Health

ERRORS AT THE HOSPITALS THAT CAUSE DEATH

Critcare

Medical Malpractice

Health System

QI-PS

The first of a series of articles on quality improvement in paediatrics and child health was published in Education and Practice in September 2013. 

In this podcast Dr Ashley Reece discusses the series with Dr Bob Klaber and Dr Alice Roueche. They discuss why these articles were commissioned, what quality improvement is and how it fits into our clinical practice with examples of QI initiatives. They also headline future articles in this series on which more podcasts are planned.

Equipped: Quality improvement in paediatrics and child health (long version)

Modern medicine has extended our lives, but is it helping us to live better in terms of aging and dying? In his new book Being Mortal: Medicine and What Matters in the End, surgeon Atul Gawande says that we have medicalized aging. Gawande examines how we can improve end-of-life care, from developing better nursing homes to holding honest conversations in the doctor’s office.

Read an excerpt at http://scifri.me/sspinx

Atul Gawande: On Being Mortal

Leslie Forman, Bridgecrest Medical’s Director of Design and Communications, spoke with Dr. Chris Carruthers about the importance of sleep in the workplace. 

Dr. Chris Carruthers has helped thousands of people with heart disease, cancer, depression, and chronic pain improve their sleep through her popular Sleep Well Tonight program. Her clients include educational institutions, healthcare organizations, companies and police departments.  She has a BSc in Kinesiology, a MSc in Coaching and Exercise Physiology, and a PhD in Integrative Healthcare and Energy Medicine. Based in Calgary, Alberta, Canada, Chris offers health consulting to clients all over the world through her website, ChrisCarruthers.com. 


Why Sleep is Critical for Health and Productivity. An Interview with Dr. Chris Carruthers.

 The importance of physical activity in your overall health, metabolic importance, heart health, Alzheimer's prevention and other benefits. How much activity you need to reap the benefits and how to fit it into your lifestyle. 

Why is Physical Activity Important?

Medical Error Scenario

Show notes at http://www.pharmacyjoe.com/episode16

There is a lot of buzz around the use of ketamine in the critical care setting, and for good reason.  But a lot of providers are unfamiliar with and hesitant to use the drug.  In this episode I’ll highlight the key points that set ketamine apart from other sedatives & analgesics, and discuss how to use ketamine in the critical care setting.

What is ketamine?
Ketamine is a noncompetitive NMDA receptor antagonist that produces analgesia and dissociative anesthesia.

What makes ketamine different from other sedatives & analgesics used in critical care?
Ketamine’s analgesic effect is dose-dependent in the same manner as opioid analgesics. Give a little bit more ketamine, get a little more pain relief.

What sets ketamine apart is how it produces anesthesia / amnesia. Ketamine causes a dissociation of the cortex and limbic systems, with the result that the patient cannot perceive the surrounding environment.  The key difference between ketamine and other agents such as etomidate, midazolam and propofol is that this dissociative state does not exist on a continuum.  It is either on or off.  I think of it like pregnancy - just like you can’t be “a little bit pregnant”, you can’t be “a little bit dissociated”.

When using it as a sedative, it is critical to keep in mind this on/off nature of ketamine.

critical care pharmacy

Episode 16 How To Use Ketamine In The Critical Care Setting

Show notes at pharmacyjoe.com/episode20

Most of my pharmacy students are surprised that I look at medications last in my pre-rounding review of ICU patients.

I am constantly tweaking and improving my method for pre-rounding on ICU patients. Here is my current routine for evaluating new ICU patients in preparation for patient care rounds.

Whenever possible I like to be in front of the patient’s room when I evaluate them before rounds. By observing the patient I can see how sick they look, whether they are intubated or have SCDs on. If the NG tube is being used for tube feeding, I know it can be used for meds too. Inadequate sedation or other problems can easily be identified by a brief observation of the patient. Also, being this close to the bedside I am available for nurses to ask me questions and to be side-by-side with the provider as they determine solutions to the patient’s problems.

In this episode, I’ll discuss how I build my pharmacy problem list, use a paper report to supplement the electronic system, list my current 5 step pre-rounding process, and explain how I prioritize which patient to see first.

Episode 20 Preparation For ICU Rounds On A Critical Care Pharmacy Rotation

Sometimes, a non-rebreather mask is not sufficient for preoxygenation.  We discuss airway and oxygenation tips and tricks that will blow your mind -- or nostrils.

CritMedic - Episode 6 - Oxygenate Differently

Show notes at pharmacyjoe.com/episode82

In this episode I'll discuss cyanide toxicity.

Cyanide is a rapidly lethal toxin. It causes death within minutes to hours of exposure.

Cyanide inhibits oxidative phosphorylation in the mitochondria, shutting down aerobic metabolism. Oxygen supply remains adequate but cells are unable to utilize the oxygen.

Cyanide is present in low background levels in the environment and is safely metabolized to thiocyanate by the liver. The capacity to metabolize cyanide is limited, and just ~0.5mg/kg is enough to be fatal.

Cyanide toxicity is relatively rare. Domestic fires, industrial accidents, and sodium nitroprusside are more common possible causes of cyanide poisoning.

Fabrics, upholstery, and melamine (often used as a coating on shelves and cabinets) can all give off cyanide when burned.

Cyanide is used in the extraction of gold and silver, and the production of nylon.

The antihypertensive sodium nitroprusside contains cyanide. Cyanide toxicity may occur in patients who receive prolonged infusions of sodium nitroprusside, have chronic renal failure, or in pediatric patients. Significant toxicity has resulted from rates higher than

Episode 82 Cyanide Poisoning

Medical error is not included on death certificates or in rankings of cause of death. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine, joins us to explain why we don't measure medical error, and why it is so important that we start.

Read the full analysis:
http://www.bmj.com/content/353/bmj.i2139

Medical error—the third leading cause of death in the US

BMJ talk medicine