One of the defining parts of the job description of an intensivist is being comfortable doing minor sterile procedures at the bedside. So, while we are not surgeons, we need to be able to place arterial and central venous lines and do the associated cutting and sewing. Just like with normal surgeries, our patients are usually asleep and family is usually not around, which means, just like with normal surgeries, there is often music playing!
I know this is not what is portrayed on most medical dramas, but most ORs are playing the spotify playlist of the most senior surgeon in the room. I've listened to classic rock, rap, pop, folk, classical, country. And you never know what the whims of any particular surgeon will be on any particular day.
It's a strange sort of status symbol to be the one in the room with a half-dozen people to get to pick the music. You'll notice if an attending scrubs out of a case and lets the resident finish closing the wound (a tedious and not particularly technically difficult task), that the resident may get to pick the music for the remainder of the time.
Well, our procedures may not be as big of a deal, but we still can play music and this was the first time I had (a) put in a line by myself, and, more importantly, (b) been the one to pick the music. Once all of our sterile gear was opened and the patient was comfortably sedated, the nurse for the room pulled up YouTube on the patient's entertainment screen and asked, "What'll it be, doc?"
I was a bit nervous about the procedure and initially tried to defer to whatever anyone else wanted, but she ignored call-outs from the resident and the other supervising fellow in the room and made clear eye-contact with me indicating that this was as necessary as the safety "time-out" we had just completed. Well, I had been on a big band kick recently and decided that I might as well dive on in. "Frank Sinatra, please!"
She was initially taken aback but then I got an approving nod. "Haven't heard that one before. I like it!" And just like that we had a Sinatra playlist setting the mood for my (very slow and very cautious) placing of this kid's arterial line. It was actually really nice. I know Frank like the back of my hand, so it was like having a familiar beat to perform to. My favorite part though, was when, after I had already successfully placed the line, and was suturing in place, the song I've Got You Under My Skin came on. "A little on the nose," I said to groans.
TILIF: Pulmonary vascular resistance (PVR) has really weird units. PVR is the resistance that blood must overcome to pass through the pulmonary vasculature. It is defined analogously to Ohm's law for electrical resistance (resistance = voltage/current), except voltage is the pressure gradient through the lungs and the current is the cardiac output. Pressure can be measured in mmHg and the cardiac output is L/min. So, while you could keep the units as a simple mmHg⋅min/L, by swapping things out for slightly dated units of force, you get units of dynes⋅sec/cm5, which is, for some reason, the continued standard. At some point people were annoyed with this convoluted and completely unintuitive mess and named an entirely new unit after one of the pioneers in PVR research, Paul Woods. So you will sometimes see PVR listed in WUs, or Wood's Units.
Apparently John Deere is a big deal in Iowa. John Deere, the person, founded his company in the appropriately named middle-of-nowhere town of Grand Detour, IL before moving operations to the Mississippi River in the IL/IA state-line-spanning Quad Cities area. Also, apparently there are several very regionally dominant farming companies that have prominent color associations reminiscent of college sports with the Americana brand-loyalty of mid-century car companies.
To give a patient a granulocyte (a type of white blood cell) transfusion, you need 24-48 hours of lead time. This is because these cells don't keep and have to be very closely matched to the recipient. So you need to find the appropriate donor, give them a medication that causes granulocyte cell overproduction, wait at least a day for it to work, then transport them to your patient.
That was awesome. So no "My Way"?
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