Welcome to the fifth ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our residents for the reading and learning they are already doing online we have created an Individual Interactive Instruction (III) opportunity utilizing FOAM resources for U.S. Emergency Medicine residents. For each module, the AIR board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our private Google Drive database, which participating residency program directors can access to provide proof of completion.
Welcome to another ultrasound-based 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 management or aided in diagnoses. In today’s case, a 74-year-old woman presents to the Emergency Department with painful right arm paresthesias.
A 74-year-old female with history of atrial fibrillation presents to the Emergency Department with 45 minutes of painful right arm tingling that are now resolving. She has been off warfarin for the past 2 weeks for knee surgery. She reports no right arm weakness or color change. She reports left shoulder pain 12 hours prior to presentation. No complaints of shortness of breath or chest pain.
Eve Purdy (@Purdy_Eve) is one of those rising stars in medical education, who “leads from the middle” in her role as a senior medical student at Queen’s University. She is already quite involved as a blogger at Manu et Corde, a Medical Student Editor at Boring EM, and as a part of the ALiEM Book Club team. I, along with many others, are eager to see what Eve has in store for the world of medical education in her early promising superstar career. Eve was tagged by Dr. Teresa Chan in a previous How I Work Smarter post and was kind enough to share her tips for, as Eve states, “TRYING to work smarter”.
The 2014 year has been amazing. As 2015 approaches, the ALiEM team has gotten quite reflective and thankful for the past amazing 12 months. We can track many things through Google Analytics, but there’s nothing like hearing from our readership directly to help us shape the upcoming 12 months. There are many innovative plans in the works, and your input would be incredibly helpful to help us tailor our priorities to what YOU want. We are a volunteer organization, made up of passionate, early-adopting educators, who are asking for nothing more than YOUR valuable input. Please donate 1 minute of your time to fill out this quick survey. Once you submit your feedback, you can see what everyone else said. The beautiful infographic results page by Google Forms is worth seeing too. Thanks!
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The full title of Gerd Gigerenzer’s book is Risk Savvy: How to Make Good Decisions [Amazon], which is exactly what makes this book so relevant, not just to the everyday reader, but to the medical reader. We make decisions every day in the medical field that range from the complex of intubating someone with low reserve or difficult airway anatomy to the less life-and-death decision of when to best time a quick food break between seeing patients. Of course, we also help our patients make very complex decisions, especially in the ED when time is short but risk can be high. And it certainly is not an easy task to attempt to bring family members up to speed on the ins and outs of intubation vs BiPAP or the complex statistics associated with radiation exposure when working up a pregnant patient with a potential pulmonary embolism. Gigerenzer’s book does a beautiful job of helping the reader not only understand how to break down the complexity of risk, but also how to go about explaining it.
There is an abundance of sympathetic stimulation in patients who present in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) whether endogenously released as a stress response or exogenously administered in a resuscitation attempt . The hope is that sympathetic stimulation will increase the coronary and cerebral perfusion pressure of the patient and aid in resuscitation. However, there are numerous detrimental effects associated with epinephrine such as an increase in myocardial oxygen demand leading to increased ischemia .
Contrary to traditional teaching, interesting evidence exists in both animal models as well as in limited reports in human subjects that show a potential benefit with beta blockade in cardiac arrest.
At the 2014 American College of Emergency Physicians Scientific Assembly, ACEP passed Resolution 44, officially recognizing Emergency Medicine Pharmacists as valuable members of the EM team. Nadia Awad (@Nadia_EMPharmD) summarized the importance of the resolution’s passage on the EMPharmD blog. The role of an EM Pharmacist has been outlined by the American Society of Health-System Pharmacists (ASHP). In addition, Zlatan Coralic (@ZEDPharm), one of ALiEM’s regular contributors, framed the EM Pharmacist as the ‘ultimate consult service.’ The intent behind this post is not to discuss the role of the EM Pharmacist, but to highlight the rigorous training process through which most EM Pharmacists have traversed to work in this amazing specialty.
“Don’t delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit.” This statement was one of ACEPs 2013 Choosing Wisely recommendations. How palliative care can be effectively and practically integrated into the ED, and which patients are likely to benefit from it is still being worked out at many institutions [1-4]. However, it is clear that the time for palliative care in the ED has come.
I am Dr. Mike Stone, Division Chief of Emergency Ultrasound at Brigham & Women’s: How I Work Smarter
Dr. Mike Stone (@BedsideSono) is well known in the medical education world especially in the field of bedside ultrasonography. In addition to being a professor for the Ultrasound Leadership Academy and Ultrasound Podcast team member, he also runs the Emergency Ultrasound Division at the Brigham & Women’s Hospital. Like Dr. Mike Mallin who tagged him from a previous How I Work Smarter post, many of us have been amazed at Mike’s ability to juggle so many roles and responsibilities at once. Here are some his secrets to success.