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)
@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.
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. = )
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
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.
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 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.
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'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.
"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. 🙏 😂😂😂
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.
Depending on the indication, dose, and patient response, some medications can double as treats - opioids, benzodiazepines, dissociative anesthetics, . . . .
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.
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.
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 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
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.
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.
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.
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.
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! 😊
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.
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 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. 😅😅
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.
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? 😂
The cusp.of fame . It's usually the innocent and seemingly innocuous little brother of " can I please have that in writing /email ?" . One of the 7th Seals is about to be opened ....
Reminds me of the fantastic "Greenside" cartoons: "No matter what you've heard, there are no stupid questions. There are only stupid people who didn't listen to me properly the first time!"
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 ❤
I guess it's a rotisserie protocol only if the patient has a fever
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.
You guys in the medical field MUST make rotisserie protocol a thing!
DUH!
bruh lol
As a medical technologist, I so appreciated the NOT stupid question of "what if it's not" (due to a lab error)! ❤
Yeah, I thought that was actually a really, really good question.
Then the 80 year old man-dude has apparently gotten pregnant, despite his age.
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 😅
Throwing in the "will you buy us lunch"? 😆
That is genuinely the most important question. All the rest are just fluff to get that one burning concern answered....😅
@@apisme9090 what if the attending only buys you deli sandwiches but there is an outbreak of Listeria in NY/NJ
@@ikazukison2 no worries. I'm in Illinois....
@@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!
"Keep the heart full of blood, keep the lung full of air." -Ortho
Actually that was critical care ophthalmology. Which I shouldn’t have memorized
Always sound medical advice, no matter which Dr gave it!
@@Cara-39 I mean from time to time you'd want to empty them so they can refill again no? Keeping them full would be a disaster :p
Honestly true tho
Or was it the other way around? I can never remember - Ortho
I was skeptic at first, but then I heard some of them and I was like: "No, hold on, let him cook"
Yeah, like DocG, please answer them.
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)
"Can you write 'pharmacy to dose' on all orders?" - how dare you put that evil out there in the universe
Critical Care rotation but a future Ortho student.
@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.
That is a funny comment. Thanks for the laugh.
I'm not one to normally throw hands, but this is a sure fired way to get suplexed through the a table.
@@canadotornadoMy impression was Pharmacy already had to fix every single order, so wouldn’t this reduce their workload? 😁
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. = )
Needs more likes😂
Same for Italian: "polmone" and "pneumologo"...
@@rftulie Thank you. XD
The Latin for lung is “pulmonis” and the Greek is “pneumon”. They decided to use different roots for the organ and the specialist because reasons.
@@evilsharkey8954 Those reasons being to make it harder for med students. XD
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
Honestly though I was very confused when I first saw one in action
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
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’
Nerd
number 4 covers 99% of medical terminology. number 10 - pretty much.
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.
Will you be on my bar trivia team?
3. In Italian, the singular is raviolo. The plural is ravioli.
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
Yeah, but actually you meant it.
@@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.
So you took the passive/aggressive route?🤪
"There are no stupid questions"
Oh you'll find them with that
"There are no stupid questions"
"That sounds like a challenge"
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.
Why does hair grow heavily on the head but lightly on the body? Why dont we have large over the head ears like most animals do?
I’m telling all the ICU nurses, it’s now called rotisserie protocol.
Future nurse...need clarification on what this is
We've been calling it that for years
@@erinnorwood6124it's a proning bed, it optimizes oxygenation on patients who are not doing well. Or were you being silly? Sorry couldn't tell.
@MarianneKat thanks I did want to know 😊
“Will you buy lunch today” asking the important questions 😂
Given current food prices and the price hike for buying from the on-site cafeteria or café, plus student loans looming, I totally get it. 😅
We pharmacists are very happy to help, but please don't ask us to dose "everything".
If you do... Don't have your stethoscope around your neck.
lol I have seen some interesting “please choose the right dose of this drug” in order comments.
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.
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.
Horses not zebras.
@@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 feel like I just spent 1:25 minutes reliving my most recent month (July) as a critical care attending…
Best of luck to you and your journey!
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...
Oooo....I'm kinda digging the "panini protocol" 😂
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.
How about "quaternion transformation"?
@@feha92You only need that if you're worried about gimbal lock. Is your patient a satellite in polar orbit?
Do it while the patient is in a bear-hugger and call it "the waffle iron".
"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. 🙏
😂😂😂
Feel better!!
I don't get it
what is rotisserie?
@@NoNameAtAll2Google Rotisserie chicken😅
I’m also inpatient rn, but due to a planned procedure. Get well soon!
Toddler questions with a medical bend. This is great!
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.
Why do we have an ilium and an ileum? Why don't we call the stomach a food bladder? Why does treating illness never involve any actual treats?
I vote for copious treats.
Depending on the indication, dose, and patient response, some medications can double as treats - opioids, benzodiazepines, dissociative anesthetics, . . .
.
If you have ever had to get a cat to take a pill, you will know that sometimes treating an illness DOES require many treats. 😺
@@jayschafer1760 As a vet student, I know this all too well. Human medicine should take note.
One I'll throw in there from my own history: "Sir, can I have this guy's sandwich since he's on the vent?"
Writing "pharmacy to dose" on everything would eliminate all of our fun when we call you and politely explain how your dose is wrong.
LOL too true
"Can you check with dr. Tyler if we are to give the patient 0.3 grams of epi or should we replace it with miligrams?"
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?”.
You start the "rotisserie protocol". 🤤😜
And what was the answer? I'm dying to know
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.
Some of these questions are pretty legit tbh
While I certainly don't want to dose ALL the orders... I think it'd save me time if I could dose all the orders of certain doctors I know
I have a four-year old. These questions sound perfectly reasonable to me
"Why cant we just order 1 bcx" actually true especially during the current shortage LOL
Blood culture vial shortage 😳
That's what we are doing at our hospital. 1 blood culture. 10ml in anaerobic and 5ml in pedi bottle
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.
That’s what I was thinking lol
@@bioboi808 Does anyone disagree with it?
After that episode, that student was never seen again.
There are rumours that he is permanently assigned to the hospital morgue. 😂🤡🤷♂️
A fresh body just came in.
No IDs.
But look at this interesting battery marks around his cranium... its almost like the bell of... a stethoscope!! 😮
Are you kidding? Upstairs we call that a Doug!
😂😂😂😂😂😂😂
I know almost nothing of what was said and I'm still laughing.
Its even funnier when you know what theyre talking about
"What *exactly* are we treating here?" 😂
This caught me off guard!
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.
Im dismayed at the deadly serious attitude my drs have. I demand this kind of bumbling humor.
They all have this humor, out if patients earshot
The attending's face was only in reaction to "can you buy us lunch today?"
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
Why DO we have two lungs instead of one big lung, Dr, Glaucomflecken?
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.
Redundancy.
If one breaks, you have one more left and can continue living. 🤷♀️
One to service each eye.
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.
This video gives me more comfort for when I type into my calculator what 2+2 is during a math test
"Sir. How do the 3 seashells work?"
That's a deep cut. Very nice. "Sir why do all the MDKs show up 30min into the shift??"
You don't know how the three seashells work?! Hahahaha!
I just curse until I have enough paper
I've had nurses call a Roto-Prone bed "the rotisserie bed" 😂 so that tracks
We used to call the Roti-Prone bed “The Extubator”!
I mean, as Gandalf once said, every knowledgeable man should have such an inquisitive student. (paraphrase)
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 thought it's a rotisserie protocol only if the patient is basted regularly.
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.
I see the interns have been hurting your brain. Happy July
Lmao "pharmacy-to-dose" on everything
All very valid questions , I just didn’t know I needed answers to them till today 🤣🤣🤣🤣
Lmao Rotisserie Protocol has got to be the funniest thing I've heard in some time. I mean it's a ROTOProne, right? ROTO must be short for Rotisserie!
This guy made my day. I will never enjoy proning a patient, but now I will because it is rotisserie protocol. It has literally changed my life.
I laughed so hard at rotisserie protocol my pulmon needed help from a pulmonologist! 😂😂😂😂😂
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.
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.
It's not rotisserie protocol it is burrito protocol. We wrapped them in pillows and sheets to get them turned.
The look of utter horror on his face! You blew his mind. 😂❤
When confronted with a catheter and bag full of urine, the goal is to look anywhere else!
Lol "What is a pulmon? What exactly are we treating here?" I mean it's the vegetable aisle, these are valid questions! 😢
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.
Vegetable aisle 😂
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! 😊
"Will you buy us lunch today?" 😂 no worries, Johnathan will be there to make you a 5 star 4 course meal in the cafeteria 😅
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.
As a newer nurse in critical care, I adore my intensivists. They really do make you feel like no questions is a stupid question.
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
There are no stupid questions, but there are a lot of inquisitive idiots...
The pulmonologist one, as a portugueses, sent me 😂 "pulmão" means lung
"Pulmon" in spanish. Obviously a latin thing
Should actually not be too incorrect of a translation, as that language should be related to latin
I love the attending's face at the end. 😂😂
Oh the rotisserie one got me good 🤣 way too many nights spent flipping patients back and forth 😴
For the rest of my career, I'm ordering rotisserie protocol!
As someone who just graduated from med school, this is incredible, i bursted out laughing multiple times, sertified banger video, thank you dr. Glauc!
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."
Rotisserie protocol 😂😂😂
best video ever. That look at the end. priceless!
0:50 "What exactly are we treating here". Actually valid question lol
Rotisserie protocol sounds delightful
Not for the chicken.
Welcome to your first (and last) day of CCM. Good luck on your next rotation.
I loved the mix of dumb and really --- not so dumb.
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. 😅😅
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.
Glaucomflecken, I have been having several rough weeks. This is the first thing that has made me laugh in a long time.
That veteran was NOT prepared for the types and amounts of questions thrown at him.
Going of the last one, i remember a pediatric hospital nurse helping in the ICU during Covid who would always call it "Tummy time"
Yeah after thirty years as a nurse I want to know too!
"rotisserie protocol"--laughed out loud!
Rotisserie protocol had me HOWLING🎉🎉🎉🎉
There are no stupid questions, but there sure as heck are nonsensical ones!
Rotisserie protocol got me wheezing and coughing in my lol’s! 😂
Rotisserie protocol killed me! This was amazing!
The cackle I just let out at 'rotisserie protocol' probably scared my entire neighbourhood. (I live in the middle of a very quiet forest).
ECMO saved my uncles life.
Nothing more to add. ECMO is awesome.
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? 😂
"All valid questions and to answer, we'll go alphabetically."
Bill? 😂😂😂 This was just great lol rotisserie protocol and will you buy us lunch killed me lol
My son just started his Pulmonary Critical Care Fellowship....oh boy...is he in for a wild ride!😅 Of course I sent this to him!!
Rotisserie protocol had me laughing too hard
🤣🤣🤣 I needed to see this this morning!!! Thanks!!! 🤣🤣🤣
The cusp.of fame .
It's usually the innocent and seemingly innocuous little brother of " can I please have that in writing /email ?" .
One of the 7th Seals is about to be opened ....
I think this just became my favourite of yours 🤣💛
Reminds me of the fantastic "Greenside" cartoons: "No matter what you've heard, there are no stupid questions. There are only stupid people who didn't listen to me properly the first time!"
BIGGEST of lungs. SO big!
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 ❤
We’re in a national culture shortage so maybe just for now you can just order 1 blood bottle.
What is the tipping point for acronyms to be pronounced like words? Like ICU is "I C U", but MICU is "Mc-you"
Nah I'm with you on the ECMO question.
I've seen it, I learned it, I used it, but what is it really?