8:00 am Mandatory Needlestick Training by Worker's Compensation Department at HUH/St.Chris

Needlesticks are reported.
Standard precautions:
- Assume that anything that is coming from body can spread illness (blood, urine, saliva, etc).
- They are meant to reduce the risk of transmission of bloodborne and other pathogens from recognized and unrecognized sources
Sharps: anything that can break the skin barrier
BBP (Blood-borne pathogens) can be spread through direct or indirect contact
HIV, Hepatitis B, Hepatitis C
Vaccination for Hep B, but no for Hep C
OSHA: all employees who can be reasonably anticipated t face contact with blood or other infectious materials through their job duties (MDs, police officers, etc) are covered under OSHA

Modes of transmission:
Blood, semen, vaginal secretions, CSF, synovial fluids, pleural fluids, peritoneal fluid, amniotic, saliva, any bodily fluid that is visibly contaminated by blood

Exposures:
Linens, trash, trays, stuck in broom or mops, during patient care through needle, splashed bodily fluid

Prevention controls hierarchy from most effective to least effective:
Universal precautions
Engineering control
Work practice control
PPE (personal protective equipment)

Sharp disposal containers:
Engineered to be puncture-proof
Never overfill – stop at the FULL line

Safety needles:
Engineered to protect workers, syringe with sliding cover back over the needle after use, they lock into place after use

Exposure control plan:
Employer's written plan on what to do (identifies employee job tasks and responsibilities) when exposure happens

Labeling containers
Job training
Hand hygiene
Safe linen handling
Laundering scrubs/gowns/uniforms
Using tools to handle sharps – never use hands to pick up sharps
Blood spill cleanup kits and training
Eyewash and shower stations
HBV vaccination
PPE

In the event of exposure:
- Assume ALL blood and bodily fluids are contaminated
- Wash with soap and water, irrigate eyes and MMs
- Sick a medical attention asap
- Report exposure!!! asap

Seek med attention at:
Employee health, Occupational health, Medical Clinic, ED
Treatment is more effective the sooner it is administered
Document exposure/injury

OSHA law protects you from retaliation from your employer for being a whistleblower. You contact OSHA within 30 days to file a complaint.

For images from this session, please contact Karima Sajadi-Ernazarova, MD at karimasajadi@gmail.com

9:00 am Case Conference by Dr. Anran Wang

Intern in hot seat: Dr. Bronia Agress
Senior lifeline: Dr. Peter Sacci
CC: seizure/agitation

Anti-hypertensive meds:
Clevidipine vs Nitroglycerin and Nicardipine showed statistically significant improvement in MAP reduction for Clevidipine arm (PRONTO 2014)
Labetalol
Hydralazine
Metoprolol

For images from this session, please contact Karima Sajadi-Ernazarova, MD at karimasajadi@gmail.com

10:00 am "The Opioid Crisis – Who? Where? Why? How?" by Dr. Brad Bendesky

Drug ODs are going up despite MDs prescribing less opioids.
Fentanyl is involved in >80%. It's cheaper to produce than heroin. Heroin now is almost always tainted with Fentanyl.

Opioids produce physiologic effect of decreased pain perception.
Natural endorphins (Serotonin, Dopamine, Oxytocin, Endorphine) have similar to Morphine structure, but Morphine lasts longer and you get addicted to it.
Endorphines = Endogenous Morphine
Food, laughing, sex, physical exercise, listening to music produce endorphins.
1980 The Letter to the Editor showed that people who were treated with opioids had no addition potential.
Purdue Company then marketed Oxycontin + professional endorsement (Dr. Alan Spanos)
Purdue spent $207 million to market Oxycontin
12-20% of opioid naïve patients who received Rx opioids after Surgery became long-term users.

A lot of efforts now by hospitals to reduce opioid crisis in USA.
Suboxone/Metadone programs is one of the initiatives.
Buprenorphine is a partial opioid agonist. They still get some euphoria, but without withdrawal and not as much respiratory depression.
Suboxone = Buprenorphine + Naloxone
COWS (Clinical opioid Withdrawal Scale):

What is X-waivered license?
Any MD with DEA # can have an 8-hour training and be able to prescribe Suboxone/Metadone.

Free Online MAT Waiver Training:
https://pcssnow.org/medication-assisted-treatment/

Bonus from Dr. Sergei Motov sent to me by Dr. Mark Ramzy:

For images from this session, please contact Karima Sajadi-Ernazarova, MD at karimasajadi@gmail.com

11:00 am Radiology Rounds by Dr. Loice Swisher

Pneumothorax:

Needle decompression sites (from Rebel EM):
1. 2nd ICS MCL
2. 4th/5th ICS-MAL
3. 4th/5th ICS-AAL

Perilunate dislocation:

Capitate is dislocated posteriorly, not sitting in the "teacup"
Neurologic problem to worry about: median nerve issues (also get it with lunate dislocation)

For images from this session, please contact Karima Sajadi-Ernazarova, MD at karimasajadi@gmail.com

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

The images being used are for illustrative purposes only; any person depicted is a model.

 
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