Practice Changers

Morning all

This podcast discusses “practice changers”, being the things that have really changed how you do your jobs, and why. Some of the things that are discussed are when epi is given in anaphylaxis, changes in terminology (ALTE is now known as BRUE), which has changed the way people assess and treat patients, or the increase in the accepted nature of head raising during intubation.

So, first, may I present to you the podcast, an ERCAST with snippets from various other podcasts. 35 minutes, if you’re going to skip a bit I would recommend the bit on Foley catheters. Unless a) you’re Tatsu, or b) you want to listen to someone else talk about how they got peed on.

ErCAST- Practice Changers

Couple of points I’ve taken from this is:

1) What are your practice changers? I’d love to hear other people’s, so please share them, with links if you’ve got them. I have a couple; but I’ll share the focus on airway in this forum last year, yet I complained of a lack of airways to manage. So, in the interest of “patient comfort”, around one patient a shift I intentionally ramp them up, for the practice. Not only do I get practice, but the majority of patients are also more comfortable and less anxious in this position.

I had problem> I looked at different ways at fixing problem> problem fixed and unintentionally discovered benefit for patient.

2) Michelle Lin discusses isopropyl alcohol use for nausea, but in the context of health providers not sharing information. As a species and industry, we have so much information available, but fail to either look or listen to those around us for the information.

What is it that we aren’t doing, or don’t know, that’s accepted as general knowledge?
3) Jeremy Faust discusses eCig usage. Surgeon general said it’s bad, and that Docs shouldn’t recommend it, but the same report also shows a lesser occurrence of harmful response (cancer, COPD, acute SOB), than smoking, AND, is effective in those people whom nicotine replacement therapy have failed. So he reccomends it in these patients… First I was like ‘oh cool’, but then I thought- what else are we doing, because someone has suggested it? More and more we go towards EBM, but there are still cases when someone more qualified or smarter has said something, and that sticks with our practice, even though it shouldn’t. Dig deeper, follow the paper, and develop an understanding of why or why not.

I’m sure we’ve all been to a CO2 retainer and their partner has said “five on, five off, or you’ll knock out their respiratory drive. Although, yes, possible- their inability to breathe through their ruined lungs and constricted airways are a little more important. So, maybe, finish the neb.
That’s enough from me, but listen and share your practice changers



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