In the Emergency Department, we often order urine toxicology screens for patients with altered mental status without an obvious cause. I find that patients are often rather forthcoming about their drug use, if they are alert enough to talk. In those cases, ordering a urine toxicology screen is unnecessary.
As I was going through the free EM-RAP Educator’s Edition podcasts, somehow missed the March 2010 podcast on how to teach procedures in the Emergency Department. In the 36-minute podcast, Dr. Mak Moayedi (Univ of Maryland) discusses a framework to teaching procedures. Check it out.
More specifically, Dr. Moayedi talks about how teaching procedures has moved beyond the antiquated “see one, do one, teach one” philosophy. Instead, we should follow principles based on accepted adult learning theories.
Occasionally, emergency physicians see patients who present because they are unresponsive despite normal vital signs and an otherwise normal exam. You detect no drugs or alcohol on board. You suspect a psychiatric or malingering etiology, but aren’t sure. They seem non-responsive to voice and minimally responsive to very painful stimuli. Is this a case of psychogenic coma or true coma (with bilateral hemispheric dysfunction)?
What test can you do to reassure yourself that this may indeed be psychogenic coma?
In academic medicine, you inevitably will need to give presentations. This may include giving lectures on clinical topics, summarizing your research findings, or presenting your meeting agenda. Usually these are displayed using a laptop and a LCD projector. Depending on the room, you may or may not be provided a cordless presenter.
Evaluations of clinical faculty typically incorporate comments from rotating medical students and residents regarding their teaching ability. In the Emergency Department (ED), how do you balance your pressing clinical responsibilities with teaching?
When I did my residency training in Emergency Medicine and in the first few years as an attending, we regularly performed diagnostic peritoneal lavages in patients with stab wounds injuries to the abdomen. Patients also routinely went to the operating room for exploration.
Now with the evolution of CT imaging technology and more clinical studies, there is now a role for a less invasive management approach. These are the Eastern Association for the Surgery of Trauma (EAST) guidelines.