In this 296th episode I welcome Dr. Mike Essandoh to do another master clinician episode. We discuss Dr. Essandoh’s tips for being successful clinically, in research, in leadership, in innovation and in technology.
CME: Link
Random Recs:
In this 295th episode I discuss the kinds of statistical questions that come up on board exams and what you need to know to get them right.
NOTE: In this episode I explained the p value in a very simplified way that isn’t strictly accurate from a statistical standpoint. A p value of 0.03 in a study that, for example, compares a medication to a placebo, actually only means that in the statistical model used, there was a 3% chance that the results that were seen would have been observed even if there was no difference between placebo and treatment. Therefore, given that it was unlikely to see these results, we conclude that there actually is a difference between treatment and placebo.
CME: Link
References:
Miller’s Anesthesia, 8th edition, El Sevier.
In this 294th episode I play the live recording from my interview with Dr. Valerie Arkoosh who is the Secretary of Human Services for the State of Pennsylvania.
CME: Link
In this 293rd episode I interview Dr. Keith Baker in another master clinician episode. Dr. Baker is a professor at Harvard Medical School, the Vice Chair for Education at MGH and was formerly the residency program director there for 15 years.
CME: Link
Random Recs:
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:
