Transvenous Pacemaker Placement - Part 1: The Walkthrough

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Transvenous Pacemaker Placement - Part 1: The Walkthrough

If you are interested in seeing the placement of a Transvenous Pacemaker after reading this post check out Part 2 (Procedural Slide Set) and Part 3 (the first person view of the procedure)

Reasons to Pace in the First Place

Hemodynamically unstable+

1. Sinus Bradycardia - seen in 17% of acute MI patients (especially inferior or anterior wall MI) [1,2]

2. AV Block - may be due to ischemia (15-19% of all Acute MI) [2,3]

3. Drug Overdose - with the goal of maintaining adequate hemodynamics while your medical therapy/dialysis has an opportunity to work.

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Lessons in Transport - Post-Intubation Checklists

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Lessons in Transport - Post-Intubation Checklists

Post-Intubation Checklists

Making a checklist can help cognitively unload you in high stakes and high pressure situations.  Post-intubation consider the following important points:

Protecting the Tube

  • Continuous wave form ETCO2... each and every time

  • Secure Endotracheal Tube at the appropriate depth (See LIT week 6)

  • Analgesia and Sedation

  • Restraints... Do you know where the soft restraints are stored?

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Snake Envenomations Podcast

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Snake Envenomations Podcast

This podcast, our first, focuses on the care of patients who have been bitten by snakes, primarily North American Crotalids.  The discussion revolves around a case of envenomation we ran recently during a Grand Rounds simulation.  In the podcast, we focus on clinical assessment of the bites including determining the severity of local and systemic symptoms, the initial care and management of envenomations, and some of the complications associated with administration of antivenin.

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The Basics of Evidence Based Clinical Practice - Asking Good Questions

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The Basics of Evidence Based Clinical Practice - Asking Good Questions

Evidence Based Clinical Practice (EBCP) is a way to bring the sometimes obtuse world of evidence based medicine to the bedside.  Instead of getting lost in p-values, ANOVA, student t-tests, multivariate logistic regressions, EBCP approaches evidence based medicine always through the lens of a patient under a clinician's care.  It is a process that starts with asking carefully crafted questions and efficiently searching for answers to those questions.  Subsequent analysis of the articles found in the clinician's searching seeks to answer: are the results valid? what are the results? and finally, how can one apply the results to patient care?

In this short video, we go through the crucial initial step of the process: asking a question.  Success in asking answerable, well crafted questions begets successful search strategies.

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