[BigBri.net] The official Brian Fields site

11Jul/130

How [not] to place a central line (part 3)

The latest in my collection of interesting CXRs.
Both of these lines were NOT placed by me.

This IJ was placed low with a lateral approach.

IJ in head

 

IJ_IN_HEAD_Close

 

...and this was an IJ that looped into the right subclavian vein:

IJ in Subclavian

IJ_SUBCLAVIAN_Close

 

 

 

Tagged as: No Comments
9Oct/100

I have to go potty!!!


We were flying to SoCal for my step- brother's wedding. We were late and had to run through the entire terminal. Devin stops 100 feet short of the gate and grabs his crotch: "I have to go potty!" he screams at the top of his lungs. I looked at my watch. The flight was scheduled for 6:20. It was 6:18. I yelled across the terminal: "Run, Devin, Run! You can go potty on the plane!" People began to stare. Devin didn't budge. In the end, we made it. Southwest rocks! they waited for us!

Tagged as: , No Comments
11Jun/100

Moving

I'm finishing up here in SoCal, and Lara moved into our new place in Oregon.

The truck took a while to get there, and Devin and Lara had to spend a night on the floor.

Our new place has a beautiful back yard with a creek that backs up to forest.

Devin was so excited when his toys came!

Filed under: Personal No Comments
21Mar/100

SLO Days

We went for a walk in downtown SLO - we raced leaves down the creek and fed bread to the ducks. Devin saw some girls using sidewalk chalk, and just walked up and started talking to them. He charmed 'em, and next thing you know, they're all painting a birthday cake!

Filed under: Personal No Comments
3Mar/100

How [not] to Intubate

right mainstem

A common mistake - the ETT was 24cm at the lip.  I heard diminished breath sounds on the left, we pulled it back and taped it.  After the CXR came back, we rechecked - it was 28cm at the lip.  No wonder the vent was alarming high pressures.

right_mainstem_tight

Tagged as: No Comments
21Sep/092

How [not] to place a central line (part 2)

As an intern, I've done a few IJ lines and a few femoral lines, but last night I did my first subclavian.  My coworker put in a right IJ, and the patient got agitated and pulled it out.  I put in the subclavian, and I knew something was wrong when I advanced the line over the guidewire.  It just felt like it was directed too superiorly.  I fully expected it to be up in the neck when I got the chest xray - a complication I had seen several times before.  This is what I got:

subclavian cxr

subclavian cxr

subclavian cxr

subclavian cxr

The radiologist's report was: "Interval insertion of right central venous catheter with tip in the region of the left subclavian"

I inserted a guidewire and redirected it into the SVC with flouroscopic guidance - what a pain in the ass...

Tagged as: 2 Comments
5Mar/090

New Plates

Here's Devin installing my new plates!

amp-epi

Filed under: Personal No Comments
4Mar/090

ED Mnemonics

Here are a few mnemonics I picked up that helped me out...

HAD CLOTS: PERC Rule - Risk factors for PE
Hormone use
Age >50
DVT/PE History
Coughing Blood
Leg Swelling - Unilateral
O2 Sat < 95%
Tachycardia
Surgery/Trauma History - Recent

AMPLE: Important history items in trauma patients
Allergies
Medications
Past Medical/Surgical History
Last Meal/Last Menstrual Period
Events/EMS/Environment

PHAILS: Toxins that cannot be decontaminated with charcoal
Pesticides
Hydrocarbons
Acid/Alkali
Iron
Lithium
Solvents

DUMB BELSS: Cholinergic Toxidrome
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis
Lacrimation
Salivation
Sweating

ME DIE:
Differentials for Osmolar Gap
Methanol
Ethanol
Diuretics (Mannitol, Sorbitol)
Isopropanol
Ethylene Glycol

MUDPILES: Differentials for Anion Gap Acidosis
Methanol
Uremia
DKA
Paraldehyde
INH, Iron
Lactate
Ethanol, Ethylene Glycol
Salicylates, Starvation, Solvents

AEIOU:
Indications for dialysis
Acidemia
Electrolytes (Potassium)
Ingestion (Drugs)
Overload (Fluid)
Uremia

I STUMBLED: Toxins that can be removed by hemodialysis
Isopropanol
Salicylates
Theophylline
Uremia
Methanol
Barbiturates
Lithium
Ethylene Glycol
Depakote

AEIOU TIPS: Differentials for Altered Mental Status
Alcohol
Endocrine
Insulin
Opiates
Uremia
Toxins, Trauma, Tumor
Infection
Psychosis
Stroke, Seizure, Shock

Tagged as: No Comments
1Mar/090

Forty Inches

Now that I'm 40 inches, I can go on roller coasters! Today I went on Thunder Mountain, Gadget's Go Coaster, and Splash Mountain! When each one was done, I told Mommy and Daddy "AWESOME!"

I also got to meet Woody and Jessie, and I told Jessie "You're pretty". That made her blush!

1Mar/091

Living Connected

I'm writing this post from my iPhone using the WordPress app. It's nice to be more connected. I'm also using a cool FTP picture uploader to send photos from the iPhone to my gallery. Look for more up-to-the-minute updates and photos from wherever I am!

Here's a photo of us at Disneyland yesterday. There's more in the gallery!

Tagged as: , 1 Comment