Dr. Baker – The Lecture Lecture (Tips for Giving Presentations)

• If using powerpoint:
  • avoid wordy slides, rather use simple slides that are visually appealing that supplement content
  • when importing images, utilize websites such as Pixabay to access free high quality images
  • if using videos, do not paste link onto slide. Instead, use software such as capto to put videos directly onto slide.
  • Try creating a story board before making slides
• Prior to presenting, record yourself
• Stand up, move around
• Plan to end early to allow for questions
• See Dr. Baker’s post below for more resources

Dr. Dan Grace – Post-Intubation Desaturation (Room 9 Follow up)

• Differential for the alarming vent/deterioration after intubation: think DOPE
• Displacement/dislodgement –see if tube has migrated, check EtC02, obtain chest xray, video scope verification
• Obstruction – think mucous plug, vent tube kink, make sure patient not biting down, try passing a suction catheter through tube
• Pneumothorax – auscultation, US, chest xray
• Equipment failure – disconnect from vent and bag, If it is “too easy” to ventilate, suggests air leak or dislodgement, if too difficult, think obstruction.
• Other things to consider: chest wall rigidity from fentanyl → give Narcan and breath stacking →disconnect vent and apply pressure to chest

Cordis and Subclavian Central Line Sim– Dr. Webb and Davenport

• Cordis: aka sheath introducer, preferred catheter in hemorrhagic shock resuscitation, provides faster flow rate given large diameter and short length
• Also used for transvenous pacing in unstable bradycardia
• The steps differ from those of a triple-lumen central line, in that the dilator and catheter are inserted together into the vessel.
• Subclavian Central Venous Access – Ideal for trauma patients with pelvic and intra-abdominal injuries and c-collar
• Contraindications -significant trauma or injury to the clavicle or first rib. And If there is concern for coagulopathy or thrombocytopenia, arterial injury is dangerous, as this site is non-compressible
•  Locate a spot 1-2cm below the clavicle where the proximal 1/3 and distal 2/3 of the clavicle meet. The needle should travel parallel to the floor towards the suprasternal notch. Use the contralateral hand to provide downward traction on the needle tip to facilitate clearance of the inferior edge of the clavicle.

Dr. Adam Ross – Percutaneous Pigtail Catheters for Spontaneous Pneumothorax

• essentially 14 Fr chest tubes with curved tip that is inserted using Seldinger technique and is less traumatic/painful to patient than traditional chest tubes
• important to secure the ipsilateral arm above the patient’s head using soft restraints
• two options for insertion: target at or above the 4th/5th intercostal space along the anterior axillary line as in traditional chest tubes or can use an anterior approach (2nd intercostal space, midclavicular line)
• can attach to either Heimlich valve or chest drainage system to suction post-instertion
• guidelines recommend against prophylactic antibiotics except in cases of trauma, where there are conflicting data.
• See Dr. Ross’s post below for resources