pigtail catheter

September 27, 2018

H&R2019 Pre-Conference Courses. May 22nd. Yup, it’s worth coming early!

So we are very, very excited about our pre-conference course lineup. It is simply awesome:

1. Full day Resuscitative TEE (Limited to 20 participants) 0830-1730

H&R2019 REGISTRANTS SHOULD RECEIVE A CODE ENABLING REGISTRATION. FOR ANY QUESTIONS CONTACT HOSPRESUSCONFERENCE@GMAIL.COM.

2. Full day Keynotable 0830-1730

3. Half day Hospitalist POCUS (Limited to 30 participants) afternoon 1330-1730

4. Half day Critical Care Procedures (Limited to 20 participants) morning 0830-1230

5 .Half day Brazilian Jiu-Jitsu for MDs (Limited to 30 participants) morning 0900-1200.

 

Note that sadly, you have to make some choices. No way to attend it all…

 

So here is some info to help you make your best pick:

 

1. Full day Resuscitative TEE: run by none other than Felipe Teran, and featuring Andre Denault as head instructor, this is a unique opportunity for a deep dive into everything about TEE in shock/arrest as well as extensive hands-on training on shock/arrest TEE using state-of-the-art simulators. Participants will obtain an Optional Competency Assessment,  providing a Workshop Certificate and a Focused TEE Competency Assessment Checklist certifying completion of 10 proctored examinations.

Limited to 20 participants. 795$USD. Note that conference registrants (minimum one day) will be prioritized for registration to this workshop, with proof of H&R2019 registration required. Remaining spots will be released to non-conference attendees on March 1st, 2019.

TEE Day PROGRAM

Flyer

 

Keynotable Montreal Flyer

2. Full day Keynotable: the brainchild of educator extraordinaire Haney Mallemat, this course is intended for those who want to add some serious game to their presentations and didactic teaching. Sharing tips and pearls that have made him unquestionably one of the best docs to man the stage and podium, this is a rare opportunity not only to leave run-of-the-mill powerpoints behind, but also to enhance your future audience’s learning and become a master presenter.

Registration 495$USD physicians, 375$USD trainees and other health care professionals. Register at http://www.keynotable.net or email info@keynotable.net.

More details here.

 

3. Half-Day Hospitalist POCUS: Learn absolutely necessary skills for the day-to-day management of your hospitalized patients. It doesn’t matter how good a clinician you are, with ultrasound you will be a better one. Learn from a world-class clinician faculty how to assess the IVC for a number of clinical scenarios, how to assess lungs, do basic cardiac views, diagnose or rule out hydronephrosis, and safely tap ascites or pleural effusions.

Cutting edge today, standard of care tomorrow…

Faculty: Rola, Ajmo, Haycock, Baker, Olusanya

Practice on state-of-the-art simulators, normal volunteers and volunteer patients with true pathology.

Your patients need you to know this.

Limited to 30 participants so that your hands on and faculty experience is maximized. 300$CAN/250$USD

 

4. Half-Day Critical Care Procedures: If you are not already familiar with these key procedures any resuscitationist should have in their pocket, don’t miss this course. We’ll go over thoracic pigtail insertion, bedside percutaneous tracheostomy and emergency surgical airway, using manikins and natural simulators. Plenty of practice, until you’re comfortable with the techniques. By the end of this activity, participants should be able to independently insert pigtail catheters and perform an emergency surgical airway, and be able to perform a percutaneous tracheostomy with the backup and supervision of an experienced operator.

Faculty:  Ajmo, Farkas, Tremblay

Limited to only 20 participants, so don’t wait too long! 300$CAN / 250$USD

 

 

 

5. Brazilian Jiu-Jitsu for MDs: Nope, you didn’t accidentally click on a link. This is part of the pre-conference day. What does it have to do with medicine? A lot. With life? Everything. If you’re already got mad mat skills, come join us for a couple hours of fun. If not, treat yourself to an introduction into a martial art, a sport and even a lifestyle that cultivates physical and mental health like no others. The rest of the conference will change your practice, but this workshop might change your life.

Faculty: Spiegel, Rola, and some guest stars!

No experience necessary, only interest and enthusiasm.

It’s a bit too early to be sure who, but expect to have some interesting surprises as to who your instructors might be…

…oh, and acute care docs should find something in the words of Rickson Gracie, one of the legends of jiu-jitsu:

Limited to 30 participants, registration fee TBA, and will open on november 1st. You can reserve your spot in the meantime by emailing hospresusconference@gmail.com.

 

So we are really looking forward to these courses. It’s a great opportunity to pick up some important skills and have plenty of time with some awesome instructors, all of whom are hoping to share as much clinical knowledge as possible.

Mark your calendars! Please email hospresusconference@gmail.com with any questions!

Register here!

 

The H&R Scientific Committee – St-Arnaud / Zambrana / Rola

September 26, 2018

A Primer on Pigtail insertion. #FOAMed, #FOAMcc

So I recorded this for our incoming residents to Santa Cabrini ICU, whom we expect to become well versed in this procedure by the end of their rotation with us. The difference between a smooth and simple insertion – best for both patient and operator, is in the little details.

Figured I might as well put it up on #FOAMed in case anyone else may benefit!

Here is the podcast:

 

And here is a video displaying the technique.

 

cheers

 

Philippe

 

 

February 12, 2014

Pleural effusion: Draining it! (Part 3 of 3) #FOAMed, #FOAMcc

Ok, so once you’ve determined you should drain a pleural effusion, your options are to insert a small catheter (CVC, pigtail, generally 8.5 to 14F) or a traditional chest tube.  CVCs/pigtails should only be inserted when (a) you have ultrasound guidance and (b) the effusion appears to be free flowing and without a great deal of echogenic contents. Why? Because to go in with a sharp needle, as the seldinger technique requires, you need to visualize a safe spot by ultrasound, and because if the effusion is complex with septations and blood/pus, it likely needs a large bore chest tube to successfully drain. For the less experienced, a traditional chest tube insertion is done using blunt dissection and exploration with a finger, such that the risk of pneumothorax is minimal (no needle).

In terms of the pigtail insertion, choose a spot using ultrasound, generally posterior to the midaxillary line to optimize drainage, then freeze, insert the guide needle then guidewire, then dilator and finally the drainage catheter.

Here is a makeshift video showing a pigtail insertion.  I will make another one more focused on the technique, as this one is a bit more focused on the ultrasound. We ca see a large effusion with a bit of atelectatic lung, and also confirm the placement of the guidewire and the pigtail catheter.

Although in this video I showed live ultrasound guidance, in most cases I prefer to pick the spot, mark the skin, and do the technique blind. It is simply faster that way. However in some cases, especially with small fluid collections, I may choose to use live ultrasound guidance.

This is actually a very practical skill to have, as otherwise pigtails are generally inserted by interventional radiology, which implies delays, and more importantly, patient transport and its inherent risks and disadvantages. So for those without experience, I would highly encourage you to seek out an experienced operator and learn this technique.

thanks!

Disclaimer: this description and video is for the sole intent of sharing medical knowledge and does not replace formal training. Do not try this without adequate training and/or supervision.