When a patient is started on anticoagulant therapy, the purpose is to prevent clot formation or propagation. Anticoagulants can improve morbidity and mortality by maintaining cardiac stent patency, reducing the propagation of pulmonary emboli, or preventing formation of intra-cardiac thrombi.1,2 Unfortunately even after minor trauma, these medications can cause major problems. When a patient on clopidogrel is in a motor vehicle collision (MVC) or an elderly patient on warfarin falls out of their bed, the once life-improving therapy becomes potentially life-threatening. It is important for emergency care providers to maintain a high index of suspicion for life-threatening bleeds in all patients on anticoagulation following even minor injuries. The purpose of this discussion is to look beyond the intracranial hemorrhages (ICH) and to consider 5 other sources of bleeding that can occur in anticoagulated patients.
Promoting wellness is a team sport. It takes more than one individual to champion it at any institution. In medicine, when a team is formed to effect change, it is called a committee. Dr. Dan Lakoff was one of the founding leaders of the council of residency wellness committee, and has also helped lead wellness efforts at his own institution. Here he shares his thoughts, his inspiration, and practical ideas that helped improve wellness at his program.
If you are graduating from an EM residency this year, you may be feeling nervous (or petrified) about your first shift out on your own. You’re wondering how you can gain the trust of the nurses and doctors at your new hospital. Perhaps you are wondering how you will keep learning without the residency leadership forcing articles and lectures on you.
In this post we will give you our top 10 tips, each with a practical pearl, for how to succeed your first year out. These keys to success will help keep you from making common mistakes, blowing your chance at a good first impression, and also help keep you out of deep, troubled waters when it comes to HIPAA violations and keeping your medical license.
Promoting the wellness and resilience of his residents and colleagues is a passion for Dr. Michael Epter. He has become a leading spokesperson on the topic within the residency leadership community. With over a decade of experience as a program director, as well as the challenges he worked through caring for twins born at 24 weeks, he has plenty of wisdom and insight to share on how we can help promote wellness in EM!
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.