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episode 45

Checklists! Keeping Track of Killer Items

Sometimes, the most complicated problems can be solved with the simplest solutions.  Nyssa and Lisa discuss “the checklist” - an elegant tool which revolutionized safety protocols in the field of aviation, and how they can - and should - be used in emergency medicine to increase favorable outcomes in patient care.

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Malcolm Gladwell’s review of The Checklist Manifesto

Over the past decade, through his writing in The New Yorker magazine and his books Complications and Better, Atul Gawande has made a name for himself as a writer of exquisitely crafted meditations on the problems and challenges of modern medicine. His latest book, The Checklist Manifesto, begins on familiar ground, with his experiences as a surgeon. But before long it becomes clear that he is really interested in a problem that afflicts virtually every aspect of the modern world–and that is how professionals deal with the increasing complexity of their responsibilities. It has been years since I read a book so powerful and so thought-provoking.

Gawande begins by making a distinction between errors of ignorance (mistakes we make because we don’t know enough), and errors of ineptitude (mistakes we made because we don’t make proper use of what we know). Failure in the modern world, he writes, is really about the second of these errors, and he walks us through a series of examples from medicine showing how the routine tasks of surgeons have now become so incredibly complicated that mistakes of one kind or another are virtually inevitable: it’s just too easy for an otherwise competent doctor to miss a step, or forget to ask a key question or, in the stress and pressure of the moment, to fail to plan properly for every eventuality. Gawande then visits with pilots and the people who build skyscrapers and comes back with a solution. Experts need checklists–literally–written guides that walk them through the key steps in any complex procedure. In the last section of the book, Gawande shows how his research team has taken this idea, developed a safe surgery checklist, and applied it around the world, with staggering success.

The danger, in a review as short as this, is that it makes Gawande’s book seem narrow in focus or prosaic in its conclusions. It is neither. Gawande is a gorgeous writer and storyteller, and the aims of this book are ambitious. Gawande thinks that the modern world requires us to revisit what we mean by expertise: that experts need help, and that progress depends on experts having the humility to concede that they need help.

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episode 46

Decoding Urgency:

The 3+ Phrases of Angor Amine

In this episode, we reveal the three (plus bonus) critical phrases that can make all the difference in patient care.  Lisa and Nyssa break down the significance of these ominous declarations, and discuss the swift decisive actions that ER nurses must take when confronted with these signals.

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episode 47

Nurses' Week Podcrawl 2024:

Hypovolemic Shock

Nyssa and Lisa talk to Up My Nursing Game's host Annie Fulton as part of a special National Nurse's Week podcrawl - a veritable cornucopia of all things shock related, shared across seven top medical podcasts!  Learn about hypovolemic shock, how your Kool-Aid recipe applies to understanding the qualities of the fluid in your patient's vasculature, what to look out for as warning signs of a dangerous loss of volume, and how to adjust your practice to keep your patients alive.

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