Everything IONM from Joe Hartman.
Information is open to anyone. But it wasn't always like that in small niches, like #neuromonitoring.
Information was protected because the scarcity gave it value.
"I was trained by Kent Rice" carried more weight than the University they came from.
Today is different. There's more information than we can access.
Plus, the field is doing more cases annually with fewer companies.
There's always a bit of dilution in corporate training when we're talking about the size and distance many compani
I thought this was a clever addition to traditional #ionm for TAAA surgery.
Using a non-limb modality (BCR, anal tcMEP, pudendal, and anal EP) the authors looked to better differentiate spine from limb ischemia.
A small sample size, but you can see the low rate of establishing BSL is improved when trying them all.
You get what you get, but better than nothing.
And talk about a great experience for newcomers to the field clinicians looking to learn different modalities.
Question: Does #neuromonitoing help reduce "shoulder syndrome" in functional radical neck dissection?
That's what this retrospective study sought to answer for patients with laterocervical lymph node metastasis for thyroid cancer.
EMG + tEMG accomplished monitoring of the spinal accessory nerve using the SCM and Trap mm.
Without IONM, the surgeon is using visual inspection and intuition to avoid injuring the nerve during dissection safely.
The problem is twofold:
- Inter and intra anatomy a
If the world around us changes faster than our business, we will soon be out of business
The same holds true for any individual.
Where we decide to spend our focus plays a large role in who comes out ahead.
The fact is that the cream does not always rise to the top. It's those that are positioned best end up with the upper hand.
I've always liked the heuristic, "it's the elevation, not the archer."
So, what's the area of focus you see paying the biggest dividends over the next 3 years?
Looking to hire an EEG tech in Stuart, FL. Message me for details. (US citizens only, please)
Looking to hire an EEG tech in Stuart, FL. Message me for details. (US citizens only, please)
An area of expansion for #neuromonitoring is its versatility. That's something to keep in mind when reading research, which is usually focused on answering fewer questions more definitively.
It can cause a reader to make inaccurate assumptions at no fault of the authors.
Here's an example.
This facility is using a multimodality approach to monitor for potential deficits in Chiari malformation surgery. The outcomes under this lens show SSEP and MEPs to be superior modalities. It might even cal
When an IONM manager is called to talk to anesthesia because of a problem, 80% of the time this is what they say (without saying it).
"I agree with the idea, but I disagree with the tone."
Most of the issues point back to sloppy communication practice, not protocols.
It tends to happen when we're the "new person" at the facility.
We need to be at our best when there's no relationship established.
And if we're new to the field, our manager might assume this to be a systemic personality prob
I used to be of the opinion that Vision Statements were a useless exercise promoted by consultants. I still am, but I also hold the opposite as true.
And it doesn't look like I'm the only one thinking this, as the chart below shows the drop in its usage (along with purpose and mission).
But I've done a little bit of poking around in this area and found out it's not the idea but the execution I have the negative bias towards.
Most vision statements seem to be vague and forgettable versions of
#anesthesia steel cage match. 5 monitors with index values go up against EEG spectogram. So, how did they do?
It would be great if the simple option was the one that won out, but the evidence suggests otherwise.
Who was involved?
• BIS
• Entropy-SE (my favorite name)
• Narcotrend
• qCON
• Sedline
Conclusions
Many clinical providers still rely on index values and manufacturer's recommended ranges for titration decision-making. That two-thirds of cases showed discordant recommendations given i
What do you do when the abnormal lateral spread response persists? Use the Z-L Response...
First, let's set the table.
People who suffer from hemifacial spasm will often be referred to surgery to remove the offending vessel(s) from the facial nerve.
Neuromonitoring can recreate an abnormal mm response by stimulating a nerve branch and recording activity from a muscle that should be silent.
It's still not completely understood whether it is a central wind-up problem (hyperexcitability), a pe
I've spent a lot of time on the 29%. On Monday, my focus switches to the 70%. Starting something new.
What's the cultural design element no one likes to give airtime?
Consequences.
And this extends past the thought of "people who do ____ fall behind."
Some consequences are intentional because they are part of the strategy.
If you're running a high end brand, you squash conversations about targeting ad clippers.
If you're customer first, you accept not being able to downgrade your customer support during economic downturn.
If you're the thought leaders, you don't get to sit comfy in the c
Hiring new talent has 2 phases in a morally fit company: Filtering and Developing. Using a "double filter" makes you a risky company.
Filtering is to be done during the interview process. This is the time to select for fit. But to truly filter, don't use the weak advice of finding a suitable candidate.
Hiring smart takes more rigor.
Interviewing done right is a conversation where the candidate has to turn a "no" into a "yes."
As in every person you interview starts as a no. It's up to the
The problem: prolonged unilateral APB with appropriate SSEP after prone positioning. The same side TOF, also lost.
This was a case study presented by Hayashi and others from the Dep of Anes, Nara Medical University.
So let's play with this a little bit.
When we have a significant change after positioning from supine to prone, we immediately go into differential mode.
Because of the degree of severity + frequency of being the culprit in prone positioning, we should be thinking about cervical
#Surgeons - how can you tell if the IONM clinician is helping you intervene in a timely manner?
A short list to consider:
#1
They took the time to optimize their signals beforehand. Asking them what they did to do so should have more steps than clicking the "on" button. This allows them to give you alerts with more confidence.
#2
When a change happens, they have already eliminated many of the possible technical problems. Some of this comes with good technique and program adapting, but a lot
"𝘞𝘦'𝘷𝘦 𝘢𝘭𝘸𝘢𝘺𝘴 𝘥𝘰𝘯𝘦 𝘪𝘵 𝘵𝘩𝘢𝘵 𝘸𝘢𝘺" implies certain death, so we adapt. We do "change management." Here's where it goes wrong...
Owners and managers put in the time and effort for models, forecasting, and analysis.
They see something on the horizon that causes the need to change direction. It's either an opportunity or a threat.
Strategy sessions ensue, and a new, more fruitful destination is chosen.
Because those in charge see their position as more "big picture," not much time is spent on dev
IONM's primary goals are to prevent injury and map structures. But what additional benefits might we find?
When we have changes that recover, we might hang that under the "prevention" side of things.
It would be hard to find too many cases where the patient woke up with a deficit that was more than transient. Usually undetectable, if anything at all.
The chances of post op deficits go up in partial or no recovery of signals.
There are cases that do not fully recover, as well as cases where t
Selective hypoglossal nerve stimulation seems to be a great option in patients with obstructive sleep apnea. Maybe #IONM can take it further?
What might not be totally obvious, unless you're looking at it, is the rate of patients with bilateral innervation from the hypoglossal nerve.
Somewhere around 40%-50%.
What, if any, difference might this make?
On the upside, maybe bilateral tongue movement and bilateral tongue base opening could result in better outcomes?
Your breathing hole ends up
