The Case of the Financial Fiasco has stimulated interesting discussion over the past week. We are now proud to present to you the Curated Community Commentary and our two expert opinions. Thank-you again to all our experts and participants for contributing again this week to the ALiEM MEdIC series.
Though lipid rescue sounds like something from a junk food detox regimen, it’s one of the most exciting developments in emergency management of drug overdose in the last 20 years. Unlike charcoal which can lead to aspiration and has relatively little data showing improved outcomes, or dialysis which relies on convincing your nephrologist to come in at 3 am, lipid rescue is a readily available, cheap, safe therapeutic that we’ve been using in TPN for adults and children for decades. And it seems to work, but why aren’t we using it?
We all know the population of the United States is aging. We know emergency physicians need to be prepared and trained to care for older adults. But how can you dive into the world of geriatric EM to learn more, to research, to gain additional training? In this post, we have gathered the wisdom of leaders in geriatric EM across the country, to share their recommendations, inspiration, and motivation.
A 44-year old woman presents via EMS with a chief complaint of a racing heartbeat. She is placed on a cardiac monitor, which displays a heart rate of 192, and a subsequent EKG reveals she is in SVT. She also complains of chest discomfort and shortness of breath. Her blood pressure is stable, and you decide to treat her with adenosine. As you take a more thorough past medical history, you learn your patient has a history of asthma. One of the EM residents mentions that he thought adenosine should not be given to patients with reactive airway disease.
How I Work Smarter Nominations
(Jul 17, 2014-Mar 22, 2015)
Today we are taking a break from our regularly schedule program and going meta. FOAM clearly helps break down borders, but sometimes, a look at a map really brings it home. These connections were launched when Dr. Michelle Lin tagged 3 people for their “How I Work Smarter” perspectives, who then each tagged 3 people, and so forth. We have had enough responders (37!) to keep this going for many months. This has cascaded and created a broad virtual international community of smart-working clinicians. Below are more close-up views of the US, UK, and Australia map and a few more insights.
Many residents and medical students are making career decisions that will last a lifetime. Some are aware of the financial considerations while others avoid discussing the topic for fear of being seen as shallow. This month’s ALiEM MEdIC series case considers how we might help a learners as they consider money in medicine. Please join us in discussing the case this month, we would love your thoughts and advice.
Are you getting a CT or bedside ultrasound as your first-line diagnostic approach to patients with undifferentiated abdominal or flank pain in whom you suspect kidney stones? In a landmark 15-center, multidisciplinary study published in the New England Journal of Medicine in September 2014, Dr. Rebecca Smith-Bindman (UCSF Department of Radiology) and her research team looked at exactly this question for emergency department patients. In the paper, “Ultrasonography versus CT for suspected nephrolithiasis,” Dr. Smith-Bindman and Dr. Ralph Wang (UCSF Department of Emergency Medicine) kindly joined us on a quick discussion about her paper.
I am Dr. Resa Lewiss, Director of Point-of-Care Ultrasound at University of Colorado: How I Work Smarter
Today we are back with Dr. Resa Lewiss (@), ultrasound guru and pioneer. She has championed ultrasound via each of the three pillars of academics. She is a clinical master of ultrasound, has taught its use worldwide, and has published extensively on the topic. To top is all off, she has taken institutional leadership as the past President of the Academy of Emergency Ultrasound of the Society of Academic Emergency Medicine and the current chair for the Ultrasound Section of the American College of Emergency Physicians. Plus, she has a TEDMed talk. Nominated by Dr. John Bailitz, Dr. Lewiss offers some pointers how she transduces work to success.
“Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things. I knew these truths abstractly, but I didn’t know them concretely – that they could be truths not just for everyone but also for this person right in front of me, for this person I was responsible for.” Atul Gawande, Being Mortal.