In this 306th episode I welcome Dr. Beth Wilson to the show to discuss Early Allograft Dysfunction (EAD) after liver transplantation and what anesthesiologists can do to prevent or mitigate it.
CME: Link
Random Recs:
In this 304th episode I welcome Drs. Meyhoff and Breteler to the show to discuss continuous vital sign monitoring for patients on the floor and at home after surgery. We talk about the pros and cons of this kind of monitoring, what the future holds, and how Anesthesiologist and Intensivists can play an important role. Dr. Meyhoff is the founder of the WARD Clinical Support System which is awaiting FDA clearance.
CME: Link
Random Recs:
In this 303rd episode I welcome Drs. Stahl and Saddawi-Konefka to the show to discuss how busy people can start using AI tools in their everyday lives to save time and make things easier.
CME: Link
Random Recs:
In this 300th episode, at the request of our listeners, I ask Dr. Dave Stahl to take the host’s chair and interview me. We discuss some reflections on 8 years and 300 episodes of ACCRAC and some clinical and life based tips and tricks that I have picked up over the years.
CME: Link
Random Recs:
Flex-Flex Intubation: https://doi.org/10.1016/S1043-1810(98)80003-1
In this 297th episode I welcome Dr. Tym Kajstura back to the show for another ABA Keyword episode. We cover high yield topics of PE and Hyper and Hypoparathyroidism.
CME: Link
Random Recs:
References:
Anesthesiahub.com
OpenAnesthesia.org
Barash, P. Clinical Anesthesia 8th edition. Walters Kluwer.
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 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 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 JL********@*********rd.edu
Dr. Agarwala’s email is AA*******@*********rd.edu
The Multicenter Handoff Collaborative is on X @periophandoffs and website is handoffs.org
Random Recs:
In this 281st episode I welcome our SICU pharmacist, Traci Grucz, to the show to discuss glycemic management of critical ill patients.
Traci is on X at @tmgrucz
CME: Link
Random Recs:
