Dr. Michelle Lall, an Assistant Professor and Assistant Residency Director is dedicated to promoting work-life balance and resilience among her co-workers and nationally. She was inspired in part by her experience growing up as the daughter of a physician who worked long hours his whole life. In addition to promoting wellness through national committees, she has developed a multi-tiered approached involving faculty, residents, advanced practice providers, as well as significant others to promote wellness at every level in her department.
Wellness is not the sole responsibility of each individual physician, rather it is something we have to foster as a community. Many if not most of the things that contribute to burnout or detract from wellness are systems-level problems. Therefore the solutions also need to be systems-based, which inspired us to launch this series on how to promote wellness in EM. The goal is to share ideas, practices, and programs that have worked at different institutions to promote wellness. Our hope is that in reading these posts, you will be inspired to take some of the ideas and implement them in your own program. In this way we can slowly change the system that has produced a 70% burnout rate among Emergency Physicians and start to build programs and systems that promote wellness, resiliency, and career longevity. In this post, Dr. Pilarski discusses how she founded the Medical College of Wisconsin Wellness Committee, the challenges she overcame, and what the committee has accomplished.
In Emergency Medicine, we are like Goldilocks when it comes to many things: We don’t like a patient’s PaO2 to be too high or too low. We don’t like the bed too high or too low when we intubate. We get concerned when we see a potassium that is too high or too low. The Goldilocks principle is also true of opening pressures on a lumbar puncture (LP). This post will discuss what the opening pressure means, and a differential diagnosis for when it is too high or too low and even when it is in the normal range.
Pain is the most common reason people seek care in Emergency Departments. In addition to diagnosing the cause of the pain, a major goal of emergency physicians (EPs) is to relieve pain. However, medications that treat pain can have their own set of problems and side effects. The risks of treatment are particularly pronounced in older adults, who are often more sensitive to the sedating effects of medications, and are more prone to side effects such as renal failure. EPs frequently have to find the balance between controlling pain and preventing side effects. Untreated pain has large personal, emotional, and financial costs, and more effective, multi-modal pain management can help reduce the burden that acute and chronic pain place on patients.1 There is evidence that older adults are less likely to receive pain medication in the ED.2,3 The first step to improving, is being aware of the potential tendency to under-treat pain in older adults. Here are 5 tips to help you effectively manage pain in older adults on your next shift.
Older adults are at high risk of poor outcomes from even minor head injuries. We see many older patients in the ED who present after a fall or head injury, and we have good decision rules for which patients need brain imaging.1 However, even patients with mild traumatic brain injuries, who have a negative CT scan, are at risk for mortality and significant long-term sequelae. The CDC has called traumatic brain injuries a ‘silent epidemic’.2,3 The first steps to breaking that silence are awareness and recognition.
If you are a 4th year medical student, chances are that interviews are taking up much of your time and thought right now. Interviews can be stressful, especially when your future job is at stake and in the hands of the somewhat mysterious match process. How can you set yourself apart from hundreds of other applicants as someone who is a good fit for a program, who should be ranked highly, and who will be a great future resident – all in the course of a 15 minute interview? This post will walk you through some important “Dos” to make you stand out, and some devastating “Don’ts” that can sink you down lower on a program’s rank list.
Hip fractures are an important cause of morbidity and mortality in older adults. The average age for hip fractures in the U.S. is 80 years, and a staggering 20% of women and 10% of men 1 will experience a hip fracture in their lifetime if they live to older age. This makes it a costly injury, racking up close to $15 billion per year in the U.S. alone. 2 Some hip fractures are obvious as soon as the patient rolls through the ambulance bay. Others can be subtle and require more than just a plain X-ray. This post will discuss risk factors for hip fractures, and how to diagnose and manage patients with hip fractures in the ED.