On Call With RK.md

I was pulled from my clinical duties as a cardiothoracic anesthesiologist to start my time as a critical care attending a bit early in light of COVID-19’s rampant spread throughout the greater Houston area. After completing my first week on service, I’ve come to realize how devastating this disease is from a medical and social standpoint. Families who have to be updated solely over the phone/video conference about their loved one dying from hypoxia and acidosis. Previously healthy patients succumbing to multisystem organ failure. Feeling like we just don’t know enough about COVID-19 or “good” therapies because… we don’t. Read More »

I was pulled from my clinical duties as a cardiothoracic anesthesiologist to start my time as a critical care attending a bit early in light of COVID-19’s rampant spread throughout the greater Houston area. After completing my first week on service, I’ve come to realize how devastating this disease is from a medical and social standpoint. Families who have to be updated solely over the phone/video conference about their loved one dying from hypoxia and acidosis. Previously healthy patients succumbing to multisystem organ failure. Feeling like we just don’t know enough about COVID-19 or “good” therapies because… we don’t. All isn’t bad though. I’ve seen many patients pull through. Many who have left the ICU and are well on their way to returning to their loved ones. Many who initially lost hope but slowly recovered. And many who continue to fight within the walls of the ICU. The way that multidisciplinary teams have come together during these times is truly remarkable. Nurses have assignments that have stretched them to the extreme. Respiratory therapists are constantly having to adjust ventilatory devices. Physical and occupational therapists continue to work tirelessly to make sure these patients stay conditioned and can perform their activities of daily living. It’s this team aspect of medicine that drew me to critical care initially, and this pandemic has only strengthened my love.

With July right around the corner, I wanted to go over some tips for soon-to-be interns as they embark on their graduate medical education! Please check out the full post I wrote at the end of my intern year for more tips.

With July right around the corner, I wanted to go over some tips for soon-to-be interns as they embark on their graduate medical education! Please check out the full post I wrote at the end of my intern year for more tips.

Of all characteristics, I think flexibility is perhaps the most desired attribute of an attending in academic medicine. Knowing how to balance trainee autonomy with protecting the patient, being a good educator, and providing timely feedback are all promoted by having a flexible approach to one’s practice. Drop me a comment with your thoughts on this podcast!

Of all characteristics, I think flexibility is perhaps the most desired attribute of an attending in academic medicine. Knowing how to balance trainee autonomy with protecting the patient, being a good educator, and providing timely feedback are all promoted by having a flexible approach to one’s practice. Drop me a comment with your thoughts on this podcast!

It’s been over six months since I’ve been an attending cardiothoracic anesthesiologist and intensivist! Listen to this episode where I discuss what I learned in that time as new faculty and things I did to be successful. Read More »

It’s been over six months since I’ve been an attending cardiothoracic anesthesiologist and intensivist! Listen to this episode where I discuss what I learned in that time as new faculty and things I did to be successful. Special shout out to my wonderful colleagues who were not only accepting of me, but have consistently provided opportunities and encouragement to spread my proverbial wings as I mature into my practice.

Throughout the course of my collegiate and medical training, the manner in which I’ve studied has evolved tremendously. In this podcast, I’ll share this process and outline how I study these days. Check out this post with book references too! Read More »

Mechanical circulatory support (MCS) devices are becoming more prevalent and sophisticated with each passing year. In this episode, I’ll briefly cover some of the basics for intra-aortic balloon pumps (IABPs), Impella, CentriMag, ProtekDuo, TANDEMHEART, and ECMO. As always, drop me a comment with your questions and thoughts! Read More »

Many healthcare workers become jaded by taking care of patients who regularly abuse drugs and seek more potent medications during their admissions (often times saying they have an “allergy” to more traditional analgesics). I’m not naive to this; however, as an anesthesiologist, I’m also very mindful of appropriate pain management in the OR and ICU settings. Every patient should be treated individually, and consideration must be given that we are undertreating pain based on the clinical situation, tolerance, drug metabolism, etc. Read More »

As a follow-up to episode 003 where I discussed inotropes and pressors I routinely use as a cardiothoracic anesthesiologist and intensivist, in this episode, I’ll discuss some of the anti-hypertensives I use in the same settings. As always, drop me a comment below with questions!

Working in both the ICU and OR settings, I’ve come to learn the workflow and considerations unique to each environment. However, with all the required tasks one must complete, I feel like patient care is sometimes jeopardized. Join me in this episode where I discuss two of my biggest pet peeves related to patient care.

Despite all the positive aspects of working in healthcare, it doesn’t take long before one experiences mistakes and patient deaths. In this week’s podcast episode, I’ll delve into how I handle these two, independent situations by promoting a culture of forthcomingness, patient safety, honesty, and supporting (rather than scolding) each other.

As a cardiothoracic anesthesiologist, I have been trained extensively in cases which require cardiopulmonary bypass (“the heart-lung machine”). CPB is similar to VA-ECMO in many ways, but for the purposes of surgery, it allows the surgeons to have a motionless and bloodless field when combined with cardioplegic arrest. […]