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< Back Sausage Tortellini and Brussels Sprouts Ingredients Sausage Tortellini 2 Tbsp olive oil 2 lbs sausage 2 cloves garlic, minced 1 c vegetable broth 2 c tomato sauce ½ c heavy cream 18 oz tortellini Salt & pepper Brussels Sprouts One package of Brussels Sprouts olive oil black pepper sea salt balsamic vinegar Instructions Sausage Tortellini Heat oil in a large skillet and cook sausage links about 5-7 minutes, until sausages are browned throughout. Add garlic and heat for 30 seconds. Remove sausages from skillet and slice into bite-size pieces. Return sausages to pan along with broth, tomato sauce, cream, and tortellini. Season with salt & pepper. Cover and simmer for 12 minutes. Brussels Sprouts Prepare sprouts by trimming the base and then cutting the sprouts in half or quarters, and then place them in a medium-sized bowl. Drizzle a small amount of olive oil and balsalmic vinegar, and then sprinkle black pepper and sea salt. Toss to coat the sprouts, let sit for at least 30 min. Roast at 400 for 20-30 min, toss halfway through. Sausages cooking Previous Tortellini in Sauce Brussels Sprouts Next

Confessions of an ICU Physician with a terrible memory Accessing the Right Information < Back Confessions of an ICU Physician with a terrible memory Training in medicine starts with textbook learning. But the art of caring for patients can’t be learned in a textbook. Higher-order thinking is essential to understand the interaction between multiple conflicting disease processes, identify nuisances of atypical presentations and find solutions for clinical conundrums. As the field of medicine grows exponentially, the volume of information is too much for one person to keep track of. I find that understanding clinical concepts is much easier than rote memorization of pharmaceutical brand names with their associated generic name, recalling the dose of a paralytic, or identifying the ideal antibiotic for a multi-drug resistant bacteria. After several years of learning and studying mechanical ventilation and how it interacts with and affects a patient's respiratory physiology, I now understand the principles of how to optimize oxygenation and ventilation. As an ICU physician, I can't re-read the basic textbook of mechanical ventilation every time I care for a patient with respiratory failure. I must be able to make decisions relatively quickly and must be able to explain my rationale to residents and bedside nurses while we are working to manage a patient with severe lung disease. But I can pause to look up the recommended dosing of a medication for a patient on dialysis or identify the best anti-microbial for a particular bacteria or fungi. What do I do about important information that I need immediate access to but that doesn't reside in the forefront of my mind? Smartphones, with access to websites and applications , have revolutionized our ability to bring evidence-based medicine to the bedside. Clinical practice guidelines can be accessed on society websites. Deployed Medicine is a resource that provides access to Tactical Combat Casualty Care and Joint Trauma System Clinical Practice Guidelines. There are apps for a wide number of clinical programs that were initially web-based, such as UpToDate. In addition to the resources that are openly available to the public, I have created a database of personal high-yield references. Medication dose ranges, CPGs for our trauma center, AAST Injury Scales, sedation/ pain scores, TEG parameters, and a wide variety of other information that I refer to on a relatively routine basis are now in the palm of my hand. I use the Trello app. I created a dedicated workspace with a group of lists (titles such as trauma, medication, ICU, etc) which each contain multiple individual cards (titles such as A-F bundle, CAM-ICU/ RASS/ CPOT, TEG). I'm not saying you have to use this. But I highly recommend finding a tool that works for you. TL;DR • Take the time to understand processes and concepts- learn one physiology concept from each pt • Have an external tool for storing “rote memorization” facts that you can readily access Previous Next

< Back Ultrasound: Just The Basics Ultrasound is a non-invasive, repeatable, portable, reproducible diagnostic tool. It can be used virtually anywhere that patient care is being performed, including pre-hospital, the ER, OR, ICU, and non-ICU inpatient wards. Ultrasound skills vary between providers. I am a strong advocate of utilizing the ultrasound, and you will become more comfortable as you increase your utilization of the US. The credentialing process for ACS surgeons is not well-established, and we do not have the same expertise as radiologists. SCCM guidelines currently support ICU providers' utilization of US for certain scenarios. However, ICU providers are not as reliable in certain diagnoses, such as biliary pathology. Basics of Ultrasound: How Does it Work? Crystal excited by electrical pulses (piezoelectric effect)→ mechanical oscillations→ sound waves emitted. Sound waves are reflected at interfaces of different acoustic densities. Higher acoustic density→ increased intensity of reflected sound and decreased transmission of remaining sound waves. If the interface is between objects of vastly different acoustic density→ complete sound wave reflects and total acoustic shadowing occurs (dark behind the object); examples include bone, stones, and air. Probe selection Linear array- parallel sound waves→ rectangular images. Near-field resolution, high frequencies 5-7.5 MHz)- good for thyroid and soft tissue. Artifact on curved surfaces. Not good for intra-thoracic or upper abdominal organs. Sector/ phased array- fan-like image (narrow nearest transducer and widening with deeper penetration). Frequency 2-3 MHz. Poor for near-field resolution. Used for cardiac imaging. Curved (convex) array- abdominal sonography. 3.5-3.75 MHz. Deeper tissue penetration. *Probe marker correlates with the dot on the screen to establish orientation. Artifacts Reverberation echoes-several strongly reflecting boundaries→ reflection of sound waves back and forth→ echoes (several parallel lines close to the transducer). A-lines when scanning the lung- hyperechoic arcs parallel to the pleural line. These are seen at intervals that are the same as the interval from the skin to the pleural line. Absence of A lines= change in attenuation coefficient of the lung (edema, consolidation). B-lines when scanning the lung (comet-tail artifact)- vertical hyperechoic lines, caused by fluid-filled intra-lobular or interlobular septa touching the visceral pleural surface. Distal acoustic enhancement- sound waves travel through homogenous fluid (low reflection)→ less sound wave attenuation, so they are more amplified compared to adjacent sound waves (because the structures they passed through reflected some of the waves). *Brightness (increased echogenicity) behind fluid-filled structures such as the bladder or gallbladder. Mirror image- diaphragm and visceral pleura→ intrahepatic structures can be seen on the pulmonary side of the diaphragm. Acoustic shadowing- interface between tissue and bone or tissue and air→ scattered beam→ inability to image deeper structures. Knobology Identify the probe Identify the selected study type (cardiac, FAST, soft tissue, etc) Gain- increases the strength of sound/ brightness of the visualized area Depth-gain compensation- selective enhancement of echoes received at different depths→ moving depth up or down increases or decreased the field of view. Time-gain compensation- adjust the strength of the beam to areas that would normally have attenuated beams. M-mode- display and measure movement of structures over time along a single lione (axis of the beam). Good for heart or valve motion (echo), hemodynamic status (respiratory change in IVC diameter) and lung sliding or diaphragm movement. Doppler- changes in frequency cause by reflections off a moving target (usually blood). References Frankel HL et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part I: General Ultrasonography. Crit Care Med. 2015 Nov;43(11):2479-502. Levitov A et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit Care Med. 2016 Jun;44(6):1206-27. Labovitz AJ et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010 Dec;23(12):1225-30. Borloz MP et al. Emergency department focused bedside echocardiography in massive pulmonary embolism. J Emerg Med. 2011 Dec;41(6):658-60. Bakhru RN, Schweickert WD. Intensive care ultrasound: I. Physics, equipment, and image quality. Ann Am Thorac Soc. 2013 Oct;10(5):540-8. Silverberg MJ et al. Intensive care ultrasound: II. Central vascular access and venous diagnostic ultrasound. Ann Am Thorac Soc. 2013 Oct;10(5):549-56. Doerschug KC et al. Intensive care ultrasound: III. Lung and pleural ultrasound for the intensivist. Ann Am Thorac Soc. 2013 Dec;10(6):708-12. Boniface KS et al. Intensive care ultrasound: IV. Abdominal ultrasound in critical care. Ann Am Thorac Soc. 2013 Dec;10(6):713-24. Repessé X et al. Intensive care ultrasound: V. Goal-directed echocardiography. Ann Am Thorac Soc. 2014 Jan;11(1):122-8. De Backer D et al. Intensive care ultrasound: VI. Fluid responsiveness and shock assessment. Ann Am Thorac Soc. 2014 Jan;11(1):129-36 Labovitz AJ et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010 Dec;23(12):1225-30. Borloz MP et al. Emergency department focused bedside echocardiography in massive pulmonary embolism. J Emerg Med. 2011 Dec;41(6):658-60 . Emergency Ultrasound Tutorials American College of Emergency Physicians: Ultrasound Lectures Previous Next

< Back Tips and Tricks General Tips Despite popular belief, you don’t need a daily CXR for every ICU patient, every intubated patient or every patient with pneumonia/ rib fractures. Don't get daily labs or daily imaging "just because". Get studies that will change your management. For stable patients, you don’t need to check a CBC immediately after every transfusion. You don’t need a PaO2 to wean FiO2. PaO2 is an infinitesimally small contribution to arterial O2 concentration. The equation is often simplified by removing it all together! CaO2= (Hgb x SaO2 x 1.38) + (PaO2 x 0.03) ≈ (Hgb x SaO2 x 1.38) Avoid adjusting multiple meds at one time when addressing a symptom (for example, adding a new medication and increasing the dose of another medication). Too many changes at the same time will make it difficult to know what medication change was responsible if there is a clinical change. Most patients don’t need a CXR after chest tube removal. If the pt has PTX that requires a chest tube, they will tell you (meaning they will be symptomatic). If you check a CXR on everyone, you will find small PTXs that don't need treatment. Not everything that hurts/ bleeds is a hemorrhoid. Exam is required to identify the etiology. If you treat a fissure with hemorrhoid meds (witch hazel, suppositories) they won't get better. Plus, witch hazel will burn and suppositories will be incredibly painful. Patients often get better despite us, not because of us. Many things we believe to be optimal treatment now will be considered heresy in the future. Sometimes not doing something is the best thing to do. Sometimes not operating is the compassionate thing for the patient. A patient doesn’t have to die with an incision on their abdomen. Working with your team Trust the nurse when they say they’re concerned. Better to have a phone call for a patient who is ultimately fine vs not getting a call when the patient isn’t fine. If you respond to nurses by telling them it’s fine and not to worry, they will learn not to call you. If you respond to nurses with hostility, they won’t go out of their way to make your life easier. Don’t call your mid level resident/ chief/ fellow/ attending without any more information than you were initially given. When requesting a consult or calling your chief/ fellow/ attending about a new consult/ admit, give the bottom line upfront. This is especially true when you are waking someone up or need them to do something quickly (ie get dressed and drive in). Tips for the OR While closing fascia, if you maintain counter-traction on the fascia with your pickup as you pass the needle through the fascia, you can release the needle while it’s still in the fascia and reload the needle farther back to push it the remainder of the way through the fascia. Then you can reload the needle and be ready for your next bite without having to touch the needle (decrease risk of needle sticks). Ask for instruments and sutures several steps ahead so you minimize pauses. Always ask for cell saver for a bleeding patient heading to the OR. You don’t want to be delayed waiting for it to be set up before you make your incision. Tips in the Trauma Bay Don’t use GCS 8 as an automatic trigger for intubation. If you intubate before addressing hypovolemia or relieving obstructive physiology, there is a high risk of cardiovascular collapse and asystole. Previous Next

< Back Studying Tips Study Techniques Reading and re-reading textbooks/ notes. Pros- simple. Cons- passive. Easy to not absorb information as your eyes pass over the same text. Reading and highlighting textbooks/ notes. Pros- simple. More interactive than merely reading. Cons- similar to re-reading- still relatively passive. Risk of highlighting everything and not focusing on key points. Reading and handwriting notes in your own handwriting. Pros- active engagement in learning, reframe the information in your own style. You can color-code, reorganize, personalize it. Cons- takes more time. When to study There are two key circadian rhythm patterns. In his book When: The Scientific Secrets of Perfect Timing ," Daniel H Pink refers to these as "chronotypes." There are three chronotypes (larks, owls, and third birds), but the differences between them are largely inconsequential, so they are simplified to two different groups, classically known as early bird and night owl. If you haven't identified your chronotype, you can do a few relatively straightforward steps to determine your pattern. Identifying your chronotype will give you a framework to plan your peak time for analytical tasks, such as studying. If you have any control over your daily schedule, even if it's just weekends, take advantage of your inherent pattern to optimize your studying. Early morning studying before class/ clinical rotations might be optimal for some, while others are more conducive to evening learning. What has worked for me? I used to be a read and re-read type. I'm a fast reader, so it worked to get through high school and medical school. During surgery residency, I used iAnnotate PDF, which allows me to highlight and make notes. When I was entering fellowship, I renovated my style. First, I wrote notes for the handful of critical care texts that I read (Fink and Marino) and the trauma text (Mattox). During the summer before my ACS fellowship, I typed notes while reading Fink and Marino. I used iAnnotate PDF because it allows me to highlight and make notes. I did switch to a hard copy of Civetta because I needed a new format to re-ignite my focus. I used old fashioned lined paper and pencil and then rewrote them into a notebook. After I got burnt out on textbooks, I made the leap to reading journal articles. Switching to primary literature was a monumental change in my studying. I always marvel at attendings who can quote journal articles with ease. It always strikes me that their memory is so crisp...I've never had that gift. When I started reading articles, I developed a system for finding, reading, and then recording the salient findings. How I built my literature database for Acute Care Surgery There are several ways to find articles. Surgical Clinics (previously known as Surgical Clinics of North America) is one of my favorite journals for reviewing broad topics. Every article is evidence-based, with abundant references. The most current journals will be a treasure trove of high-yield references. The open journals and published guidelines (read: free!) are another excellent resource. The references in reviews and guidelines are the basis of evidence-based medicine. Read! You don't have to read every word, and as you read more articles, you will develop a sense of which papers can be perused and which deserve a more diligent review, such as landmark articles (see suggested articles). Highlight, make notes and ask yourself, "how will this change my practice". Previous Next

Measuring Cups and Spoons < Back Kitchen Hacks #2 Measuring Cups and Spoons Cooking versus baking…what's the difference? Technically cooking is a general term encompassing all manners of food preparation. But cooking is typically used to indicate a style that doesn't involve baking. Baking is a science that requires attention to detail and precisely measured ingredients that often have to be combined in a specific order. Recipes for baked goods frequently indicate weight in ounces (which required a small countertop scale) as well as volume (measured in your dry measuring cup). On the other hand, cooking allows on-the-fly modifications- it's much more forgiving to small variations. Baking requires precise measurements- so you'll need a variety of dry and wet measuring utensils. If you're unfamiliar with baking, here is a quick summary of how to measure dry and wet ingredients. What are dry measuring cups and how do I use them? These hold the exact amount of an ingredient (you fill these to the top). Either spoon the ingredients into the cup or scoop the cup into the container holding the ingredient (ie wide-mouthed containers). Fill to the top without packing, and level off the top (knife, the handle of a cooking utensil, chopstick, whatever you have). The only ingredient that gets packed is brown sugar- otherwise, unless the recipe specifically mentions packing, don't pack! What are liquid measuring cups or beakers and how do I use them? These have graduated indicators to allow pouring an exact amount of liquid, and the top measurement is below the top of the cup (no spills when pouring). Why can't I just use dry measuring cups for liquids? If you use a dry measuring cup for liquid, it will be very challenging to avoid spilling the ingredient when adding it to the recipe (remember, dry cups get filled to the top). What can I measure with a measuring spoon? Fortunately, these can be used for both dry and wet (although if you have beakers with small measurements, you can also use those for measuring out liquids). Warning about dry ingredients. If a dry ingredient is specified by weight (ounces), this cannot be converted to cups! 8 ounces of flour ≠ 8 fluid ounces of liquid, which is 1 cup of liquid. If you want a visual of the range of what 1 cup of dry ingredients can weigh, check out this extensive list . Previous Next

Practical Tips on Having a Difficult Discussion How Do I Do It? < Back Practical Tips on Having a Difficult Discussion This blog is complementary to the previous blog about becoming more comfortable with uncomfortable conversations. After many difficult discussions with families during my critical care fellowship, I finally became comfortable with uncomfortable conversations. It's impossible to develop a script to use for every conversation, but here are some of the techniques I've adopted over the years. Sit down in a private room, have tissues if appropriate. Make sure your phone/ pager won't interrupt the conversation. Have someone else with you. It’s always good to bring the patient's nurse, and there is often spiritual support staff (ie chaplains) who can accompany you and provide support for the family. Introduce yourself, and ask who everyone in the room is, specifically how they're related to the patient. "Nice to meet you, I'm really sorry it's under these circumstances." If it's your first conversation with the family, it's important to establish a foundation to build on (or establish the absence of a foundation). You can ask "what do you know so far" or "what's your current understanding of the situation"? This also allows them to express their current questions/ concerns. Judge their level of comprehension and adjust as needed. This does NOT mean being patronizing or imposing stereotypes. Pay attention to facial expressions and listen to their questions/ responses. It's easy to fall back into speaking medical jargon- you need to deliberately focus on using easily understandable words. Words that we use every day are meaningless to most people who aren't in the medical field. Keep the conversation brief and take frequent pauses. They don't hear everything you say, and they'll hear even less if you talk non-stop. Allow them time to process what you’ve shared, and allow them to ask any questions they have. Acknowledge that it’s common to be overwhelmed by the discussion. You can validate them by offering "I know I just told you a lot of information" or "I know this can all be overwhelming". It’s also helpful to say, “I’m sure you will think of other questions, please write them down so we can discuss them later” Encourage them to discuss things amongst themselves and provide them a quiet private place to regroup after the meeting. It’s also helpful to say, “I’m sure you will think of other questions, please write them down so we can discuss them later.” This validates their feeling and reassures them that they don't have to worry about remembering every detail. Specific difficult topics - Death and dying. Acknowledge that what they are feeling is normal- regardless of what they feel, it's normal. Denial, angry, scared, guilty, confused, conflicted, exhausted, numb. - When they are wrestling with the decision about transitioning to comfort care (colloquially known as "withdrawal of care", or crassly, "pulling the plug") and they've verbalized that they know it's what their family member would want, acknowledge how difficult that decision can be but also reaffirm that they are doing the kindest thing by honoring their family members wishes. For other helpful tips, check out "Sunburn". "For patients who are alive, concentrate on the ‘big picture’ and avoid the inclination to catalog every injury during this initial encounter. The primary concern in these settings often consists of survival, brain damage, paralyzation and other major morbidities. Again, an overabundance of information can be overwhelming." Velez D et al. SUNBURN: a protocol for delivering bad news in trauma and acute care surgery. Trauma Surg Acute Care Open. 2022 Feb 9;7(1):e000851. Previous Next

14 Scienceblind Why Our Intuitive Theories About the World Are So Often Wrong Intuitive theories- our best guess as to why we observe the events we do and how we can intervene in those events to change them. Infer causality from our observations. Similar to historical theories- how we used to understand things before we had the ability to understand the reality (like heat as an “object” versus “energy”). Emergent process- system wide (no clear cause/ effect explanation), equilibrium-seeking, simultaneous, ongoing. Heat, weather, evolution are all emergent processes. Molecular theory, scientific theory. Holistic theory- matter is continuous and has heft and bulk Intuitive theories of the physical world Matter- substances are holistic and discrete, instead of particulate and divisible. Conservation- clay flattened, water poured from short fat glass to tall skinny glass. The difference between weight and heft, volume and bulk? Energy- heat, light and sound viewed as substance instead of emergent property. Why can you touch the 400 degree air in the oven but not the pan itself (without oven mitts)? The pan transfers heat better than air. How do we change from viewing “sound” as an “object” to viewing it as “energy”? First, we stop attributing permanence (noise doesn’t continue forever), then weight (clock doesn’t become lighter with each chime) and then mass (noise can pass through a wall, doesn’t have to maneuver around wall). Extra-missionist- rays go out of the eye and then return to create vision vs intro-missionist- rays enter the eye to create vision. Gravity- weight is an intrinsic property of objects instead of relation between mass and gravity. Objects don’t fall because they’re heavy- they fall when they don’t have upward force on them that exceeds gravity (center of gravity). Motion- force is something transferred between objections (“impetus”), instead of external factor changing the objects motion. What path will an object take- for example, a ball in a spiral slide- takes straight path after exiting, doesn’t gain an inherent “spiral” motion. Cosmos- earth is a motionless plane orbited by the sun. Changing of the tides, seasons (tilt of the earth as it revolves around the sun, the side closest to the sun is summer). Earth- continents and mountains are eternal and unchanging vs transient/ dynamic. Tectonic plates- similar land features on different coasts. Greenhouse effect and global warming- humans causing it, but the earth will live beyond us. Vitalism- living things possess an internal energy, or life force, that allows those things to move and to grow. Essentialism is the idea that an organism’s outward appearance and behavior are products of its inner nature, or “essence.” Intuitive theories of the biological world Life- animals viewed as psychological agents vs organic machines. Death= cessation of biological processes. Growth- eating is for satiation rather than nourishment, aging is a series of discrete changes vs continuous change. Vitalism- living things possess an internal energy, or life force, that allows those things to move and to grow. Essentialism is the idea that an organism’s outward appearance and behavior are products of its inner nature, or “essence.” Inheritance- parent-offspring resemblance viewed as nurture, vs transfer of genetic information. Illness- disease is due to supernatural causes, instead of microorganisms. Adaptation- evolution is the transformation of an entire population (butterflies become slightly darker with each generation) vs selective survival (darker butterflies survive to reproduce). Ancestry- species develop linearly (monkey→ ape→ human) rather than branching from common ancestor. Previous Next

Meal Prep: Eating with Intention < Back Kitchen Hacks #1 Meal Prep: Eating with Intention Want to stop eating cereal or takeout for dinner? Want healthy food options in the house? Whether you have a big family or you’re cooking for one, you CAN be more purposeful about your eating habits. Cooking healthy delicious meals while maintaining variety at meal time and keeping your kitchen stocked so that you’re able to cook without having to make multiple trips to the store doesn’t have to be an intimidating endeavor. Let’s walk through the key components of a successful cooking plan. * Create a collection of recipes . Some people might not routinely rely on recipes when cooking- if that’s you, feel free to skip over this. However, for the rest of us, recipes serve as the basis for meal prep. Your collection can be as simple or complex as you want. Recipe cards in a box or book, pages ripped out of magazines, cookbooks with bookmarks, links to recipes online, a basic phone app or even just a simple word document- whatever works best for you. After you decide on how to collect your recipes, the next step is making recipes easy to find. ** Organizing- Start with a few broad categories, such as breakfast, side dishes, sandwiches, main course and dessert. Once you are familiar with how you use your recipe collection, feel free to create more specific categories. For example, my categories include apps and side (sub-category: vegetables), bread (sub-category: breadmaker), breakfast, dessert (sub-categories: brownies and bars, cakes, candy, cookies, cupcakes, ice cream and pies), dinner (sub-categories: chicken, crockpot and fish), dips and sauces, new recipes, pasta, pizza, salad and finally, sandwiches and burgers. * Create a collection of meals. You probably have a few combinations that you routinely prepare and serve. For example, meatloaf, mashed potatoes, and green beans. Not every food needs a recipe, and you might even do some meals from memory. But creating a list of meals can help remind you of dishes you haven't had in a while and gives you more options to choose from when you’re in a rut. * Create a list of items in your pantry (and fridge/ freezer)- specifying quantity is important. You don’t have to include every item, but keeping track of commonly used items can help avoid situations such as three extra bags of white sugar or running out of key spices. * Create a meal schedule. Just like everything else, this can be as simple or detailed as you would like. Whether you do a weekly meal prep session or plan meals a day or two at a time, a schedule can help you remember to set aside or purchase the necessary ingredients ahead of time. A schedule can also help when projecting leftovers- like what meals are a good setup for packing a lunch the next day. * Create a grocery list. At a minimum, you should jot down what you need before leaving the house. But there are several ways to optimize your preparation for the grocery store. Making the list at home is key, because you can check what you have in your pantry/ fridge. ** Develop a list of commonly purchased items - this will make it easier to add things to your list before you head to the store. ** Keep a list near the refrigerator or pantry- this can be a simple notepad, a white board or whatever else suits you. When you are in the kitchen and notice that you are running low on something you normally have on hand, just jot it down on the list. Then on shopping day, it’s easy to keep track of staple items. ** Using your meal schedule/ recipes, you can gather the ingredients that aren’t in your collection of staple items. This is often fresh fruit/ produce or dairy/ meats. ** If you find yourself at the grocery store on the way home from work (or anytime you haven’t had a chance to make a list), you can pull together a meal by selecting from your recipes or meals and then sorting through your pantry list to determine what ingredients are missing. * I recommend downloading the Paprika application (iTunes application , $4.99). It is an all-purpose tool for collecting/ sorting recipes, creating menus, keeping track of ingredients in your pantry/ refrigerator/ freezer and making a grocery list. You can add recipes from almost any website and can also manually add personal recipes (and even add a picture of your own creations!). You can create a menu schedule and grocery list directly from recipes. Keeping everything in one place avoids the need to refer to different resources (recipe book, list on the refrigerator, electronic version of a pantry list). * Here are two of my favorite websites for recipes. ** Cooking Light Free access to countless delicious healthy recipes! ** How Sweet Eats Started following this years ago when I stumbled on some of the recipes on Pinterest. Love the name- we are both fans of James Taylor! Previous Next

10 Loonshots How to Nurture the Crazy Ideas That Win Wars, Cure Diseases, and Transform Industries - S type and P type loonshots. Innovators (creating loonshots) have to co-exist with the “businessmen”- you can’t just segregate different groups. The innovators need the company to make a profit so they can continue to take risks and make discoveries. And the business needs to nurture loonshots. - In case you were wondering how polarizing crystals were discovered. Or check out this article in Science magazine. - Bad decisions may occasionally result in good outcomes. But you need to analyze wins- you might not be so lucky next time. - Good decisions may result in bad outcomes. You made the best decision with the information at your disposal. In those same circumstances, you’d make that same decision. - How do crickets synchronize their chirps? - Percolation. A mathematical explanation for predicting events based on an inherent variable. - How do forest fires spread? Relevant variables- the distance between trees, humidity, wind. - How do pandemics start? How appropriate…depends on the proximity of individuals. - Phase transitions - Why do traffic jams occur? Just above a certain density of cars on the roads→ jam. - Emergence- innate characteristics of how a group functions based on the size (ie what patterns shift after the group reaches a size, although the precise size is variable for groups) While individuals remain puzzles, man in the aggregate becomes a mathematical certainty. Meaning- group dynamics are universal, regardless of the characteristics of the group members. Previous Next

[Editorial inspired by @kari_jerge] Why Don't They Believe Us? < Back [Editorial inspired by @kari_jerge] Seen on Twitter recently: Troll: I demand pictures of your full ICU to prove to me it’s full Female surgeon: None of us owes you a damn thing. Especially not pictures that will get us fired. But I’ll get right on that… What do you do if you accidentally injure yourself while working or making home improvements? Do you call 911 or have someone drive you to the ER? What do you do if you have high blood pressure, or diabetes, or depression? Do you go to a primary care doctor? What do you do if you have severe arthritic hip pain that doesn't resolve with conservative (non-operative) management? Do you consider talking to an orthopedic surgery about a hip replacement? I don't know what portion of the population inherently trust the medical community, but for the remainder of this editorial, I will presume that it's a majority. For those that don't, this doesn't apply. If you don't trust modern medicine, I won't convince you that you should trust our reports about this pandemic. Let's assume you accept modern medicine, including visiting the emergency department, having a primary care doctor, taking prescription medicine, and any of the other various diagnostic tests, consultations, and treatments. If this is the case, why would you think we would voluntarily try to deceive you about the capacity and occupancy of our ICU facilities? Why would so many medical community leaders actively speak out with a nearly singular voice to spread a lie? Ranging from the widely known Dr. Sanjay Gupta to a wide assortment of medical providers in many specialties. We have nothing to gain from building this whole façade. This isn't just a few people speaking up. This is a monumental effort to warn people. Social media has given a voice- and many have worked very hard to dispel the myths spread by many loud voices that continue to spread falsehoods. We have nothing to gain. You trust us to save your life when you have a heart attack, need emergency surgery, or care for you when you're severely ill from any matter of diseases. We haven't changed as a community to collectively spread these myths. It really is as bad as we say. We genuinely don't get paid more for patients who die from COVID. We don't have adequate PPE. We aren't lying. If you continue to deny reality, we will still care for you or your family and friends, in the unfortunate case you become ill, because that's what we do. We are just hoping that we will have the resources you need. And if we stretch our personnel any thinner, we will not have enough nurses and providers to care for you. We are the last hope. Don't make choices you'll regret. Previous Next

What is ACS? A day in the life of an Acute Care Surgeon. FAQs. ICU Rounds. Trauma Surgery. Acute Care Surgery What is Acute Care Surgery? Medicine, particularly surgery, has become increasingly specialized, with providers developing progressively narrower expertise. Previously, surgical critical care fellowship was the primary pathway for specialization in the management of critically ill and injured patients. Management of "sick" surgical patients, regardless of the underlying surgical etiology, requires flexibility in addition to width and breadth of knowledge to manage a wide spectrum of clinical challenges, including deranged physiology and complex surgical pathology. Balancing an acutely hemorrhaging patient, an elderly patient with severe poly-trauma, a ventilator-dependent patient with an acute abdomen...the list is endless. Acute Care Surgery (ACS) was brought about to ensure that there is access to a specialized physician that can manage a spectrum of critically ill patients, including trauma, emergency general surgery (EGS), and surgical rescue . Surgical rescue involves the management of procedural complications or clinical situations that require emergent surgical intervention: "airway emergency, hemorrhage, intestinal obstruction, perforated viscus, tube/line/device dysfunction, uncontrolled sepsis with a surgical etiology, visceral ischemia, and wound complication." Management can include the following interventions: "airway intervention, biliary repair/ reconstruction, bowel resection, hernia repair, hemorrhage control, source control of infection, surgeon-guided resuscitation, tube/line/device repair, and wound debridement."(1) Pillars of Acute Care Surgery 1. Kutcher ME et al. Surgical rescue: The next pillar of acute care surgery. J Trauma Acute Care Surg. 2017;82(2):280-286. 2. Kutcher M.E., Peitzman A.B. (2017) A History of Acute Care Surgery (Emergency Surgery). In: Di Saverio S., Catena F., Ansaloni L., Coccolini F., Velmahos G. (eds) Acute Care Surgery Handbook. Springer, Cham. Who Is Our Patient Population? Read More A Day in the Life of an Acute Care Surgeon Read More What happens during Surgical ICU (SICU) Rounds? Read More Who is on the Trauma Team? Read More What happens in the trauma bay? Read More The Trauma Bag Read More Frequently Asked Questions Read More Definitions Read More More Information on Acute Care Surgery Read More