On Call With RK.md

In this episode, I discuss the MacOS applications I use on my MacBook Pro and iMac Pro in 2021. Be sure to check out the entire app listing for links.

Organ donation after the circulatory death (DCD) or clinical diagnosis of brain death is a highly coordinated process primarily driven by organ procurement organizations (OPOs). I’m fortunate to be involved with a streamlined process whereby organ donors from our hospital are cared for in a dedicated “donor specialty care unit” while finding potential recipient matches at hospitals all over the country.

Just inside this ICU is a commemoration that reads:

Here we stand…At the threshold of this new beginning.We bless the intention, vision, and laborof those who brought this spacefrom mere possibility into solid reality.May we honor and bless the patients and familiesWhose generous but broken heartsHave made the difficult decisionIn offering the most precious gift of allTo those they’ve never met.May those who serve hereBe continually renewed in their spiritAs they, too, give of themselvesWith wisdom and compassion.May their lives be bountiful with love and blessings.Through all of these giftsThe sacred speaks and smilesFrom behind those giving eyes.May we all be giversAs we rise together in this new beginning.

I love my Virtuoso+ burr grinder, but like similar grinders, I had issues with static electricity causing coffee grounds to fly around, stick to the coffee bin, and even complicate cleaning the grinder afterwards. Now if I’m grinding a small amount of coffee, I’ll add beans to the hopper, add a few drops of water …

Left ventricular (LV) wall motion abnormalities (WMA) are associated with myocardial ischemia and can be generalized or regional. In this transgastric mid-papillary short axis view of the LV, one sees a clear difference in how the inferior and lateral walls are contracting compared to the septal and anterior walls. Decreased inward motion of the endocardium …

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 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 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.

Here’s a transesophageal echo (TEE) clip I’ve taken of an interesting congenital condition: transposition of the great arteries (TGA). Whereas the aorta (Ao) normally comes off the left ventricle (LV), in this case, it comes off a very hypertrophied right ventricle (RV). TGA comes in two variants. D-TGA has atrioventricular concordance but ventriculoarterial discordance resulting …

Superior vena cava (SVC) syndrome is characterized by facial plethora, upper body venous engorgement, chest pain, soft tissue swelling, dyspnea, and even neurologic changes. Anything that impairs SVC drainage by intrinsic obstruction (thrombosis, anatomic narrowing) or extrinsic compression (mediastinal masses, non-small cell lung cancer, non-Hodgkin’s lymphoma, etc.) can result in this syndrome. Remember, venous structures …

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.

Lumbar drains are a mainstay for spinal cord protection when patients undergo operations like thoracoabdominal aortic aneurysm (TAAA) repairs and thoracic endovascular aortic repairs (TEVAR) with subclavian artery debranching. Why? Because the anterior spinal artery receives contributions from paired intercostal arteries that can be disrupted by the aortic pathology itself in addition to the operation …

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!