Sterile Field Guide

We are on a pancreas journey! In this episode, we talk about the MANY etiologies of pancreatitis, the diagnostic workup, scoring systems (and a little dismantling of the Ranson Criteria throne), and the management of pancreatitis. Next week, we'll be talking about some specific pancreatitis complications before we move on to neoplasms in the pancreas. Hope you enjoy!

Not the ERAS tour you wanted but the ERAS tour you deserved. In this week's episode, we're talking about the process of applying to residency (specifically general surgery residency, but a lot of what we talk about generally applies to most application processes) and how you can start getting organized at different stages of your training. In summary, don't panic, this is doable and you know most of the answers already :) I hope you find this helpful -- be sure to ask questions you still have on our instagram (@sterilefieldguide)

Hey friends! In episode 21, we go over acute respiratory distress syndrome diagnostic criteria, risk factors, and management. A big part of ARDS management is appropriate ventilation. Ventilation strategies for ARDS have been called "lung protective ventilation" or "low tidal volume ventilation" (LTVV) and have intricacies that are helpful to be aware of. Some of these intricacies include tidal volume calculations, PEEP requirements, and the possibility of proning. We talk a lot about proning and the data behind prone ventilation, the contraindications to proning, and how to keep your patients safe while doing prone ventilation. Hope you learn something new in this episode!

Hey friends! In this episode, we take some time to talk about the basics of oxygenation and ventilation and how ventilators work. Specifically, we will cover volume control, pressure control, PRVC, pressure support, and assist control and SIMV adjuncts. After learning about the basics of ventilator settings, we dive into plans that you as a medical student might start to suggest. "Wean to extubate" and "wean vent settings" are commonly thrown around but what does this mean? We cover "minimals" or minimal ventilator settings, spontaneous awakening trials (and the data supporting them!), and spontaneous breathing trials. Hope you learn something new! Be sure to check out the instagram for more information (@sterilefieldguide).

Continuing on with our critical care series, in this episode, we are talking about types of shock and the management of these types of shock. There are a lot of hemodynamic changes to keep track of for clinical diagnosis (as well as your boards exams), but don't worry, there will be a neat little table (as well as some other resources) available on the instagram (@sterilefieldguide) for your review. We will talk about cardiogenic, obstructive, hypovolemic, and distributive shock in this episode as well as review a few of the NINETY-THREE recommendations made by the Surviving Sepsis Campaign (found here for your perusal: https://journals.lww.com/ccmjournal/fulltext/2021/11000/surviving_sepsis_campaign__international.21.aspx). Enjoy!

In episode 18, we start talking about vasopressors. Vasopressors (or just "pressors") are commonly encountered in the hospital and it's important to consider what you are targeting when choosing the right pressor. We discuss the proper administration of pressors, how they impact subcutaneous medications, and commonly used pressors and the receptors they work on in this episode. Enjoy!

Hey friends! In our second episode about anesthesia, we talk about inhaled agents, in contrast to last episode where we talked about IV anesthetics and paralytics. We begin to talk about MAC (minimal alveolar concentration), how the gasses work, and side effect profiles of different gasses. Specifically, we talk about reasons you wouldn't have to use gasses, such as severe post-operative nausea or history of or susceptibility to malignant hyperthermia. I hope you learn something new in the episode!

Hey friends! In this episode, we are switching gears to talk about the induction of anesthesia. We start by talking about the difference between rapid sequence induction (RSI) vs. standard induction and which drugs you would use for each. We then talk about the differences between non-depolarizing and depolarizing paralytic drugs (specifically rocuronium vs. Succinylcholine) and the mechanism of action, indications, and side effect profiles of commonly used drugs. We spend quite a bit of time talking about propofol and propofol infusion syndrome (PRIS) and new research on GLP-1 agonists and how they interact with anesthesia. LOTS of info in this episode -- hope you love it!

Hey friends! This episode is a touch late since I started my LAST clinical rotation last week. In this episode, we finish up our series on solid organ injuries by talking about renal trauma. Don't worry, urology friends, there is a scoche of urological trauma talk in this episode too. We go over the AAST grading scale for traumatic kidney injuries and the approach to management for different kidney injuries, including operative (kidney salvage vs. nephrectomy), urologic (stenting, catheters, percutaneous nephrostomy tubes), interventional (embolization), and nonoperative (your favorite, serial abdominal exams!). I hope you enjoy, even if a few days late!

Hey friends! In this episode we talk all about traumatic liver injuries. Combined with the spleen, these are the two most commonly injured organs in blunt trauma. We review some important anatomy, like the portal triad and talk about the Pringle maneuver, the physical exam and imaging findings for traumatic liver injuries, and talk about the management, both operative and non-operative for liver injuries. We discuss the INR of cryo, interventional radiology procedures for liver bleeding, a REALLY interesting management strategy for hepatic artery bleeding, and surgical approaches to damaged livers. I hope you enjoy!

Hello friends! We are starting a 3 part series on solid organ injuries and their management with one of my favorite organs -- the spleen! In this episode, we talk about relevant splenic anatomy, non-operative management (as well as some of the data supporting NOM of splenic trauma), splenic artery embolization, splenectomy, and splenectomy with distal pancreatectomy. Some additional tidbits in this episode involve the importance of the pulse pressure and an introduction to how to evaluate for the class of hemorrhagic shock (although more to come on this), why we place JP drains, and the AAST grading system for solid organ injuries. There are more details plus a QR code to my paper on the management of splenic trauma on the instagram (@sterilefieldguide). I hope you enjoyed!

Hey friends! Clerkship season is upon us and some of you will be freshly minted clinical students very soon! The surgery clerkship can seem extremely overwhelming -- the hours are long, you've heard the lore about grumpy residents, etc. etc.. Your surgery clerkship does not have to be miserable, although it will be hard work. Here are some of my tips for physically making it through your clerkship. This episode paired with the episode on studying for your clerkships, how to be helpful on the floor and in the OR, should round you out for getting oriented to your surgery clerkship. Godspeed!

Hello friends! In this episode, we are talking all about how to approach studying for your shelf exams, specifically the surgery shelf exam. These are some basic tips to get you started as you start working on your schedule for your clerkship. The resources that I mention in this episode are ones that I have personally used and do not (unfortunately for me) sponsor this episode. We talked about which UWORLD questions to do, if you should use Anki, and if it's okay to study in the hospital. I hope you find this helpful! Instagram: @sterilefieldguide

Hey friends! Today we are taking a quick detour from clinical episodes because it's boards season! This can be a very scary time and it's very easy to get lost when thinking about this giant exam. In this episode, I talk about how I studied for USMLE STEP2, the resources I used to study, how much UWORLD I did, how I scored, and what modes I used, and my biggest pearls for maintaining sanity during dedicated. Here is a list of the resources I used for your perusal! Best of luck, please reach out if there is something we can help with! UWORLD Boards and Beyond (worth the money!!!) Sketchy Free 120: https://orientation.nbme.org/Launch/USMLE/ UW SIM 1 UW SIM 2 NBME 7 (would not recommend)

Hello friends! In this episode, we are finishing up our series on the trauma bay. We talk about the secondary survey, which includes a complete physical exam from head to toe. We talk about multiple diagnoses that you can find in a trauma patient and what physical exam findings may clue into certain injuries. We expand a bit on when pelvic binders are indicated, different bruising patterns for different injuries, as well as some tips and tricks on the rectal exam that I wish I knew the first time I did it 😅 I hope you enjoy this episode in that it is helpful to you in someway! Check us out on instagram @sterilefieldguide and feel free to message if you have any specific topics you would like to hear about. Thanks for listening!

Hello friends! In this episode, we talked about the third and final part of the trauma primary survey, the disability and exposure portions. For disability, we talk about the Glasgow coma scale (GCS) and how to calculate this value yourself! Knowing how to keep track of the GCS can be helpful during a clinical rotation, both for prognostication and for tracking the status of your patience. We finish up by talking about why exposure is important in the trauma bay and an example of what a trauma primary survey sounds like. Enjoy!

In today's episode, we talked about the ABCDEs of trauma. Specifically, in this episode, we talk about circulation including common sites of hemorrhage, tourniquets, approach to bleeding in the trauma bay, the FAST exam, primary survey adjuncts, as well as the Triad of death and a general approach to fluid resuscitation and trauma. There is a lot to learn about trauma, so this episode is merely a broad overview and we will dig into these topics deeper in separate episodes. Next week we will finish talking about the primary survey about disability and exposure. 

Hey friends! In today's episode we begin to talk about the primary survey in a trauma activation. This consists of airway, breathing, circulation, disability, and exposure. In this episode, we talk about airway and breathing and we will visit circulation, disability, and exposure in future episodes.  Specifically, we talk about how to identify if an airway is patent,  what to do if it is not patent, how to identify breathing emergencies, and common approaches to management of breathing emergencies in the trauma bay such as needle decompression, finger thoracostomy, and chest tube placement.  If you are starting your trauma rotation, or are curious about how trauma activations are run, this is based on ATLS guidelines, and should apply to your Center in most cases. Again, this podcast should not serve as your primary source of education on how to perform procedures. always defer to your team, and make sure that you have the proper training before attempting any procedures on your own.

Hey friends! In today's episode, we talk about how to be helpful on the floor as a medical student. Knowing what to do on the floor is just as helpful as being competent in the or, and can be a great way for you to show off your skills as a medical student on your surgery clerkship. In this episode, we talk about the different tasks that you may get to partake in, as well as general approaches to procedures on the floor. As mentioned in the podcast, this should not serve as your primary education on how to perform procedures, however, it may serve you well as a roadmap. always make sure that you have supervision when necessary.  Join us next week as we dive into our first batch of clinical episodes!

Hey friends! In this episode, we talk about the best part of the surgery clerkship (okay, I'm biased), being in the OR!! The operating room can be a scary place if you don't know what is going on and the worst feeling is not knowing how to be helpful in the hospital. I hope that by talking about the order of operations as well as common tools you will encounter in the OR is helpful for you and gives you the confidence to jump in on day one, feeling prepared and ready to retract to your heart's content. You can find us on instagram, where we post summary slides of the episodes at instragram.com/sterilefieldguide and you can support us on Patreon at patreon.com/sterilefieldguide! Thanks for listening!