@mgh.harvard.edu
Dr. Agarwala’s email is AAgarwala@mgh.harvard.edu
The Multicenter Handoff Collaborative is on X @periophandoffs and website is handoffs.org
Random Recs:
In this 283rd episode I introduce a new podcast from University of Cincinnati Department of Anesthesiology hosted by Dr. John Crowe. This episode is about Primate Anesthesia and John interviews one of his colleagues who does some anesthesia for primates at the local zoo. I think they’re doing great work on this podcast and look forward to more episodes to come!
CME: Link
Check out Style Points at https://www.stylepointspodcast.com and contact them at StylePointsPodcast@gmail.com
