Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 300: Reflections and Tips and Tricks with Dr. Stahl interviewing Dr. Wolpaw
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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.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 297: Keywords part 29: PE and Parathyroid
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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.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 288: Keywords Part 28: ECT and Transfusion Reactions with Tym Kajstura
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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.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 286: Central Lines with Elisa Walsh
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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.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 284: Perioperative Hand-offs with Jamie Sparling and Aalok Agarwala
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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.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 280: Keywords Part 27: Shock States and A Tribute to Dr. Gillian Isaac
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In this 280th episode I share the shocking and tragic news that Dr. Gillian Isaac died suddenly and unexpectedly a few weeks ago. She was an incredible human being, teacher, doctor, wife and mother. She will be missed more than I can say by more people than we can possibly count. I know that she would want us to continue with these keyword episodes that she loved doing and so I am going to try. I know they will never be the same, but they will be dedicated to her memory. Today I address the keyword of shock states and discuss the 4 types of shock and how they may be covered on your exams. I miss you, Gillian.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 274: Anaphylaxis and Other Perioperative Hypersensitivity Reactions with Jonathan Kay
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In this 274th episode I welcome Dr. Jonathan Kay (JK) to the show to discuss perioperative hypersensitivity reactions. We focus on the diagnosis and treatment of anaphylaxis and also discuss antibiotic allergies and how to deal with the ever present allergy to PCN.
Dr. Kay is available for virtual consultations and to give Grand Rounds talks on this topic anytime. You can reach him at jkay11@mac.com.