Discover and read the best of Twitter Threads about #surged

Most recents (11)

Surgery rotations are one-of-a-kind experiences.

In some ways it resembles an endurance race, and in others ways, an audition.

How can you do the best you can on your surgery rotation? A thread. 🧵 ... /
1.Pace yourself

It’s tempting to start with an all-out sprint but this is a marathon. It is potentially the rest of your life

Find a pace that allows you to feel challenged, but also leaves you some reserve to learn, feel content, and push harder when the opportunity comes
2.Observe, pause, observe, then reach

My 1st surgical rotation reminded me of when I immigrated here.

I was entering a new community, with an open-mind.

Surgery has its own language, and culture. Observe them with all of the curiosity and respect it deserves.
Read 8 tweets
CPB 🧵pt4. Dessert course. Circ arrest.

Yes we know it’s a lifestyle.

But what IS it actually? Why do we do that to a person - stop blood flow to their whole body. Isn’t blood flow necessary? Or at least preferable?

#surged #meded #CTSurgery #CardioTwitter
To understand why we “circ arrest” someone- meaning arrest or stop the circulation to the whole body- we have to return to the basics of vascular surgery (bc cardiac surgery is kind of the ultimate #vascularsurgery 🙃)

it’s all about proximal and distal control
Let’s say you want to fix a psuedoanuerysm on the common femoral artery.

Well you need to get proximal and distal control with vascular clamps so that you can work on the area of interest.

Now while you’re working, the leg is a little sad 😔 but it’s got some collateral flow
Read 18 tweets
Ok let’s keep going with #cardiopulmonarybypass. Several requests for circulatory arrest, but first let’s understand how to go on and off bypass and a few flavors of cannulation and cardioplegia

🧵primer pt 2: going on and off bypass

#CardioTwitter #surged #meded #CTsurgery
Again, don’t get overwhelmed by the surgeon shoving a large number of tubes into the heart. Think logically what each one does and why it is needed.

If you know your stuff and you can’t come up with an answer, then maybe you’ve identified an inefficiency in their process. 🙃🙃
But maybe wait until you’re a PGY-10 to tell them 🙃
Read 19 tweets
For student coming onto #cardiacsurgery: here’s a primer on cardiopulmonary bypass I usually give between rounds and incision

You won’t pass perfusion boards from this 🧵but hopefully you’ll feel more oriented at the table.

#cardiotwitter #surged #meded #CTSurgery
When I was a sub-I on cardiac surgery I was totally lost on what all the different tubes did and would see a diagram like this and think I should stick to belly surgery:
But it’s not actually that complicated. Basic idea:
Bypass helps us overcome some unique challenges of operating on the heart:
🫀It’s full of blood
🫀It moves
🫀If it’s not moving, then something else needs to perfuse the body while we interrupt it from doing that
Read 15 tweets

Morrison’s pouch, sphincter of Odi,
Langer’s lines, cover the body,
Virchow’s triad, virchow’s node,
Scarpa’s fascia, should it be sewed?

1/7 #SurgEd
Angle of Louis, McBurney’s point,
Foramen of Winslow, Charcot’s joint,
Auerbach's plexus, keeps the gut well,
The long thoracic nerve of Bell,

Meckel’s Diverticulum, Toldt’s Line,
Gerota’s fascia, Murphy’s sign;
Pouch of Douglas and Morrison’s Pouch,
Buerger’s test, the leg raise off the couch,

Read 8 tweets
The Inferior mesenteric, artery’s course,
Starts at the aorta, the original source,
Originates at, the level of L3,
At the inferior edge, of the 3rd part of Dueee…;
Supplies splenic flexure, to upper rectum,
Of the three splanchnic vessels, this is the small one,
Keeps hind-gut alive, the proctologist’s chum,
Friend of that strange bunch, who work on the bum;
Left colic then sigmoid, branches supply?
Errr.. Left colon and sigmoid?… don’t be a wise guy!
Superior rectal, the terminal branch,
Over upper rectum, holds perfusion ‘Carte Blanche’;
Read 6 tweets
The makings of a surgeon…
Prize if you can name all four. 👍

What makes a surgeon, as good as they can be,
Technical prowess and dexterity?
A sympathetic smile, and good bedside manner?
Mechanical mind? Being good with a spanner?

An eagle’s eye, at least at the start,
The hand’s of a lady, a lion’s heart?
Decision making, thoughtful with care,
Acceptance of failure, hopefully rare,

Ready to cut, to leap into action,
A strong arm, appreciation of traction?
Patience and courage, when hoping for the best,
‘Sitting tight’, can be a real test,

Read 5 tweets
Superior Mesenteric Artery:

The SMA is the next of the splanchnic vessels,
Leaves aorta at L1, to it’s right SMV nestles,
Drops anteroinferiorly behind the neck of the pancreas,
Occlusion up here makes the whole small bowel gangrenous; Image
It’s branches are many, we’ll start from the top,
Pancreas gets a branch, acts as coeliac trunk prop,
Inferior pancreatico duodenal artery,
Adds to the pancreas and duodenal symphony; Image
Then jejunal branches, and ileal next,
And our friend ileocolic, which also supplies appendix;
Right and middle colic, gives Colon its blood and,
The watershed kept alive, by the marginal of Drummond; Image
Read 5 tweets
Recall of gut anatomy wanes and waxes,
So let’s quickly recap the coeliac axis,
The first of three vessels to supply the intestine,
The content of these vessels normally fluid and sanguine;

#SurgEd @roux_group #SoMe4Surgery @ASiTofficial
Arising from the aorta, at the level of T12,
From beneath the arcuate, into the abdomen it does delve,
Enters lesser sac, then divides into three,
At the upper border of ‘The Queen’, like an inverted tree;
COMMON HEPATIC is first, and heads off to the Right,
Gives off GDA and RIGHT GASTRIC, when liver’s in sight,
‘PROPER HEPATICS’ to the liver blood do serve,
The RIGHT GASTRIC does the same, to the stomachs lesser curve;
Read 6 tweets
My take on teamwork in healthcare…for what it’s worth. 😄#SurgEd

Ada from Lincoln, 4 score years and seven,
Had lived a good life, she was destined for heaven,
Developed a pain, down in her left groin,
Decided to fight, that it wasn’t her time;
Called up her practice to book an appointment,
They listened intently, suggested some ointment,
Explained ‘if things get worse, call 999’,
They couldn’t see her, just didn’t have time;
Later that evening, as she entered ED,
A stressed looking nurse, complained about the GP,
‘They just send you all in, don’t do nowt at all,
Waste of time picking, the phone up to call’;
Read 13 tweets
Re-upping the latest excellent #feedback thread from @GStetsonMD @MedEdTwagTeam, and emphasizing this point- someone is not a 'struggling trainee' or, even worse, 'the difficult trainee'. 🤨
#MedEd #SurgEd
A trainee not meeting expectations reflects on the unit as much as the trainee. Our local saying is 'not a trainee to fail until they are a *properly supported* trainee to fail'. Importantly, this does not mean the support provided to the last successful trainee is sufficient.2/6
Recall the difference between equality and equity. Teaching cannot be 'one size fits all'. Teaching must be tailored to prior knowledge, learning opportunities, learning goals, preferred ways of communicating, and much more*. 3/6

*#DiversityIceberg 👇👇👇. Read on!
Read 6 tweets

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