Worth Losing Friends Over — Doctor Enough

Today, I hurt. I’ve been talking about this pandemic for well over a month. My friend list is dwindling, and there are several people I don’t plan on catching up with when this pandemic is over—and now entire communities. America’s privilege is showing, in a terrible way. Rural areas that have been luckily unaffected are […]

via Worth Losing Friends Over — Doctor Enough

What the COVID Era Means — Doctor Enough

Did you know? I am blessed to be based at a hospital that has had a decent supply of PPE this entire time. And when we got close to getting too short, friends of mine donated N95s and made cloth masks, button headbands, face shields, and scrub caps in a matter of days. Our hospital…

via What the COVID Era Means — Doctor Enough

The Bad Guys in Healthcare Aren’t Who You Think They Are — Doctor Enough

I’m going to take a stand on something that really gets my blood boiling… health insurance companies. People want to blame physicians for bad outcomes (I’m looking at you NRA supporters that are claiming we, as physicians, need to fix our own lane first). They want to blame hospitals for long wait times, they want […]

via The Bad Guys in Healthcare Aren’t Who You Think They Are — Doctor Enough

Toxins

Who knew that toxins exist EVERYWHERE? I certainly wasn’t cognizant of my exposure to toxins. Teflon, PABAs, air, water, food, etc. But, I have learned so much and am constantly learning of the dangers of these toxins in our everyday lives. Most recently, all the soaps, lotions, and cleaning products have been updated in our house.

From Union-Bulletin.com

We use (all can be found on Amazon):

  • Puracy natural dish soap
  • Everyone Soap: hand soap and lotion
  • Nature Clean dishwasher detergent
  • Everyone 3 in 1 soap (adult and kids)
  • Everyone lotion
  • Attitude natural shampoo

EWG:

EWG: Skin DEEP:

  • ThinkSport spf 50+ sunscreen
  • Super Goop Play 50+ spf face sunscreen (currently a 3; would consider a better option)
  • Ilia, RMS Beauty, Lawless, Aether Beauty makeups

EWG: Food Scores:

  • Baby purees: Beech Nut, Earth’s Best Organic
From The Good Human

Profound Documentaries on Toxins/Food Industry:

Current Favorite Reads Regarding Health:

Continuous Regional Anesthesia Catheters

We’re setting up continuous regional anesthesia catheters in our hospital. It hasn’t been easy, but I’ve learned a lot along the way.

From Essentials of Pain Medicine (Fourth Edition)
2018, Pages 135-140.e2

Update on Continuous peripheral nerve block techniques


The Cleveland Clinic Experience with Supraclavicular and Popliteal Ambulatory Nerve Catheters. The Scientific World Journal
Volume 2014, Article ID 572507, 9 pages

  • Arrow, StimuCath continuous, nerve block procedural kit ASK 05060-cch 19 Ga, 60 cm catheter, insulated needle, 18 g 3.81 inch
  • The catheter was advanced 3–5 cm beyond the needle tip. During supraclavicular catheter insertion, the catheters were placed dorsolateral to the nerve plexus.
  • During popliteal catheter insertion, the catheters were placed next to the nerve with the needle coming from the lateral side of the thigh. The catheter was advanced 3–5 cm beyond the tip of the needle to end within the space between the semitendinosus and semimembranosus muscles medially and biceps femoris muscle laterally.
  • AmbIT pump (Summit Medical Production, Inc., Salt Lake city, UT, USA)
  • After catheter placement, an initial bolus dose of 20 mL ropivacaine 0.75% was administered. All patients were evaluated for sensory and motor block prior to surgery. Before discharge, the catheters were connected to AmbIT pumps infusing ropivacaine 0.2% with an 8 mL/hour basal rate and a 12 mL demand dose once per hour.
  • On the fifth day, patients were instructed to stop the infusion for 6 hours and then remove the catheter if their pain scores were less than 5 and well tolerated by the patients. If pain was more than or equal to 5 we asked patients to restart their infusions and we did the same every day until the catheter was removed.
  • The results of study demonstrate that the prolonged use of ambulatory catheters for a period up to 5 days did not lead to an increased incidence of complications as compared to other studies. Main complications were minor infections and pharmacological symptoms, which resolved with catheter removal and without the need for additional medical intervention.

Case Report: Continuous Erector Spinae Plane Catheter for Analgesia After Infant Thoracotomy. A&A Practice: November 1, 2018 – Volume 11 – Issue 9 – p 250–252


Erector Spinae Plane Block Catheter Insertion under Ultrasound Guidance for Thoracic Surgery: Case Series of Three Patients. Eurasian J Med. 2018 Oct; 50(3): 204–206.

  • epidural catheter (Perifix® Complete Set, B-Braun, Germany)
  • LA solution (a 1:1:1 mixture of 30 mL of 0.5% bupivacaine, 2% lidocaine, and 0.9% saline)
  • Block placed about 3 cm lateral to T spine
  • Rescue dose of LA mixture (15 mL of 0.5% bupivacaine and 15 mL of 0.9% saline) was injected through the catheter.
  • In addition, we used a 30 ml volume of LA, and we believe that plane blocks, such as ESP, need more volume, and that these blocks are volume dependent. 

Mitral Valve analysis

Review article: TEE of Mitral Valve. International Journal of Perioperative Ultrasound and Applied Technologies, September-December 2013;2(3):122-130.

New Concepts for Mitral Valve Imaging.  . 2013 Nov; 2(6): 787–795.

A Quantification Approach to Echocardiography of Mitral Valve for Repair. Anesthesia & Analgesia 12(1):34-58 · July 2015

4D-transesophageal echocardiography and emerging imaging modalities for guiding mitral valve repair.  Ann Cardiothorac Surg 2015;4(5):461-462.

Method—Comparison of Transthoracic and Transesophageal Echocardiography. Clin. Cardiol. 25, 517–524 (2002)

Virtual TEE: spectral Mitral valve

Echocardiographic atlas of the mitral regurgitation. J Saudi Heart Assoc. 2011 Jul; 23(3): 163–170.

Intraoperative transesophageal echocardiographic assessment of the mitral valve repair. Ann Card Anaesth 2010;13:79-85.

 
 
 

Computer-based comparison of different methods for selecting mitral annuloplasty ring size. Journal of Cardiothoracic Surgeryvolume 12, Article number: 8 (2017)

Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography. . 2011 Jun; 12(6): 445–453.

 
 

The choice of mitral annuloplastic ring—beyond “surgeon’s preference”.  Ann Cardiothorac Surg 2015;4(3):261-265

Gold Standard to Measure MR – PPT 2016 U of Wash.

Paravertebral Block and Catheters

Review: Thoracic Paravertebral Block. Anesthesiology. Sept 2001.

Ultrasound-Guided Paravertebral Block Anaesthesia Tutorial of the Week. April 2018. Tutorial #376.

YouTube: PVB catheter technique

YouTube: LSORA U/S-guided PVB

YouTube: U/S-guided PVB by Block Jocks

YouTube: nerveblocks U/S-guided PVB

YouTube: thoracic PVB and anatomy

YouTube: Ottawa Hospital PVB

From SPPM Newsletter

Insertion of paravertebral block catheters intraoperatively to reduce incidence of block failure. Interact Cardiovasc Thorac Surg. 2012 May; 14(5): 648–649.

Continuous paravertebral block using a thoracoscopic catheter-insertion technique for postoperative pain after thoracotomy: a retrospective case-control study. Journal of Cardiothoracic Surgery volume 12, Article number: 5 (2017)

From The mid‐point transverse process to pleura (MTP) block: a new end‐point for thoracic paravertebral block. https://onlinelibrary.wiley.com/doi/abs/10.1111/anae.14004
Table 3. Drug and Dosage for Thoracic Paravertebral Block

A Systematic Review of Randomized Trials Evaluating Regional Techniques for Postthoracotomy Analgesia. Anesthesia & Analgesia:September 2008 – Volume 107 – Issue 3 – p 1026-1040