r/SipsTea • u/sco-go • 14h ago

Wait a damn minute! Bad time for a how-to YouTube video.

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u/Loud-Bee6673 12h ago

Exactly. The standard of care is not a static line - it is moving ALL THE TIME! If I don’t read articles and listen to lectures/podcasts I would still be practicing the medicine I learned in med school. 18 years ago.

As an ER doc, we are sometimes in a position to be doing something that we have never done. Some procedures are seen so rarely, but when they do show up, we have to do them.

A couple examples …..

(and trigger warning as these can be considered disturbing ……)

Lateral canthotomy - someone has an injury that causes an expanding pool of blood behind the eye. This is putting pressure pushing it out of the socket. If it continues unchecked, it will squish like a grape. We have to cut the tendons surrounding the outside of the eye to relieve the pressure. I’ve never done one, just simulation.

Pericardial drain - the sac that surrounds and normally lies flat around the heart becomes filled with blood. The squeezes the heart and makes it ineffective. Eventually it will cause tamponade and death. This ultimately needs a heart surgeon, but to get them that far we may need to thread a catheter between or under the ribs inside that sac, and use it to drain fluid. I have done this twice and my butt cheeks were clamped the entire time.

Perimortem C section - if a pregnant patient is coding, the treatment for the mother AND the fetus is a crash C-section. We are not OBs and it is not pretty. I have never done this and I pray to god I never do. But I watch videos about if from time to time so I can if I need to.

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u/thehenryguy1 12h ago

Our ICU section chief will watch videos for uncommon procedures right before he does them because of all the reasons you stated.

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u/pilot3033 11h ago

Perimortem C section - if a pregnant patient is coding, the treatment for the mother AND the fetus is a crash C-section. We are not OBs and it is not pretty. I have never done this and I pray to god I never do. But I watch videos about if from time to time so I can if I need to.

There's one of these on The Pitt in season 2 and yeah, I hope you never have to, either.

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u/Responsible-Quote717 11h ago

Bless you, and all the work that you do!

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u/Dismal_Fox_22 11h ago

I’m and ED nurse and totally agree. There is stuff that comes up that we have to deal with that we just don’t see often enough. There’s things I might only do once every few years. I’ll go to the manufacturers YouTube channel and review the process. It’s what’s it’s there for. It’s a resource. I can’t be an expert in everything all at the same time.

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u/Deadsuooo 10h ago

What about swamps of dagobath?

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u/tummlr 10h ago

oh you watched season 2 of the pitt

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u/Loud-Bee6673 10h ago

I only got through the first episode of season one. Felt too much like being at work. Not surprised they used that one, though, it is one of the most dramatic things to happen in EM.

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u/shining_path_ 8h ago

Tamponade, world's worst soft drink

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u/Logical-Primary-7926 12h ago

Scary thing is many doctors are still pretty much doing what they were doing 18 years ago. Heck my old dentist is still in business (not sure I'd call it healthcare) and he finished dental school before the internet...he is a pretty crapy dentist but he makes good $ thanks to a f ed up biz model.

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u/Malusorum 7h ago

Dental is pretty set, there's nothing new in the method. The new are the tools available, and thankfully, the tools get replaced with newer technology ever so often as the old has been outphased.

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u/Logical-Primary-7926 4m ago

Not really, there is actually a ton of variation in dentistry in terms of methods, tools, and materials, and that can make a massive difference in outcomes. Unfortunately many dentists don't really stay up to date on that stuff and tend to use cheaper older materials/tools since there is so little oversight in the industry. For example my old dentist unnecessarily wrecked one of my teeth with old methods/materials when a newer and more time consuming one would have left it totally unharmed.