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 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 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:
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.
CME: Link
References:
Anesthesiahub.com
OpenAnesthesia.org
In this 278th episode I discuss what you need to know about liver physiology for your exams.
CME: Link
Random recs:
Regional Anesthesiology and Acute Pain Medicine Youtube Channel
References: Miller’s Anesthesia 8th edition, El Sevier
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.
CME: Link
Random Recs
This special 266th episode was recorded before a live audience at the Anesthesiology 2023 Annual Meeting in San Francisco. I interviewed Dr. Deb Culley about post-op delirium and Dr. John Eichorn about the history and future of patient monitoring.
CME: Link
Random Rec:
In this 264th episode I welcome Dr. Mimi Wynn to the show to discuss anesthesia for TAAA repair. We discuss preoperative concerns, intraoperative management, postoperative concerns especially spinal cord ischemia, and how to reduce the risk of that dreaded complication.
CME: Link
Random Recs:
