Podcast 153 – In Memory – John Hinds, On How He Ran His Unit - a podcast by Scott D. Weingart, MD FCCM

John was one of the most wonderful people I knew in medicine. He was kind. He was an amazing doc; strong and confident in what he believed was right, but the consistent trait noticed by all who met him in the FOAM world was his rare humility. John was just lovely, with an acerbic wit that kept me in tears whenever I was around him. He was trying to better the trauma care of Northern Ireland, hopefully his work will be continued and his amazing contributions remembered. My thoughts are with John's family. He left us far too soon, and I miss him so.



If you want to send condolences to John's Family, please contact Rob Mac Sweeney--Tweet (@CritCareReviews)



Please see these words from John's friends in the FOAM World:



* The St. Emlyn's folks

* Michelle from the LitFL Crew

* Cliff from resus.me

























A few months ago, John came and visited us at Stony Brook to give EM Critical Care Grand Rounds. He was easily the speaker of the year. He gave an amazing lecture on how he ran his unit (along with his 5 amazing colleagues). The audio quality of the recording was crap (my fault, not John's). We had plans to rerecord it as a podcast, but that can't happen now, so I hope you love listening to John in any form possible, as I know I do:

How John Ran His Unit

When not in the field as a road-racing doc, John was an Anesthesia-Intensivist at Craigavon Area Hospital. He worked in a ten bed unit, only eight of which could have mechanically ventilated patients and yet...



The unit has



* CO2 Dialysis with Novalung

* One of the first centers in the UK to offer REBOA (done by the intensivists)

* Tele-Critical Care

* TEE



Central Lines



* Remove all peripheral ivs

* Remove all resus placed lines

* Place all resus lines 5x ports in left sub clav sunk to 20cm. 10% of them sit in the right atrium; they've had no problem with cardiac erosion. John felt this is a relic of the past.

* Place all CRRT lines r subclav sunk to 20 cm (intra-arial)

* They get CVP off prox port

* Most dangerous drug in the distal

* Subclav is the Line of Champions

* 800-1000 lines per year, no infections in the past year. Pneumothorax rate 0.8% in the last 300 lines tracked



Sepsis



* All get arterial line

* Serial Lactates

* All get a central line

* Fresh PIVs

* Norepi or epi

* Max fluid load of ~2 liters and then need a good reason to give anymore

* No etomidate; They use ketamine, it is open shelf

* No Inodilator (b/c they run their patients extremely dry)

* Phenylephrine and Metaraminol are banned to prevent lazy resuscitation

* No cardiac output monitors until they are not random number generators--they use TTE and TEE

* They don't see ARDS (You need to listen to the Podcast)

* No standing maintenance fluids



InoPressors

Not in the lecture,

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM