Westafer-Slaying Prehistoric Practicecontroversies-and-consensus.com/lectures/11_westafer_2017.pdfHalf of what you know is wrong Standard of care reversed 40.2% of cases Standard of

Lauren Westafer, DO,MPH

Slaying Prehistoric

Practice

Photo: Kristina Alexanderson@LWestafer

None

Photo: Shelly S

Photo: ESA

ABC CABPhoto: 3nglishn3rd

Knowledge Translation Gap

Davis D, Evans M, Jadad A, et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ. 2003;327(7405):33–5. .

Knowing

&

Doing

Knowing is hard

20-200

Number Needed to Read

Hall JC, Platell C. Half-life of truth in surgical literature. Lancet. 1997;350:1752. Poynard T, Munteanu M, Ratziu V, Benhamou Y, Di Martino V, et al. Truth survival in clinical research: an evidence-based requiem? Ann Intern

Med. 2002;136:888–895

Half of what you know

is wrong Standard of care reversed 40.2% of cases

Standard of care reversed 35% of cases

Knowing is hard…

Doing is harderPhoto:Torbackhopper Photo: Kate Mccarthy

1 IN 5 SURGEONS*

Burcharth J, Pommergaard HC, Alamili M, Danielsen AK, Rosenberg J. [One in five surgeons do not wash hands after visiting a toilet - an ethnographic field study.] Ugeskrift for laeger. 176(50):. 2014.

*100% COMPLIANCE IN WOMEN

Muller MP, Carter E, Siddiqui N, Larson E. Hand Hygiene Compliance in an Emergency Department: The Effect of Crowding. Acad Emerg Med. 2015.

HAND HYGIENE

29% OF THE TIMEPhoto: Gaelx

26% OF THE TIME AFTER TOUCHING BODILY FLUIDS

Muller MP, Carter E, Siddiqui N, Larson E. Hand Hygiene Compliance in an Emergency Department: The Effect of Crowding. Acad Emerg Med. 2015. Holmes, O. W. (1843) Microbiology Today. Vol 28. p. 173.

HAND HYGIENE

We have a knowledge translation problem

It’s hard to do the right thing

Unlearning is the key

Photo:KristinaAlexanderson

Photo: VelvetteGypsy

You must unlearn what you have learned

-Yoda

Photo:VelvetteGypsy

We are emotionally tied to our knowledge

Denial

Depression

Shock

Acceptance

Anger

TIME

MOR

ALE

/COM

PETE

NCE

What?? What am I supposed to do without my laryngoscope? This is

ridiculous!!

Uh, I’m just going to slide this in there real quick, what’s the harm…

You know where I can stick this laryngoscope??? Right up your….

Resuscitation is useless, why bother…

Yoga for your brainUnlearning Requires flexibility

Requires training

Unlearning…

TrainingExposure

Photo:TheGiantVermin

Early Repeated Exposure

Community

Photo:AnthonyThobald

Free Open Access Medical Education

Blogs Podcasts

FOAMUNLEARNING:

THE WORKOUT

IV Contrast

Kidneys

2013

2015

2017

ACR Manual on Contrast Media v 10.3 2017Aycock, Westafer et al. Annals of Emerg Med. 2017, In Press

Needle decompression…where?

A

C

E F

G H

D

B

H

2012

2013

2016 ATLS: >50% will fail

with 5cm needle

C2nd ICS MCL

MidclavicularAvg depth 4.28cm

AxillaryAvg depth 3.42cm

Laan D V., Vu TDN, Thiels CA, et al.

Fails 24-54%Fails 8-22%

Pulse check

…. if an organized rhythm is observed, a pulse check

should be performed.

Circulation. 2010;122[suppl 3]:S729–S767.)

2013

2015

2017

American Heart Associations

"Because of difficulties with pulse assessments, interruptions in chest

compressions for a pulse check should be minimized during the resuscitation, even to

determine if ROSC has occurred"

Berg RA, Hemphill R, Abella BS et al. Part 5: Adult Basic Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 122(18_suppl_3):S685-S705. 2010.

Pulse check

Recognize pulseless patient in 10 sec

2%

Dick WF, Eberle B, Wisser G, Schneider T. Crit Care Med. 2000 Nov;28(11 Suppl):N183-5

Pulse check

ACCURACY78%

Tibballs J, Weeranatna C. Resuscitation. 81(6):671-5. 2010.

ETCO2

Resuscitation 95 (2015) 100–147

Only if organized rhythm observed

Pulse Check

Neumar. Circulation 2010. Photo:Corwin

email: [email protected]: @LWestafer

References: shortcoatsinEM.blogspot.com/