Rotisserie Protocol was for Saint Lawrence. Story goes that he told his executioners, "Turn me over. I'm done on this side." The annual celebration of Saint Lawrence is August 10.
Sometimes, the first reason for abnormal values is improper sample collection. For example, hyperkalemia is very rare in children, but can happen when the blood is squeezed out of a thin needle causing hemolysis. Low platelet counts in scrub typhus despite no real thrombocytopenia is due to giant platelets and platelet aggregates making the machine confuse then for WBCs.
@@Pope_Balenciaga Yes, but I'm a lab tech at an oncology specialist. Trust me we wish that the results we see are lab errors. But two months in and so far I haven't heard of any.
Yeah i really appreciated it as well. I get real tired of "lab errors" when statistically its always during preanalysis shit goes wrong with a sample. In my experience most often with not collecting enough blood in citrate tubes. "Lab error" usually means we fucked up, but we cant admit it. Im not bitter, just annoyed, i promise 😅
@@ikazukison2 As someone that lives in Manhattan and regularly visits family in NJ, I can confirm this would be a valid concern right now 🤣 Maybe stick to pizza - it's always safe!
Just so you know skeptic is the noun, like a person is a skeptic, skeptical is the adjective you'd use to describe something (I was skeptical at first)
Weirdly, here in Portugal, the word for "Lung" is "Pulmão". So you'd think having Pulmonologists would make perfect sense for us, right? WRONG! Over here, pulmonologists are called pneumologists, after pneuma, the ancient greek word for "breath". Moral of the story, words in Medicine are just chosen to make life harder for everyone, and not because they make any semblance of sense. = )
1. Someone called Kerley 2. Because embryological development is generally symmetrical 3. Because alveoli is the plural of alveolus whereas ravioli is the singular term not raviolus 4. A pulmon is from the word for lung in Latin I think. In medicine when naming things, we flip a coin and if it’s heads it’s Greek and if it’s tails it’s Latin and then we just add an English suffix 5. Asses the urine: volume, colour, clarity, sediment. You don’t need to smell as you’ll notice it on the way in if it smells bad and please don’t taste as we have dipsticks to test for glucose now. 6. We have 5+ problems listed and they are all likely/probable diagnoses but nothing is certain. 7. Not if you want to live 8. Unlikely unless it’s the end of the attending’s on call and they like everyone on rounds. So, no. 9. Something something microbiology, something something low validity, something something only 20% of sepsis cases have a positive blood culture. 10. Then we panic 11. No, I just vibe with that one/it’s hospital policy 12. A machine that operates as a replacement heart and lungs with the lung bit functioning with similar principles to dialysis but tbh I don’t really understand it. 13. I’ve heard that and we should call it that but apparently ‘it’s unprofessional’
You are awesome. Please purchase a giant cupcake for yourself and enjoy it. Or Chinese food, if you prefer. In any case, you deserve a treat for being so awesome. And also @anncondon2689 is correct. You are a nerd. Nerds are awesome.
The pressor question was decent. Tragically, the answer is usually "I pick my favorite one, and the attending you had last week who picked a different one is an incompetent heathen."
Pressors all have potentially gnarly downsides, exacerbated by the fact that patients you start them on are inherently really sick already, so I suppose it makes sense for each attending to stick with something they're used to; or at least, that's my impression.
I mean, the guidelines for just about everything say "noradrenaline first, then use bedside echo to see whether he needs volume, more vasoconstriction or inotropic support"
The answer is usually "start with norepi, but if you're receiving an emergent ambulance it'll usually be epi and you'll have to transition before you send them upstairs"
I've seen epi/norepi, vasopressin, dopamine, but my favorite pressor has to be the physically inflatable cuff that squeezes bags of PRBCs/FFP during MTP /j
When I was a senior resident & had supervision over students, they might say “this may be a stupid question”, to which I would reply “there are no stupid questions”. After they asked, I would respond “that’s the stupidest question I’ve ever heard’. Of course, I would immediately smile & ham it up to let them know I was kidding. It broke the ice a bit.
I think it would still hammer their ability to ask questions. I used to have this resident, who said "Ask me any questions, I will not judge you, not in front of your face at least," which always hammered my will to ask qwuestions. Of course, he was a personality too
@@TheRm65 Uh, no. I told the students up front that rounds would be loose, & that any kidding was all in fun. They were encouraged to join in as well. I did however tell them not to say they thought their questions were stupid. I said something like “I’ll be asking the stupid questions around here”.
@@bmd2959 Well, this was the 1990’s, a much different time. No badgering or berating took place on my rounds, & I found that some humor got them to relax a bit which enhanced their ability to think & present their patient findings. If a student did something they shouldn’t have or didn’t do something they should have, that was discussed in private. Today of course you can’t say much of anything. All this was on resident rounds; during attending rounds we all stayed quiet unless called upon.
The ECMO question is actually a good one. Explaining it doesn’t do it justice until you actually see it for the first time and you’re stepping over garden hoses full of blood and wondering what mad scientist invented this thing
When I was training to be an x-ray technologist last summer (in the clinical practicum portion of training), I had to take a portable chest x-ray of someone on ECMO, their sternum opened up, heart basically exposed (not beating, obviously), and all of it covered up with what appeared to be sterile kitchen wrap. It was WILD (one of the craziest things I've ever seen, and I've seen a guy who got attacked with an ax to the face, and had his cheek flesh peeled away from his facial bones). So like you, I think that's a pretty good question. [It was also nice that each room in the CCU was equipped with a ceiling lift, so we didn't have to deal with the dead weight of a guy who was actually "dead" (functionally, at least).]
My stepdad was a RT for who knows how long. He worked in the NICU and was ECMO certified and something to do with him being in the OR on occasion. Can’t remember what that was.
The pumps used for ecmo and plasma donations are so neat! They were invented iirc at the turn of the last century (not originally for medicine) and were hand cranked. The way they move fluids without ever touching them therefore providing a sterile and closed system which requires less cleaning/sterilization, and keeping the pump mechanism crosscontaminant free is awesome. Plus, dead and alive all at once.
@@dr.floridamanphdECMO is basically the same as a bypass machine used in the OR. He probably was running a bypass machine in cardiac surgeries since the management is very similar
@woodysmith2681 Speaking as someone who works with ortho, I kind of wish they *did* do this. I think that'd be preferable to the alarming prescription combos I see them giving out on the regular.
I'm not in medicine, but I feel like "but what if it's not" is one of the most valuable questions a med student can ask. Like, an experienced person in any field can get into a state where their experience tends to override what they're actually seeing. Having a fresh pair of eyes question those habitual cognitive biases has got to be a really valuable thing.
@@johnserosanguineous1886 Yeah, and that's valuable for young people to hear, I'm sure, but humans like to bury our eyeballs in other tasks, listening to horse hooves, while a stripy-looking equid parades past our faces...
Honestly, that is one reason that the good teaching hospitals are so great, they are constantly challenged by new thoughts and minds from students just taught with the most recent information. They gain experience and knowledge on how the book knowledge works in the real world and the institutions gain fresh ideas and thoughts. We see the same thing in pharmacy. Also, students have the time to do deep dives into 1 patient and really do all the steps while the professionals usually have a whole floor and need to prioritize.
It also goes the other way. As an inexperienced person, you rely on clear protocols and textbook examples to get through tasks, hoping that you won’t get anything too crazy and abnormal that you were never prepared to look for. Asking “what if” types of questions prepares you for unusual situations and allows you to develop your understanding of a subject or procedure before you are actually confronted with it in practice.
Agreed, I am a med lab scientist and one time I had a NICU baby that kept coming up with a potassium of 9 (way too high to be alive) and I assumed it was a "lab error" and re-ran it, but in the time it took to rerun it with so little sample left, the doctor called asking for the result and said that was legit. Had I called to ask what if it's not a sample error, I would have had the results out in half the time.
I've found that the real stupid questions are any asked in bad faith, where the asker already knows the answer they want to hear. Most of the questions in this video aren't stupid, but there's an appropriate setting to ask, and that isn't it.
I'm going to try to get "rotisserie protocol" to catch on in the OR for when we have to do a squish-and-flip spine case. OR maybe "panini protocol"? Choices, choices...
I have a handicapped son, and I used to call rolling him over "spatulating" because it reminded me of rolling up an omelette with a spatula. And then there was how I used to pick him up by getting one hand under his shoulders and the other under his butt. That was the roast beef lift. When my dad would make a roast beef for his deli, he transfer it from the pan to a tray by sticking a large fork in each end and lifting it, and that's what it made me think of.
I know the system works differently in the US, but I haven't asked a pharmacist for a dose in all of my ten years as a doctor in Germany. Pharmacists are not seen as equals over here and the only thing they are expected to know better is about drug interactions. Some ICUs have a pharmacist going over orders about once a week, that's it.
@@MedEwok As the head of my german hospital's pharmacy department that makes me sad, but on the other hand due to legal reasons we can't really do more than than counselling and hospital management usually isn't too keen on financing comprehensive ward pharmacists to work on pharmacist-doctor-relationships 😒
@@maldo2211 it is sad because the interaction with pharmacists can be very fruitful, as I know from doing rounds with them on the ICU. But outside of that context it is extremely uncommon to ask the pharmacists directly, and sometimes (apparently) unwanted as well. I work in a smaller hospital nowadays and the availability of a pharmacist in-house is abysmal. As you correctly mentioned, this has a lot to do with management cutting costs and simply not caring. Also, arrogance of some doctors admittedly plays its part.
As a manufacturing engineer, when one of my technicians says "i have a stupid question", i always respond with "there are no stupid questions, only stupid engineers"
There are two types of questions. One is explorative and the other is probing. There are no stupid *explorative* questions, as that’s how we learn together. There are many stupid probing questions, as they can show lack of contextual observation skills.
Ive known a few engineers who asked LOTS of insane questions and these guys prob could have built a decent space shuttle in their garages... The ones who ask lots of stupid questions are thinking in 4D while the rest of us are doing 2D or 3D at best. Let em cook, its usually worth it when that train of thought they are on comes to an end...the dumb question is step 1 most of the time.
"Rotisserie protocol" 🤣🤣🤣 By chance, I am watching this as an inpatient after being rushed to the ED last Saturday, due to a medical emergency. I truly appreciate this much needed laugh. 🙏 😂😂😂
This reminded me of friend from nursing school who always asked the questions we all wanted to know, but didn’t have the guts to ask. Like, when we finished this huge lecture on amputation and phantom pain, the professor asked if there were any questions, she asked “what happens to the leg?” At the professor’s puzzled face, she said, “you know after they cut it off?”.
I guess it really depends where you live. But generally it is put in a plastic bag (and usually in another carton-bag to avoid "identifying the waste) and then collected as a biological waste. In my understanding biological waste is just burned like any other burnable waste, but probably with some protocols to ensure that everything indeed becomes ash. I am not an expert on waste management, so couldn't tell for sure, I just work in OR. @@traveller23e
A hospital I worked at, at the entrance to the OR, had chutes in the wall labeled “limbs” and “other”. Apparently that’s how they used to deliver samples to pathology back in the day!
Being a bilateral above the knee amputee, I thought they should give them to me to put in my burial plot to await the rest of me. It was kind of a weird feeling knowing parts of my body were off somewhere else.
I have some medical training, lemme try this - 1 - Kerley A, B, and C lines are just named after John Kerley, who first described them 2 - Having two lungs instead of one big lung means more surface area, making gas exchange more efficient 3 - Ravioli and alveoli are borrowed from different languages, hence the different pronunciation 4 - Pulmon is just the Latin word for lung 5 - Checking on patients 6 - Within the context of critical care medicine, you try to make sure very very sick and/or injured people don't die, so any treatable problem that directly causes death if left unaddressed 7 - It's not a crime or anything as far as I'm aware, but the hospital you work for might have policies prohibiting you from doing that 8 - Almost certainly not 9 - To test for multiple unrelated problems, and because blood cultures can become contaminated forcing you to restart 10 - Then either the patient is moments from death, or the problem is very rare, or you've just discovered a new medical problem 11 - I was taught to choose based on lab values and PK parameters, so no it's effectively math-based 12 - ECMO is basically just a machine that pumps blood out of the body, oxygenates it, then returns it to the body. It's useful in situations like if the patient's heart and/or lungs have shut down 13 - The word 'rotisserie' didn't exist in its original language (French) yet when this decision was, so it simply wasn't an available option at the time
The answer is that skin contaminants are common in blood culture results. Ordering 2 helps identify if one is contaminated, avoiding unnecessary treatment. Whether or not you agree with the practice is up to you.
Depending on the indication, dose, and patient response, some medications can double as treats - opioids, benzodiazepines, dissociative anesthetics, . . . .
I'm a former ICU director. I used to ask myself the same questions. 😂 Critical care is not for those who need definitive answers. You spend a lot of time wondering, " WTF is going on with this patient?" No matter how much technology you have, you'll be baffled by a lot of patients. That's what I loved about the job - teaching residents how to unravel the knots.
I used to say to my students when I taught geology - there are no stupid questions, only stupid answers. And while it was kind of a joke, I do also believe it (mostly - there are "unnecessary" questions, wherein people ask questions that have already been answered, or which one could easily find the answer if one was paying attention, and "ridiculous" questions, wherein the answer is so far out of the topic at hand that nobody is even LOOKING for an answer...but in either case, I don't see stupid). As for stupid answers, that's easy...if you are talking out of your rear end, for example. That's stupidity. Don't claim to know things you don't know.
Hey, not often you see a fellow geologist in the comments of a Glaucomflecken video! I’m a planetary geo grad student who asks lots of questions, so I very much appreciate profs like you :)
To be fair, ECMO is a pretty WTF piece of kit. It looks like something that I would have put together as a kid if I'd combined the meccano and lego sets, then added some garden hoses.
As someone in an absolutely non-medical field but who has a lot of fun chronic health things that keep me looking at medical stuff, I a genuinely glad that I don't actually get most of the specific references but can still appreciate the humor.
No idea where we read this, but if you ever have to have a lung removed (for some reason) the other one will actually expand into the empty space to compensate. So the reason you have two lungs instead of one big lung is because you're scared to make your unipulmonary dreams a reality.
My guess is that as usual evolution being weird... At some point(300-400 million years ago) there might have been something in between them or splitting them in two instead of one.
As a teacher, I cannot tell you how much I love this! It's like every day in my classroom with that one super smart kid with ADHD! FREE entertainment! 😂 And humbling.
I know its been said before, but thanks for asking the lab question. Im a lab scientist, so tired of being accused of doing errors when i can see and track everything thats happened before the samples ended up at the lab.
lol good one! Wb the “feel free to ask any questions”, asks a question pertaining to clinical knowledge, then gets graded 80% on evaluations for not knowing what the attending knows! 😊
trained a new employee yesterday (i work as a bht in a psych ward), and as i was erasing an open room on the board and putting "M" and saying that i liked to do open room and male/female beds in different colors, she asked "okay so what does M stand for?" LOVE it actually. like in a completely serious way, i did a lot of things wrong b/c i was too scared to ask about the "right" way to do them, so i tried to encourage her to ask as many questions as she could and answered even the silly ones non-judgmentally. better to ask a question that makes you look stupid for a second than look stupid for months
The vegetable aisle?? Wait till you hear someone call the person you love a vegetable. Staff who use words like that should be fired. Human beings are never vegetables.
I love the "rotisserie protocol"! We rotisserie spine patients who need anterior and posterior procedures. It's a little different and quicker than in the ccu.
The one thing I learned as a professor: There ARE stupid questions. But as an old AF Sergeant said, "There are stupid questions. The problem comes when you ask the stupid question TWICE."
Sitting in library preparing for my md entrance. Landed on the video, burst into laughter too loud. Now, embarrassed to make an eye contact with anyone. 😅😅
I am 100% with the student. Throughout the years you will absolutely stumble upon things like perfusion-rate or similar small things. Most of the time you'll try to figure it out by consulting with slightly more knowledgeable peers. But getting the chance to actually ask these "stupid and basic questions, is a blessing ❤
Back in my anatomy class we had one professor who was like, "I won't say there are no stupid questions. There is an infinite number of incredibly stupid questions but I'd rather you ask me a stupid question that give a stupid answer to a patient one day!" I just wish our professors in clinical modules adopted her philosophy because they would get mad at us even for normal questions. Someone once asked a surgery prof a question and he was like "Ugh, you were supposed to learn that in infectious disease rotation!" And then we reminded him we had infectios disease rotations cut in half because we had them in early 202 and first COVID patients were brought to ID department and nobody wanted to have 125 4th year students going anywhere near the highly contaigous, unknown disease if not absolztely necessary.
Gotta start somewhere! A lot of it is anecdata of "well when I've used it in this patient type, it seems like it's worked the best" and maybe with a research study that would be validated, but maybe not, but it's fine as a place to start!
@@Cabbage-dk6nuExactly. Each psychiatrist seems to have their own (different) favorite meds and hierarchy of preferred meds that works for them and their patients. To be fair, though, when a doc says, "Well, I have really good luck with this med, so let's try it," it's probably better than the doc asking the patient what med the patient wants to be put on. At least the former approach gives the patient more confidence and more of a placebo effect.
As someone who's been on every antidepressant under the sun.... I knew it! Lol. I'm an internist, and I think I might have a fair chance of making a good guess at which psych med to give at this point!
Snakes do have a single big lung. Still, mostly a tetrapod tradition to have two of those; other bony fishes have different configurations for their air filled digestive tube invagination.
I'm an ICU nurse, the junior docs ask us the silly questions! I coached a baby doc through ordering insulin haha. And I'm definitely using "rotisserie protocol" next time we prone someone!
Patients watching: umm...about blaming things on lab errors...and maybe or maybe not wondering if they're not lab errors. Should we add this to our list of things to worry about whether or not we should worry about? 😂
