As a medical student, do you remember your EM clerkship experience and whether you saw a wide variety of patient chief complaints? Did your fellow medical student on the EM clerkship rotation, who was going into Orthopedics, seem to only see patients with orthopedic complaints?
If a journal gets accepted it into the Medline database, it is viewed with significantly more legitimacy. It follows then that your academic CV is better regarded if your publications appear in journals which are listed on Medline. Plus, it’s just fun to see your name listed in Pubmed when you search yourself! Hmm, that sounded more egotistical than I intended, especially since I don’t have that many publications on Medline…
Nothing frustrates me more than not being able to obtain intravenous access in hemodynamically unstable patients, especially because I give a talk on “Troubleshooting the Difficult Vascular Access Patient.”
What would you do in this trauma case?
Recently on my ED shifts, there were several especially challenging endotracheal intubation scenarios.
- A patient with thick frothy sputum constantly oozing out her trachea such that we couldn’t see the vocal cords– no matter how much suction we used. Imagine the Diet Coke and Mentos backyard experiment. I’m not kidding.
- A 300+ pound agitated trauma patient with almost no neck, who eventually was found to have an epidural and subdural hemorrhage.
- A COPD patient who was increasingly lethargic, hypoxic, and hypercarbic (pCO2>115), who I knew would start desaturating quickly as soon as rapid-sequence induction drugs were given.
Dr. John Brown is the well-known (infamous?) Medical Director of the San Francisco EMS Agency — not a small task or for the weak of heart. He also practices at SF General Hospital and manages to keep level-headed in the midst of chaos. I’m constantly impressed by his clinical and political saaviness. You would never know how big of name he is when you meet him. Totally humble and understated, especially given all that he’s done for the city and our specialty.
Do you feel like you are routinely checking various websites to follow up on recent journal publications, reading blogs, catching up on the news? What’s new in Annals of EM or Academic EM? What’s on today’s CNN or EducationPR blogs?
I’m a firm believer that technology should make things streamlined and easier, rather than creating more steps and hassles. I recently discovered online RSS readers on the web. If you don’t have one, you should get one.