In this episode I discuss hyperoxia and review the evidence in regards to the damage it can cause in patients with a wide variety of illnesses.
CME: https://cmefy.com/moment?id=t4l2-JC
Slides to accompany the episode can be found here: hyperoxia slides
In this episode I review the common IV agents used in anesthesia excluding opioids. I cover Propofol, Barbiturates, Benzodiazepines, Ketamine, Etomidate and Dexmedetomidine.
CME: https://cmefy.com/moment?id=txf7gHH
NOTE: There is an error in the audio recording regarding the dosing units for dexmedetomidine. I say on the podcast that the dosing units are mcg/kg/min which is INCORRECT. The correct dosing units are mcg/kg/HOUR. I have corrected this in the accompanying slides. Thanks to Melanie Browder for picking this up!
Good luck to the recent graduates taking their written board exam on July 29th!
Slides to go along with the podcast are here: IV induction agents slides
In this episode I review the basic medication setup for the operating room including premedication, induction, neuromuscular blockade, antibiotics, reversal and antiemetics. I discuss weight based dosing and comment on a few alternatives to consider once you have the basic setup down. This episode should be useful for new CA-1s getting started in the OR but I would also like to ask senior residents to comment on what their basic setup is and how it may differ from what I’ve mentioned here.
CME: https://cmefy.com/moment?id=nG8Bz4H
Here is a list of the medications I discuss: Basic med setup w dosing
This is the second and final episode dealing with the management of respiratory diseases. In the first episode I covered the initial evaluation and preop preparation. In this episode I cover intraoperative management, post-operative management, special issues related to one lung ventilation and special issues related to total pneumonectomy.
CME: https://cmefy.com/moment?id=25jRxL5
Slides to go along with the episode can be downloaded here: Management of Respiratory Diseases part 2 slides
This is the first of a two part series of episodes on the management of patients with respiratory disease. In this, part 1, I cover the preoperative evaluation, history and physical exam, and the preoperative planning and optimization of the patient. This includes the key board topics of smoking cessation and cardiac risk assessment.
CME: https://cmefy.com/moment?id=nH8vxYC
Here are the slides that go along with this episode: Management of Respiratory Diseases slides part 1
In this episode I first announce the new ACCRAC website here at ACCRAC.com. Big thanks to Bryan Mariscalchi for his help setting it up. I also mention the problem the last two episodes had with only playing out of one ear on earphones. I hope I’ve cleared that problem up. I mention a fantastic book called “Missing Microbes” by Martin Blaser, here is a link to the NY Times review: Missing Microbes
CME: https://cmefy.com/moment?id=BcKWKWm
The bulk of the episode is a description of the paraglossal approach to endotracheal incubation. Here is a youtube link to a video of the technique: Paraglossal video
Have you ever used this technique? Do you like it?
In this episode I review restrictive lung disease. This is meant to be a companion episode to Episode 4 which covered obstructive lung disease.
CME: https://cmefy.com/moment?id=39_hgzN
I cover the following topics:
-Definition and diagnosis of restrictive lung disease
-Spirometry
-Extra-pulmonary causes (neurologic, musculoskeletal, pleural/mediastinal)
-Parenchymal causes
-Infant RDS
-ARDS
-Pulmonary Fibrosis
The accompanying slides can be downloaded here: Restrictive Lung Disease slides
Remember to join the mailing list by clicking on the link at the top right on the website. You can leave comments on the website or email accrac@accrac.com or accracpodcast@gmail.com.
In this episode I mention the new ACCRAC mailing list which you can sign up for with the link right below the show description on the website accrac.libsyn.com. You can also post comments on the website and email questions to accrac@accrac.com or accracpodcast@gmail.com. I also highlight Rob MacSweeney’s fantastic critical care site called criticalcarereviews.com and his newsletter which you can subscribe to on his site. The weekly newsletter includes the week’s top trials and papers in critical care.
CME: https://cmefy.com/moment?id=j8C2-wW
The rest of the episode is a high yield board review of the ABA topic of obstructive lung disease. I cover the following topics:
#Upper airway obstruction including extra thoracic and intra thoracic obstruction
#Flow volume loops and how to interpret them
#Lower airway and parenchymal obstruction including
#COPD
#Asthma
#Cystic Fibrosis and bronchiectasis
#Mediastinal masses
The slides to go along with this episode can be downloaded here: Obstructive_Lung_Disease_slides
And the article that I mentioned about full helmet Bipap can be found here:
There are a few announcements I wanted to make including:
Check out pedsanesthesia.net. Dr. Robert Greenberg, a pediatric anesthesiologist here at Johns Hopkins runs it and it has lots of great information and topics in pediatric anesthesiology.
CME: https://cmefy.com/moment?id=VZ7M3tT
If you have suggestions for a better website than this one please let me know!
If you know a good way to set up an email list serve for these kinds of announcements please let me know that as well.
And, finally, I address a surgeon’s comment to one of our residents that you should always use 100% fio2 when ventilating one lung during a thoracic case. Listen to the podcast for details but the bottom line is you should NOT use 100% oxygen unless you have to in order to prevent hypoxia.
Here is a link to a great review on this topics published last year in Critical Care: https://www.ncbi.nlm.nih.gov/pubmed/26278383
In this episode I review the topics of intraoperative hypothermia and temperature regulation. Lots of good board review topics and some sample board review questions. The slides are available here: Temperature Regulation Slides
CME: https://cmefy.com/moment?id=2MHTwZM
You can leave comments here or email accracpodcast@gmail.com.
Topics covered:
Hypothermia: Etiology, Prevention, Treatment, Complications
Effect of Drugs/Anesthesia on Temperature regulation
Heat Loss and mechanisms
Temperature Regulating centers
Heat Production and Conservation
Body Temperature measurement sites and gradients
Non MH hyperthermia syndromes
Fever facts
NOTE: I updated this episode a couple of days after it was first published. One of our residents pointed out that I had incorrectly stated that hypothermia increases MAC when it actually lowers it. I have now corrected the episode to reflect that and to clarify the role of increasing the temperature of the operating room itself.
