It is near the end of your shift and one of the nurses asks you to see a fellow ED staff member’s nine-year old daughter who has accidentally put a foreign body into her ear. You go see her and the otoscope reveals a small shiny jewel within the ear canal however flushing does not work to get it out. Next you try using the otoscope, while exposing the ear canal and holding the forceps to grasp the object. Unfortunately, it is difficult to get your assistant to align the light, and the otoscope speculum is limited in view and access.
In the world of medical education and Twitter, Dr. Oliver Flower (@OliFlower) is a virtual celebrity. Oli has been a central figure in FOAM and serves the daunting role of being a co-organiser for the upcoming buzz-worthy SMACC conference in Chicago (June 23-26, 2015) alongside Roger Harris and Chris Nickson. He is incredibly efficient and effective, juggling multiple deadlines and responsibilities. It was no surprise to us when Oli was tagged by Dr. Rob Mac Sweeney from a previous How I Work Smarter post as someone whom we could learn a lot from. Oli was kind enough to send along his responses.
In this month’s ALiEM Book Club selection, Humble Inquiry: The Gentle Art of Asking Instead of Telling, author Edgar Schein describes a model of communication termed “humble inquiry” which he defines as “the fine art of drawing someone out, of asking questions to which you do not already know the answer, of building a relationship based on curiosity and interest in the other person”. Although a very quick read (100 short pages!), it is packed with profound insights about the way we communicate and a vision for what might be! Communication is so pertinent to our work in the medical field from encounters with our colleagues, our learners, and our patients. Striving to improve communication is a goal that every provider should have and this powerful book can help!
Welcome to another ultrasound-based clinical case, part of the “Ultrasound For The Win!” (#US4TW) Case Series! In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed the management or aided in diagnoses. In this month’s case, a 93-year-old female presents to the Emergency Department with crushing chest pain.
A 93-year-old female with no available medical history is brought to the Emergency Department by ambulance after she was noted to clutch her chest and collapse while at home. She is unable to provide any history due to altered mental status.
Traditional teaching recommends naloxone doses of at least 0.4 mg IV to reverse opioid toxicity. Drs. Lewis Nelson (@LNelsonMD) and Mary Ann Howland (@Howland_Ann) co-authored the opioid antagonist chapter in Goldfrank’s Toxicologic Emergencies . They write:
“However, this dose [0.4 mg] in an opioid-dependent patient usually produces withdrawal, which should be avoided if possible. The goal is to produce a spontaneously and adequately ventilating patient without precipitating significant or abrupt opioid withdrawal. Therefore, 0.04 mg is a practical starting dose in most patients, increasing to 0.4 mg, 2 mg, and finally 10 mg.”
With interview season now in full swing this winter season, we gathered a few more of our favorite program directors to discuss the hot topic of making the post-interview communication etiquette. We feature Dr. Jim Colletti (Mayo Clinic), Dr. Jessica Smith (Brown University), and Dr. Jeff Schneider (Boston Medical Center). Thanks again to Dr. Mike Gisondi (Northwestern) for spearheading this innovative and helpful EM Match Advice video series for medical students.
ALiEM-Annals of EM Journal Club: Spontaneous pneumothorax, pigtail catheters, and outpatient management
We are very excited this month to bring you another installment of the ALiEM-Annals of EM Global Journal Club. The highlighted article is Voison et al. on the “Ambulatory Management of Large Spontaneous Pneumothorax With Pigtail Catheters.” We hope you will participate in an online discussion based on the clinical vignette and questions below from now until Nov 17, 2014. These Respond by commenting below or tweeting using the hashtag #ALiEMJC. In a few months, a summary of this journal club will be published in Annals of EM.
On Fri, Nov 15, 2014, we hosted a live Google Hangout with Dr. Stéphane Jouneau, the senior author of the Annals of EM publication who resides in France.
I her original post for the “How I Work Smarter” series, Editor-in-Chief Michelle Lin (@M_Lin) called out Dr. Esther Choo (@choo_ek), who then called out Dr. Lainie Yarris (@lainieyarris) from OHSU… and in an unexpected turn of events, Lainie then somehow decided to tag me. How odd… Lainie is a mentor of one of my friends, and she’s been kinda a hero to me, so I find that this is both flattering and somewhat flabbergasting… There is no way I fit within the ranks of those others’ whom have been tagged in this wonderful game of academic “you’re it…”, but as the great Barney Stinson once said: “Challenge accepted.”