Trying to learn ANY medical procedure
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- Опубликовано: 10 сен 2024
- It can be....a bit frustrating at times.
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This is so accurate - its infuriating how every teacher has issues with how the other teacher teaches
It's SO frustrating being thrown in and receiving contradictory instructions 😭 that said, I have a good story! Recently I was on night shift and nurses called me to insert a VERY difficult cannula in an edematous patient - asked an anesthesiologist for help, I watched her do MAGIC, and then I used all her techniques to cannulate FOUR more patients with difficult veins! That's an example of how teaching in an effective manner can be immediately beneficial for the learner and patients!
EDIT: part of being a doctor learning to be a good teacher - it's shocking how poor some are teaching, so when you come across the gems, it really sticks in your head! I'm super keen on medical education and want to continuously improve my teaching skills!
I wish you would have been my anesthesiologist. Last time I had surgery (two years ago), the anesthesiologist had to try seven times to get an iv in. I’m pretty pale and my veins looks visible, but when you go to try to get access it’s a nightmare. He finally gave up and got a vein finder. No problem after that. Truth me told, I only have one good vein between both arms and it’s used to death for blood draws.
I had a bunch of bruises on my arm but the surgery itself was a breeze.
ok, now you must share the tips for this please >
Where.... where exactly would I find this anaesthetist .... asking for a friend?
Please share the tips
I'm not the OP but 1. Palpation over sight is the key. Palpate larger stretch of the vessel than You'll think You need, see if it bounces back from pressure, if it feels or sounds odd - you feel or hear cracking, the area around the vessel is very firm in few places it might mean the vessel is unviable - especially if the patient is elderly, has received chemotherapy or other IV medications known to be harmful to veins or is an IV drug user. Feeling larger stretch of the chosen vein allows You to visualise the best approach and angle. It's far less discomfort for the patient to be gently prodded than jabbed dozen times without success. 2. If the patient is in good enough condition ask them to squeeze their fists, pump and swing their arms, keeping the patient's arm warm helps bring vessel to surface - some nurses swear by keeping the "poke room" in "walking wards" icy cold as something that helps them stick older patients but objectively it's more comfortable for both the patient and provider and to my knowledge so far heat helps with vasodilation.3. If patient isn't able to move, lowering the extremity where the access is to be placed below the heart level (while of course watching out so they don't roll over. Having some movement or de-elevation of the extremity before placing the elastic pressure wrap (called stasis in my country,no idea what's the common healthcare name for this apparatus 😅) is extremely helpful - also, don't pull it too tightly in one go. Rather if having problems palpating vessels without it on, increase the tightness incrementay, allowing more blood to pool in. 4. Remember not to aim directly at the chosen spot (or else You'll either overshoot, puncture the vessel, have the cannula bend or press on the vessel's walls or luck out) but slightly below it, remembering to maintain the right angle - usually 35 is as extreme as it will go and that only if the vessel is deeper. Try to aim for a spot that is followed by a stretch of vessel that is straight without pulling on it (especially in older patients). If the patient is conscious asking them to put hand in fist helps with rolling veins on the upper side of the arm and hand but either way, pressing firmly and gently pulling the skin and tissues below the poke point helps with stabilising the vessel so it doesn't roll away (more common with cannula than needle) 5. If the patient is a drug user - don't be afraid to ask them where they have good veins, be more thorough with palpation to feel out the scarring and unviable vessels. In such cases knowledge of anatomy and variations of deeper vein placement is crucial as these may be the only viable veins for cannulation. 6. Use the smallest bore cannula in suitable range especially with elderly patients. Avoid using topical numbing,it increases difficulty and probability of needing to fish out for the vein, increasing child's pain and distress. In all cases of fearful, anxious patients (and especially those that You are anxious about because of the difficulty or because of their vulnerability) - engage them in conversation, try asking them about something they like and will likely have to focus and elaborate on, such as hobbies, local or national sports they may be fan of, their family - but if You fear you may be received as too friendly stick to neutral or medical topics such as their experience during their stay, whether they have any complaints, needs, suggestions - keep them engaged and their focus away from incoming needle. The best sticks are when patient doesn't realise you're already done 🙂 7. Avoid digging with cannula unless You feel certain You're about to perfectly slide in. By their nature and size it's far more painful for the patient than doing the same with the needle and it's better to just use a new one than cause a whole lot of pain and bruising (at the same time increasing difficulty of puncturing the vessel). Be aware of major nerve placements in the arms. Try practicing with ultrasound or vein-finder but avoid relying on them in case they aren't available at the time of emergency and use them when it's really medically warranted. Practice and observation are best tools. 8. Don't be afraid to ask for help or to follow a colleague who is more proficient. I'd suggest trying on Yourself if it wouldn't get me burned at stake 😂 Practice, knowledge of anatomy and lack of fear and hesitation are key elements. As with anything in a perfect educational setting You'd increase difficulty level slowly - from young athletes to 60 year old IV drug users after chemo,but as we all know its impossible so don't hesitate to ask for help right away - tis' miles better than growing fearful and start doubting yourself after multiple failed attempts force You to do so. Happy vampiring ✨😁
Reasons why it's good to have talked through it properly beforehand by someone who remembers learning and who can talk about common pitfalls and troubleshooting and useful tips - not someone for whom it's second nature and they forget that it's not easy and quick for everyone
Unfortunately, bosses like this are not limited to the medical profession. They can be found everywhere.
Agreed
@@Doc_Schmidt you forgot "use more water..... now you're using too much suction"
that sigh at the end when he heard that another 8 waited for him
The impatience is amazing and some attendings have no problem yelling at you in front of patients
Oh God, this happened to me during my surgery rotation. I was doing a laparoscopic procedure. The attending was getting frustrated that I was almost having to pull the scope all the way back to get a good image. Then, it turned out the camera was zoomed in all the way lol
the backseat driving of teaching and learning 😅
It’s inevitable 😅
OMG, it is spot on.
I am in veterinary medicine and that happen to me so many time.
Amen...I almost decided not to do scopes during my (family med) residency due to the conflicting "advice" from all the different attendings!
That was by all means a fairly gentle teacher.
Watch a surgeon teach someday!
We are learning to be gentle and patient these days.😁😁
Did you strategically post this one after you completed your fellowship so you don’t have to face your attendings?! Haha it’s spot on.
Doesn't he have a year left? Lol
I remember my cardiology registeror used to say the same about our professor, that he's a nice guy but such a pain during angiography.
Ya that's just one attending. There's usually a few more with their idiosyncrasies on why their way is the best and trying to remember each ones preferences especially when you with a different one each day of the week!
And the student has to remember each ones idiosyncrasies and scope "their way" when they're in the room, eventually they'll end up (hopefully) with distillation of all the best techniques.
I'm crying at the accuracy
One of many reasons I chose a non-procedure specialty (even though the pay is much less).
I can't even imagine having someone looking over my shoulder when I was working. I think I would be so nervous that I would mess it up. I feel bad for anyone who has that. I know doctors have to learn that way though and kudos to them for being able to handle it.
how on earth did you insert Dr Schmidt's face next to your name😂
@@sarahh1007 😅 I joined his membership club. It just shows up now. Lol
Hahahhaha that's so funny
Watched a colonoscopy once where the attending told the fellow “you’re going so slow they’re running out of propofol”
"I WANT A NEW SCOPE" Said the GI doctor. They are extremely cheap though (said no one ever!)
Well there are disposable Duodenoscopes and bronchoscopes now but decontamination is still cheaper and a Col scope is only a fraction of the cost of an Ultrasound scope .... so it's all relative?
Hi Dr, Schmit it is so very interesting knowing how you medics have to interact and learn all procedures. I guess you can relate to someone who is willing to be patient and teaching skills required. I adore your videos and you explain in a straightforward comedic way too. My very best to you and your family. My utmost respect for all your colleagues and everyone in medical profession. Thank you so very much. Kindest regards.
And that video proves why I enjoy night shift. I work in housekeeping at a hospital. I night I am just in my areas with no boss over my shoulder. I know what to do and bust my butt to finish in time.
That wig on your boss🤣🤣
Pft I'm ready for this. Try holding a flashlight for my dad
I've had people doing similar to me a few times & I usually end up telling them to make up their mind. It's the equivalent of pressing the accelerator & brake simultaneously.
I had an EGD and not gonna lie it’s kind of weird to think about strangers looking inside of my intestines 😂 but I’m extremely great full they did
I'm getting stressed just listening to the instructions 😱
So true 😭
LOL. In the hospital now cuz. The attending (?) brought in the team and a 1st year med student and was asking the student Questions. I could answer some, but that’s because it’s my disease so I’ve had 5 years to study….
This is spot on. Great for non medical folks to see!!
Was that part of a real scope? If not, was was it??
Usually someone will say something to you and you'll dismiss it as crazy talk and then a few years later when you are competent and realise the other person was also competent you try it and suddenly that's not so crazy. Like when I was riding a motor bike someone told me if you are going round a corner and leaning isn't making you turn enough you can turn the wheel away from the corner slightly to make you get lower to the ground. At the time I was like that's insane I'll just end up either falling over or turning into the outside of the corner but later on I realised that's actually a pretty good way to control your lean.
Spot on.
i haven’t even started residency and i somehow relate to this
This is like the medical version of backseat driving
Exactly 😅
That's what was thinking ! With a clutch lol
Nursing school flashbacks 😞😅
If it is any consolidtion, every procedure from surgery to central lines can go like this.
Bless his little heart 🤯
I didn't think other people could see my nightmares
Maybe teaching skills should be taught alongside medicine?
In my country, there programmes like "training the trainers workshop" but there will always be people like this.
Oh great - I have another colonoscopy in a fortnight. Very reassuring 🤪
Yeah, backseat driving is always frustrating.
I like Benjamin’s personality
Blessings to all!
LOL! "That was fine good job."
Me experiencing a similar situation in military: "What did I do that was good? Do you want to at least look to make sure I didn't mess something up?"
So accurate.
Bro.
So. Fucking. True.
Nailed it!
after all those maneuvers and going forward and backwards, out of sudden ,the worst case nightmare of any GI doc , happens ..perforation ..call the ER and the surgery team
Literally the struggle when your attending switches lol
0:38 polyp? Is there a coral/cnidarian growing in there? Honestly I don't even know what happens here but anyway....
These shorts are very funny.😅 I'm a little apprehensive about having a colonasscopy now. 😮😵😲
This is anaesthesia training in a nutshell 😅
Hey, Doc! How many scopes per week you usually did as a resident?
So accurate
oh god. the conversation of my nightmares ☠️
That's triggering 😬
pain
lol yeah
If that ain’t the truth 😂
That was stressful to watch
funny
What a hair 😆😆😆😆😆😆😆
Hahahaa! So funny
Lol 😝 yes!
lol !
At some point a simple, “make up my mind “ would seem very appropriate…
I am very triggered
I love your videos, truly, I just have one critique (I expect the frustration), can you just have a bit more delay between characters? That’s all. You nail everything else, truly. The transition just feels quick between characters.,… I’ll continue watching, though
🤣🤣
XDDDDD
As you’re a GI doctor, may i please take a moment to ask a question…
History :
I spent 3/4 years as a younger man taking anti inflammatory medication for arthritis. I was not aware of the long term consequences of doing so at the time.
One day i suddenly started vomiting blood. I went to the hospital and was told that it was because of the medication.
The medication had over time progressively broken down my stomach lining and caused some stomach acid to basically eat some of my stomach wall.
A “GI bleed” they called it.
I spent a few days in hospital and was discharged with medication to repair said stomach lining and also instructions to cease taking the anti inflammatory medication.
It’s now been 10 years since all that happened, but…
The question:
I still have a very week stomach and am sometimes physically sick for no other apparent reason… The sickness is only ever in the morning and within the first 30 minutes of getting out of bed… That timing makes me feel like it could be a local issue on one particular part of the stomach wall, that either gets exposed or covered with the change in posture from lying to standing.
Does any of that make sense and is any of that a normal after effect for such a condition?
Thank you
He can't answer.
Go see a physician in person. Don't ask for medical advice online. A physician needs to evaluate you in person