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Archive for March, 2009

Patient Flow as of March 30, 2009

few clarification to the revised flow:

Pt flow:

The attempt to improve pt flow taught us many lessons, but for now leadership has decided to return to pt distribution the “old way”: esi 2’s and 3’s will be distributed in rotation to all 6 primary rn’s evenly.  We will no longer be “cohorting” admitted pts.

Resus Pts will rotate to north and south teams for care.  (if no resus resident is scheduled)
Pts coming out of the resus room will be distributed to the appropriate zone.

When a resus resident is working:   all resus pts will go to the resus resident.  pts coming from the resus room, will be evenly distributed to the north and south zone geography and rn staff.

Physician staffing:

If staffing permits, an EM resident will be assigned primarily to care for  pts in the resus room.   Post stabilization resus pts will be distributed to both the north and south zone– they will continue to be monitored by the resus resident and resus attending.

It is possible that the south zone may be staffed by 2 interns and an attending.  This staffing poses risk, especially if esi2 pts are assigned to the south zone.  Attending physicians are encouraged to adjust staffing in the ED on a shift by shift basis, and they are encouraged to discuss staffing with the charge nurse to ensure the safety of our pts at all times.

Kevin M Baumlin, MD

Written by reuben

March 31st, 2009 at 4:36 am

Posted in ED Flow,Residents

Glidescope

with 2 comments

[Update 8/19/09]

EMFaculty, EMResidents:

You complained, and then you complained some more. Now we have a new and improved Glidescope tethering system, see photo.

vaishali glidescope-1

We have installed two very sophisticated devices that attach the blade and the stylet to the base on retractable strings. To use, TURN THE KNOB to loosen, then, once you’ve gotten the string out to length, turn it the other way to tighten. No more dangling phone cords.

Remember, to clean: move the entire unit into the dirty utility, unplug the video cable and cap the digital port on the blade, wash off in water, dip blade and stylet into sterilizing solution for one minute, wash off again in water, dry with paper towel, re-attach the video cable to the digital port, and put the unit back opposite the resus computers.

Let me know if you have any questions and keep those complaints coming.

Thanks to Nicos, Scot, Phil, Micah, and Vaishali.

reuben

Overview

Glidescope is stored with ultrasound machines between north computers.
Cleaning Solution is in the North Zone dirty utility room.
Glidescope should be brought to bedside for all intubations, at the discretion of the treating team.
Can be used as the primary airway device, or as a rescue device after unsuccessful conventional laryngoscopy.
Can be used with RSI technique or awake technique.

For educational purposes, PGY I and II residents should generally use conventional laryngoscopy; PGY III and IV residents have the option to use the Glidescope. However, provider roles are always at the discretion of the treating team.

Post-Intubation care of Glidescope

Intubating resident is responsible for cleaning and replacement.
Bring glidescope to North Zone dirty utility.
Disconnect data cable and place waterproof cap over data plug.
Clean handle and stylet using running water.
Sterilize handle and stylet by dipping both into sterilizing solution for 1 minute.
Dry off handle and stylet.
Return Glidescope to its special place.

Tips on using the Glidescope

Looking at the mouth, first insert the Glidescope into the midline of the oral cavity, then look at the monitor and advance the Glidescope to view and then elevate the epiglottis, exposing the glottis.
Less force is required to expose the glottis using a Glidescope than with conventional laryngoscopy because of its steep angle. The Glidescope can be used to elevate the epiglottis indirectly by placing the tip of the handle into the vallecula (Macintosh technique), or by using the handle tip to directly lift the epiglottis (Miller technique).
Once optimal glottic view is obtained on the monitor, look back at the mouth to insert the ETT immediately adjacent to the handle, then, as the tip of the ETT approaches the tip of the Glidescope, look back at the monitor to guide the ETT through the vocal cords.
If the ETT does not easily pass into the glottis, use your thumb to push the stylet out of the ETT 2 inches as you advance the ETT through the vocal cords.
It may be easier to advance the ETT if the view of the glottis is relaxed, so that you see less of the cords.
If using a conventional malleable stylet rather than the Glidescope stylet, bend the stylet to 50-60 degrees at the cuff to match the Glidescope handle.

Contact reuben.strayer@mssm.edu with any problems regarding the Glidescope.

pdf version available here.

Written by reuben

March 30th, 2009 at 3:56 am

Posted in Airway

Cisco Phone Support Contact

Written by reuben

March 26th, 2009 at 12:31 am

Posted in Contacts

2009 Intern Composite

Written by phil

March 20th, 2009 at 2:21 am

Posted in Residents

CV Template

From Andy.

This link that provides the template required by the promotions committee for preparing your CV.  Life is much easier if you use this template and keep it updated on a regular basis.

Please update your CV using this template and send a copy to Jill Zaheer to keep in your faculty file; this CV should be updated each year.

http://www.mssm.edu/forfaculty/ap/dept_admin.shtml

Written by phil

March 19th, 2009 at 3:39 pm

Posted in Career

Overweight Adolescents Study

Dear Colleagues,

The Mount Sinai School of Medicine’s Department of Psychiatry and Department of Pediatrics are collaborating on a study involving two interventions for overweight or obese adolescents.  The purpose of this federally funded trial is to compare a new family-based intervention to nutritional education counseling in addressing overweight status in boys and girls ages 13-17.  Study evaluations and interventions are offered at no cost as part of this two-year study.  The study is part of a multi-site collaboration with the University of Chicago, and is approved by the Mount Sinai School of Medicine Institutional Review Board (Protocol 07-0216; PI: K.L. Loeb).

Inclusion criteria include:
•       Ages 13-17
•       Male or female
•       Living with at least one parent or guardian who is willing to participate in the study intervention
•       A BMI percentile >85% for gender and age (e.g., overweight or obese)


Exclusion criteria include:
•       Current psychotic illness
•       Current alcohol/drug dependence
•       Active suicidality

•       Eating disorders (e.g., binge eating disorder)

•       History of bariatric surgery

•       Medication associated with significant weight changes (e.g., antipsychotics)

•       Serious medical or physical conditions resulting in significant weight changes

(e.g., pregnancy, genetic disorders).

•       Complications of obesity that contraindicate moderate physical activity

Please feel free to discuss this study with qualifying patients to gauge their interest. If they would like more information, they may contact Lauren Alfano, 212-659-8724 or Dr. Terri Bacow at terri.bacow@mssm.edu.  Please don’t hesitate to contact me (or the study coordinators) directly if you have any questions about the study.  Thank you.

Terri L. Bacow, Ph.D.

Instructor, Department of Psychiatry

Eating and Weight Disorders Program

Mount Sinai School of Medicine

1 Gustave L. Levy Place, Box 1230

New York, NY 10029

Ph: (212) 659-8891

Fax: (212) 859-1469

Email: terri.bacow@mssm.edu

Written by reuben

March 18th, 2009 at 8:45 pm

Posted in Peds,Research

Mailing lists

Several exist.  From least to most inclusive:

mssmemdocs@mssm.edu – MDs, Minerva, Jill

mssmemfaculty@mssm.edu – MDs, PAs, Admin

emfaculty@mssm.edu – MDs, PAs, Admin, All Affiliates.

Written by phil

March 18th, 2009 at 6:17 pm

Posted in Contacts