Comments for ercast.org http://blog.ercast.org Emergency medicine podcasts, reviews and curbside consults Thu, 17 Jul 2014 03:22:54 +0000 hourly 1 http://wordpress.org/?v=3.9.2 Comment on Art of the Chemical Takedown by Jennyhttp://blog.ercast.org/art-chemical-takedown/#comment-807 Thu, 17 Jul 2014 03:22:54 +0000 http://blog.ercast.org/?p=2844#comment-807 Great!!! In regards to the droperidol prolonging the QTc, it was discussed to get an EKG to check the QTc . When you give geodon (ziprasidone), do you also check an EKG since it also can cause QT prolongation? Thank you!

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Comment on Art of the Chemical Takedown by Luke Embleyhttp://blog.ercast.org/art-chemical-takedown/#comment-801 Tue, 08 Jul 2014 10:05:17 +0000 http://blog.ercast.org/?p=2844#comment-801 Incredible podcast, information and highly entertaining! Great music, great guests. One of my favorite podcasts of the year! Very well done.

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Comment on Psychology of the Difficult Airway by Rob Ormanhttp://blog.ercast.org/psychology-difficult-airway/#comment-782 Fri, 13 Jun 2014 05:51:31 +0000 http://blog.ercast.org/?p=2804#comment-782 It was some crazy rock face that I think was El Cap.

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Comment on Psychology of the Difficult Airway by Jennyhttp://blog.ercast.org/psychology-difficult-airway/#comment-749 Thu, 15 May 2014 00:12:17 +0000 http://blog.ercast.org/?p=2804#comment-749 Great airway talk. I think we have all felt like a deer in the headlights, when we didn’t have a plan and things started going down. Dr. Levitan, what is your advice to EM residents who may have a difficult airway algorithm from our sim/airway course when your attending jumps in and wants you to follow their difficult airway path -- how do you not become a deer in the headlights when you have a plan and then your attendings algorithm for difficult airways is different than yours? Thanks a million.

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Comment on Splint like a pro by Benhttp://blog.ercast.org/splint-like-a-pro/#comment-747 Tue, 06 May 2014 21:25:07 +0000 http://blog.ercast.org/?page_id=1928#comment-747 Rob- excellent videos! They have been the “go to” for my medics. What is your email address? I can’t find it on the website. Thanks. BB

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Comment on Pulmonary embolism in pregnancy with Jeff Kline by Investigation of PE in pregnancyhttp://blog.ercast.org/pulmonary-embolism-in-pregnancy/#comment-745 Sat, 03 May 2014 11:52:38 +0000 http://blog.ercast.org/?p=2170#comment-745 […] http://blog.ercast.org/2013/04/pulmonary-embolism-in-pregnancy/ tweetmeme_url = 'http://adelaideemergencyphysicians.com/2014/05/investigation-of-pe-in-pregnancy/';tweetmeme_source = 'ADLEmergDocs';tweetmeme_style = 'compact'; […]

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Comment on Psychology of the Difficult Airway by CJhttp://blog.ercast.org/psychology-difficult-airway/#comment-743 Fri, 02 May 2014 03:55:02 +0000 http://blog.ercast.org/?p=2804#comment-743 Wow, great podcast with great pearls. My favorite Levitanism is definitely the Beauty to Death ratio.

I would like to share a viewpoint and my thoughts on this subject. It may be old news to you though I did not specifically note it in the podcast and I apologize in advance for the ranting. I trained for the Olympics and failed and part of my path was an undergraduate major of exercise science, emphasis--motor control and learning. During my studies I was training 4-6 hours most days and coaching my sport another 4 hours or so also most days. This meant a lot of direct application of the principles I was reading about in myself and in others. My sport was taekwondo, and while not as glamorous as a fighter pilot or army ranger, my opponents wanted to knock out my teeth. I think that the comparisons that we make to fighter pilots, combat medics, general pilots, etc. are fascinating and exciting. They can be helpful qualitative models for us. However, I do not think that only such sensational comparisons have the insight to be useful and informative in medicine. The application of what I learned benefited the athletes I coached greatly and allowed them to perform well under great pressure. I was more successful as a coach than a fighter myself.

I feel that simulation medicine and research, whether ACLS or airway related are dancing around a subject and implementing some common sense elements of it without actually realizing the depth of knowledge and mountain of literature that exists and that could help us describe and fine tune what we research or teach and understand how best we can train for success and peak performance in the ED. The field of motor control and learning, a subfield of psychology and an integral part of exercise science training, as well as sport psychology itself has been asking the question about how to perform when it really counts for upwards of 40 years or more at this point and I feel like we are in some ways reinventing a wheel. In the podcast Dr. Levitan noted some comparison to his chosen sports but I think the literature about performance in sport has even more to offer. While some of the concepts from the field of motor control and learning are common sensical there is, nevertheless, often fascinating and illuminating data behind these concepts and well worth perusing for anyone involved in teaching procedures or resuscitations.

As a first example, the number of cognitive variables that one must consider affects reaction time. If you are choosing between two possibilities you will make your final decision faster than if you are choosing between 6. This is common sense, but the data demonstrating and proving this is fascinating. This is one reason that simpler can be better and plays out in both a macro and micro form--observable both in big slow decisions, like which of the many back up airway options will be selected next, and also in faster fine motor decisions like how you adjust your angles and depth during DL.

A description of the “principle of specificity”, first coined in 1973 was given regarding the approach to the airway course cadavers and experience. Creating a realistic feel and appearance is important! The principle of specificity and the literature describing it from every angle essentially states that if you want to perform something well, the practice and preparation should approximate the real deal as closely as possible. This is why Peyton Manning did not play catch with his receivers before the super bowl. He wore pads, ran EXACTLY the plays they wanted scripted against the Hawks in as realistic a simulation as possible. Unfortunately, Coach Fox did not confer with me before the super bowl and mistakenly decided that the super bowl, as he remembered it, was not that loud, therefore, he chose not to use simulated crowd noise in practice the week before the big game. While the super bowl may be tame during offensive snaps overall, the first minutes of one is louder and crazier than even a seahawks home game. On the first snap of the game crowd noise created an error on the snap and the ball sailed out of the endzone for a safety giving the seahawks an instant lead and a mental edge that was never recovered from. They did not adhere to the principle of specificity in practice. This principle is the reason I cringe every time I hear an award is handed out for taking medical students to the art museum to work on their perception or whatever the heck else they think that activity might enhance. If you want to be perceptive when looking at art, look at art. If you want to be perceptive when looking at humans, look at humans. Preferably sick ones.

There are numerous additional concepts that can further help to optimize training. The frequency, timing and form of feedback are among many important contributors to improvements in performance. Not all feedback is created equal. The concepts of memory, transfer, retention, Fitt’s Law and schema theory are also enlightening. The concept of memory is one of my favorites. What is 34 + 27?

Good.

What is 34 + 27?

34+27?

Easier the second and third time? If you repeat the same thing over and over you are not reaccessing the part of your brain where the skill resides and are not therefore reinforcing that skill but rather just remembering. Clever studies have demonstrated that this is true whether the skill is math, kicking someone in the head or otherwise. This is why you should do one DL, one surgical airway, one fiberoptic, etc. when in the airway lab and avoid doing the same maneuver more than once or twice in a row (depending on your interpretation of the memory in skill acquisition literature).

Finally, sport psychology and training to achieve peak performance in stressful situations, like when your opponent is trying to knock you unconscious has been studied in sport since the Soviet Union decided embarrasing the US in the Olympics would be an inspirational thing to do. I think that concepts such as peak performance, hyperfocus and flow as described by Csikszentmihalyi in 1975 can be very valuable to simulation and learning in medicine. “Reinterpretations of Csíkszentmihályi’s flow process exist to improve performance in areas as diverse as business, piano improvisation, sport psychology, computer programming, and standup comedy.” Maybe medicine is next in line…

My hope would be that leaders in simulation medicine of all types could learn from these established concepts and avoid the time sink of reinventing certain wheels.

Thanks Dr. Orman for your oustanding podcasts and I look forward to my next airway lab!

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Comment on Psychology of the Difficult Airway by Ben Azanhttp://blog.ercast.org/psychology-difficult-airway/#comment-742 Fri, 25 Apr 2014 23:11:47 +0000 http://blog.ercast.org/?p=2804#comment-742 Wait, did they really climb El Capitan?

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Comment on Pulmonary Nodule: The incidentaloma by Dennis Conkinhttp://blog.ercast.org/pulmonary-nodule-incidentaloma/#comment-740 Fri, 18 Apr 2014 23:11:29 +0000 http://blog.ercast.org/?p=2455#comment-740 non md “numerous” lung nodules on pulmonary ct 2′/2104 to rule out emphysema /suspected copd after normal spirometry--3-4mm in various places right and left lungs , all solid non claicfied smaked 1 poack x 20 years
age 61 this really helpef put things in perspective for me as did a direct reading of the Fleschner Society guidleines but my pulmonologist still wants a seconf CT scan in JUne. Thanks. I am not so terrified.

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Comment on How to run a code by andrewrcogginshttp://blog.ercast.org/run-code/#comment-734 Sun, 23 Mar 2014 09:09:02 +0000 http://blog.ercast.org/?p=2720#comment-734 The Crisis Resource Management Skills needed in Cardiac Arrest really outweigh any knowledge content you can learn from a book. Karel’s comments on managing the pre-hospital environment and Cliff’s thoughts on team management are especially useful to reflect on… One useful tip is try to create a culture of debriefing your codes -- it does take a few minutes but it can really help progress your “human factors” skills

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