grand rounds topic...ideas?

[pwrpuffgirl]

I'm a CA-2 and this year we are required to present a grand rounds topic. I still have a few months to prepare but I'm starting to agonize over what topic to choose. This anxiety has only grown after attending two other fellow classmates grand rounds, which were: Ultrasound guided regional and Pre op evaluation of the cardiac patient for non cardiac surgery. Both presentations were of excellent quality. So now the bar has been set fairly high. Last year the presentations were pretty lame by comparison: ventilators, invasive monitoring, glucose control... So thanks to my overachieving classmates I now feel that I need to have a topic that lends itself to a stellar grand rounds. I have thought about talking about local anesthetic toxicities and to include Intralipid treatment. However one of the staff didn't think that would be enough for a 45 min presentation and that the data behind Intralipid was not that strong. Please help me out with any suggestions😕

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[militarymd]

sodium and water metabolism.....






people always think I'm kidding...but I'm dead serious....

It is fascinating....and most anesthesiologists AND other doctors know sooooo little about.

 

[Noyac]

Bicarb and fluid resusitation in trauma. Everyone gives bicarb but they are unaware of the intracellular mechanisms involved.

 

[Jalopycat]

Bicarb and fluid resusitation in trauma. Everyone gives bicarb but they are unaware of the intracellular mechanisms involved.

Thank you for saying that! I'm an intern and was criticized for not giving bicarb during a code a few months ago, and when I tried to explain intracellular acidosis, everyone laughed at me. It really made me mad.

Everyone always wants to give bicarb during codes (nurses, RT's, and anyone else who happens to be in the room). I think most of the time they are just treating themselves.

I also hate it when people push to get an ABG when someone is in PEA/asystole. Hmm. I think the pH will be 6.8....

Ok. I know I changed the subject. I just had to get that out!

 

[TIVA]

How about ...

The walking epidural. It's neither walking, nor an epidural. Discuss.

 

[toughlife]

Thank you for saying that! I'm an intern and was criticized for not giving bicarb during a code a few months ago, and when I tried to explain intracellular acidosis, everyone laughed at me. It really made me mad.

Everyone always wants to give bicarb during codes (nurses, RT's, and anyone else who happens to be in the room). I think most of the time they are just treating themselves.

I also hate it when people push to get an ABG when someone is in PEA/asystole. Hmm. I think the pH will be 6.8....

Ok. I know I changed the subject. I just had to get that out!

You as the person in charge should tell them what to give so if you don't want bicarb then it does not happen. Codes are not the time where 'wannabes' get to play doctor. You set the tone.

 

[TIVA]

You know, while it's true that bicarb doesn't improve intracellular acidosis, and in fact worsens it, the purpose behind giving bicarb is that it momentarily improves your blood pH, which improves cardiac contractility.

The heart becomes extremely sluggish when the pH drops. So, the purpose of giving bicarb isn't to correct acidosis, the purpose is to increase cardiac contractility in order to buy you time. The only thing that'll ultimately correct acidosis is tissue perfusion. If your heart ain't contracting, you ain't gonna perfuse.

That's why you will find that giving an amp of bicarb during a liver transplant or during on pump CABG (as your coming off pump), actually helps improve your hemodynamics.

So if I was in a code situation, I would not have any problems throwing bicarb and the kitchen sink at the patient. Do what you need to do to salvage an already bad situation. Once and if the patient is stabilized, then you can concern yourself with improving intracellular acidosis.

Of course, some of my teachers on this forum will say that there is no data or evidence to support the use of bicarb in a code. I would like to remind them that there is also no data that atropine works in the setting of hypotensive bradyarrythmias. But that's what we do. Why? Because it's in the code algorithms and besides, what else are you gonna do?

 

[Noyac]

You know, while it's true that bicarb doesn't improve intracellular acidosis, and in fact worsens it, the purpose behind giving bicarb is that it momentarily improves your blood pH, which improves cardiac contractility.

The heart becomes extremely sluggish when the pH drops. So, the purpose of giving bicarb isn't to correct acidosis, the purpose is to increase cardiac contractility in order to buy you time. The only thing that'll ultimately correct acidosis is tissue perfusion. If your heart ain't contracting, you ain't gonna perfuse.

That's why you will find that giving an amp of bicarb during a liver transplant or during on pump CABG (as your coming off pump), actually helps improve your hemodynamics.

So if I was in a code situation, I would not have any problems throwing bicarb and the kitchen sink at the patient. Do what you need to do to salvage an already bad situation. Once and if the patient is stabilized, then you can concern yourself with improving intracellular acidosis.

Of course, some of my teachers on this forum will say that there is no data or evidence to support the use of bicarb in a code. I would like to remind them that there is also no data that atropine works in the setting of hypotensive bradyarrythmias. But that's what we do. Why? Because it's in the code algorithms and besides, what else are you gonna do?

Codes are different. Wasn't Bicarb changed to "consider" in the code algorithm rather than "give"? The difference is effectiveness of the respirations.

 

[dr. mccoy]

I'm a CA-2 and this year we are required to present a grand rounds topic. I still have a few months to prepare but I'm starting to agonize over what topic to choose. This anxiety has only grown after attending two other fellow classmates grand rounds, which were: Ultrasound guided regional and Pre op evaluation of the cardiac patient for non cardiac surgery. Both presentations were of excellent quality. So now the bar has been set fairly high. Last year the presentations were pretty lame by comparison: ventilators, invasive monitoring, glucose control... So thanks to my overachieving classmates I now feel that I need to have a topic that lends itself to a stellar grand rounds. I have thought about talking about local anesthetic toxicities and to include Intralipid treatment. However one of the staff didn't think that would be enough for a 45 min presentation and that the data behind Intralipid was not that strong. Please help me out with any suggestions😕

You can get ideas by looking at the ASA annual meeting lecture book, or look at the ASA closed claims study for ideas. How about patient awareness (movie to come out next year in theatres regarding this), ASA difficult airway algorithm, anesthetic drug interactions (e.g with nutraceuticals), etc. Hope it works out.

 

[dr. mccoy]

I forgot to mention that one of the issues that recently came to my attention which may be worth talking in your grand rounds is about the TRALI study which helps support the lesser use of transfusions. TRALI stands for transfusion related acute lung injury. This study shows that HLA antibodies which are in all blood products are leading cause of noninfectious morbidity in transfusions.

 

[nutmegs]

I did a presentation on massive transfusion & traumatic coagulopathy which went over extremely well, and I think I'll probably turn it into a bigger talk at some point. got to review mechanisms of coagulopathy in hemorrhage, factor VII data, anes role in the concept of damage control surgery, etc.

 

[IN2B8R]

Be creative: talk about money, everyone will intently listen. 😉