Procedure Notes: Central Venous Catheter (CVC) Placement

Central Venous Catheter (CVC, Central Line) Placement

Date: <____>
Time: <____>
Indication: Hemodynamic monitoring/Intravenous access
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was placed in a dependent position appropriate for central line placement based on the vein to be cannulated. The patient’s <right/left> < neck/shoulder/groin> was prepped and draped in sterile fashion. 1% Lidocaine was used to anesthetize the surrounding skin area. A triple lumen <9-French> Cordis catheter was introduced into the the <subclavian/internal jugular/common femoral vein> using the Seldinger technique <and under ultrasound guidance>. The catheter was threaded smoothly over the guide wire and appropriate blood return was obtained. Each lumen of the catheter was evacuated of air and flushed with sterile saline. The catheter was then sutured in place to the skin and a sterile dressing applied. Perfusion to the extremity distal to the point of catheter insertion was checked and found to be adequate. <Attending/Resident> was present for the entire procedure.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Lumbar Puncture

Lumbar Puncture

Date: <____>
Time: <____>
Indication: Altered Mental Status
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was placed in the <LEFT/RIGHT> lateral decubitus position in a semi-fetal position with help from the nursing staff. The area was cleansed and draped in usual sterile fashion. 1% lidocaine was used anesthetize the surrounding skin area. A <20-gauge 3.5-inch> spinal needle was placed in the <L3-L4/L4-L5> interspace. Clear cerebral spinal fluid was obtained and the opening pressure was noted to be <?cm>. Four tubes were filled with 4 mL of CSF. These were sent for the usual tests, including 1 tube to be held for further analysis if needed. <Attending/Resident> was present for the entire procedure

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Thoracentesis

Thoracentesis

Date: <____>
Time: <____>
Indication: Large pleural effusion
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient’s <right/left> side was prepped and draped in a sterile manner after the appropriate infiltration level was confirmed by ultrasound. 1% lidocaine was used anesthetize the surrounding skin. A finder needle was then used to locate fluid and clear yellow fluid was obtained. A 10-blade scalpel used to make the incision. The thoracentesis catheter was then threaded without difficulty. The patient had <?mL> of clear yellow fluid removed. <Attending/Resident> was present for the entire procedure. A post-procedure chest x-ray was ordered and the fluid will be sent for several studies.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Swan-Ganz Catheter

Swan-Ganz Catheter Placement

Date: <____>
Time: <____>
Indication: Hemodynamic monitoring/Intravenous access
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was placed in a dependent position appropriate for central line placement based on the vein already cannulated with a 9F Cordis catheter. The patient’s <right/left>  <shoulder/neck/groin> was prepped and draped in sterile fashion. A triple lumen continuous cardiac output Swan-Ganz catheter was brought onto the field and each line flushed with sterile saline and the SVO2 sensor calibrated. The catheter was introduced into the Cordis catheter to a distance of 15-17 cm. The balloon was then inflated and the catheter was advanced through the right ventricle and into the pulmonary artery until a wedge position pressure tracing was obtained. The balloon was then deflated and verification of return of a pulmonary artery pressure tracing made. During the floating procedure to position the catheter the position of the catheter tip was determined by continuous pressure monitoring via the distal port. The catheter was locked to the Cordis with the tip inserted to a distance of <?cm> and a sterile dressing applied. <Attending/Resident> was present for the entire procedure.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Endotracheal Intubation

Endotracheal Intubation

Date: <____>
Time: <____>
Indication: Respiratory Distress
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was placed in a flat position. Sedation was obtained using <Versed 3mg>, and additionally with <Etomidate 20mg>. The patient was easily ventilated using an ambu bag. The <GLIDESCOPE TECHNOLOGY/ MAC 3 BLADE> was used and inserted into the oropharynx at which time there was a Grade 1 view of the vocal cords. A 7.5-french endotracheal tube was inserted and visualized going through the vocal cords. The stylette was removed. Colorimetric change was visualized on the CO2 meter. Breath sounds were heard in both lung fields equally. The endotracheal tube was placed at 23 cm, measured at the teeth. <Attending/Resident> was present for the entire procedure.

A chest x-ray was ordered to assess for pneumothorax and verify endotrachealtube placement.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Thoracostomy (Chest Tube)

THORACOSTOMY (CHEST TUBE) PLACEMENT

Date: <____>
Time: <____>
Indication: Pneumothorax/Hemothorax
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was positioned appropriately for chest tube placement. The patient’s <right/left> chest was prepped and draped in sterile fashion. 1% Lidocaine was used to anesthetize the surrounding skin area. A <2 cm> skin incision was made in the mid-axillary line at the inframammarycrease. Utilizing blunt dissection a subcutaneous tunnel was created cephalad just adjacent to the superior rib. The pleural space was entered bluntly and gush of  <air/blood> was observed. A finger was inserted into the pleural space to check for anatomy and guide tube insertion. A <36F/40F> thoracostomy tube was inserted using a Kelly clamp and positioned appropriately. The chest tube was sutured securely to the skin and a sterile dressing applied. A pleurevac was attached to the chest tube and a chest x-ray obtained. <Attending/Resident> was present for the entire procedure.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Arterial Line

ARTERIAL LINE (A-Line) PLACEMENT

Date: <____>
Time: <____>
Indication: Hemodynamic monitoring
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. Allen’s test was performed to ensure adequate perfusion. The patient’s <right/left> wrist was prepped and draped in sterile fashion. 1% Lidocaine was used to anesthetize the area. A <18G/20G> Arrow arterial line was introduced into the <radial/femoral> artery. The catheter was threaded over the guide wire and the needle was removed with appropriate pulsatile blood return. The catheter was then sutured in place to the skin and a sterile dressing applied. Perfusion to the extremity distal to the point of catheter insertion was checked and found to be adequate. <Attending/Resident> was present for the entire procedure.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

U.S. Residency Programs Under Probation

The ACGME is incharge of accrediting U.S. medical and surgical residencies. There are three decisions that can be made: Accreditation, probationary accreditation, or withdrawl of accreditation. The ACGME compiles an up-to-date list of residency programs under probation or with withdrawn accreditation in all specialties. I had previously reported on the list for 2012, but many of these programs have either dissolved or have been able to regain good standing with the ACGME. Rather than list all the current institutions on probation, a list which is always in flux, it is best to search the database yourself. You can search for all specialies, or by a single specialty. This is probably a very good thing to do when deciding where to apply.

Click here to search for programs under ACGME probationary accreditation 

Click here to search for programs whose accreditation has been withdrawn

 

 

 

The Best Free Software For Students

If you are anything like me, you will do anything to avoid paying thousands of dollars for the next Adobe product.  After ten years of higher education (and at least 4 to go!) I have tested hundreds of software packages; in this post I will list the best free and open source programs I have found.  Learn to love open source software…and you will soon learn how to spend those thousands of dollars you saved!  My software list will certainly not be a comprehensive list of all the great open source programs. For a complete list of free software programs I have three recommendations.

  • The best resource is sourceforge.net which is a nearly complete collection of all reputable free software.
  • FileHippo.com is a free website that lists hundreds of free software packages by category
  • schoolforge.net is a compilation of hundreds of free and open source software programs that is easily searchable.

 

WEB BROWSER

Google Chrome is a no-nonsense, super fast web browser.  Here is just one reference proving Chrome's speed superiority (from cnet.com). For mac users, Safari is a distant second.  While I used to enjoy Firefox, it takes nearly twice as long to load web pages than Chrome.  We all know how terrible Internet Explorer is.

 

WORD PROCESSING, PRESENTATIONS, SPREADSHEETS

OpenOffice is a well known counterpart to Microsoft Office.  The free software includes a fully capable word processor, a presentation organizer, and a fully loaded spreadsheet tool.  In essence, you get Word, PowerPoint, and Excel for free.  An added bonus, you can save any file in OpenOffice format OR in the corresponding Microsoft format so there will never be compatibility issues.

 

CALENDAR

My love for Google products will now show through.  Google Calendar is simple and highly effective.  You can merge nearly all online calendars into your Google calendar account. You can send yourself reminders using email, phone call, or text message. You can list recurring events in any imaginable patter (e.g. same date each year, 2nd Saturday of March each year, etc.)

 

IMAGE MANIPULATION / GRAPHIC EDITOR

1. Gimp is a professional image editor with a student's pricetag.  This free program comes with nearly all the bells and whistles you would find in the newest version of Adobe Photoshop.  The user interface is not idea and takes some getting used to. However, with a price tag of $0 this is a great piece of software.

 

2. I have heard great things about Paint.Net.  I must admit, I have never used it because I have spent so much time using Gimp that I don't need anything else.  However, it is worth a try if you are looking for more free graphic editing options.

 

AUDIO EDITOR

Audacity is a free, open-source program that facilitates the recording and editing of all audio and sound files.  I often use it to make my own 'radio edited' song versions.

 

PDF READER AND WRITER

Foxit Reader is far better than the free Adobe Reader. It requires far less resources when it is running on your computer, and it provides free mark-up tools including text editing, highlighting, commenting, and basic geometric shapes.

 

PDF CREATOR / CONVERTER

CutePDF Writer is the free version of CutePDFs vast line of products. The free writer allows you to convert any image, document, or screen shot to a PDF.  I use this product all the time. I save documents as PDFs and place them on my thumb drive rather than printing everything out.

 

ANTIVIRUS SOFTWARE

There are actually quite a few free antivirus options out there. Many of the web giants (Google, Yahoo, MSN, etc) have their own free antivirus software. My personal favorite is Avast!, which the program that comes with GooglePak.  Just be sure you click on the FREE version, as they have other options.

 

PERSONAL FINANCE

Mint.com allows users to track all bank accounts, credit cards, loans, and investments in one place. The software is similar to costly software like Quicken, but is free and is web-based: which means you can check your information on any computer, any time.

 

 

BIBLIOGRAPHY, CITATIONS, REFERENCE MANGER

The best resource in this category, I must admit, is not free. EndNote is a must-have resource for research and reports. It is user friendly and will save you hours of time by automatically plugging in your references and bibliography. There are a number of free programs that try to mimic EndNote's features. Some are good, but after trying them I ended up purchasing a student edition of EndNote because it is so much better.  Here is a list of free bibliography and reference managers. Or you can check out the wikipedia page which compares all reference managers, free and non-free.

 

STATISTICAL ANALYSIS

R (The R Project for Statistical Computation) is a free text-based statistical computational software program.  It is not for the feint-hearted. The learning curve is steep, but once mastered, this free software provides all the tools to run any statistical analysis, graph, or plot.

 

LaTeX EDITOR

Not all LaTeX editors are created equal.  WinEdt is a clean editor without the frills of other programs. I have used this software for 5 years and I have never had even one problem (something that can NOT be said about most LaTeX editors!)  The free version will frequently ask the operator to purchase the full version, but it is never required.

 

BRAINSTORMING AND MIND MAPPING

XMind assists individuals and teams in keeping track of ideas and goals. If you have never used mind-mapping software, you need to start. XMind creates the prettiest visual map, but there are other options that work just as well. FreeMind is another great one.

 

 

Did I forget something? If you know of more great, open source software please leave a comment.

Resident and Fellow Salaries and Benefits

2011 Average Resident and Fellow Stipends

Every year the Association of American Medical Colleges (AAMC) compiles a survey of intern, resident, and fellow salaries across the country.  While most medical and surgical residents are paid similar stipends, there are certainly differences.  This will become a somewhat important factor in ranking residency programs during the fourth year of medical school.  The recent AAMC resident and fellow stipend report can be found here as a pdf document. The complete document describes current resident salaries and displays a chart of the average resident salaries all the way back to the 1960s.  Additionally, it details the difference in stipends between the northeast, the south, the west, and the midwest. Finally, it explains in detail what is included in the average benefits packages (i.e. medical insurance premiums, retirment plans, life insurance, disability ect).

The report contains salary information for all training levels, intern thru post graduate year (PGY) eight. The national mean salary of each PGY level and the percent change from 2010 is shown below.  (taken from the AAMC document)

The next table displays the average first year resident (i.e. ‘intern’) salary each year since 1968.  The average increase in salary in recent years has been 2-4%.

As you will see in the complete document, the residency programs that pay the most are church sponsored hospitals in the northeast.  Those that pay the least are state hospitals in the south.

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