A common problem that emergency physicians share and struggle over is the circadian “dysrhythmia” of working random morning, afternoon, and night shifts. Shift work is the blessing and curse of our profession. I have yet to figure out the best way to adjust back to the daytime world after night shifts. Do you have any tricks?

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What part of your job do you love the most?

In academic emergency medicine, nothing energizes me more than brainstorming with creative, like-minded, and motivated people. From my experience, most of my past major projects have all started in similar informal, small-group settings.

For instance, the CDEM organization was built when a small group of undergraduate medical educators went to dinner during a SAEM conference. We conspired to build something bigger and better. Two years later now, we now have over 100 members and are a new member of the major interdisciplinary organization Alliance for Clinical Education.

1. This week, I got a call from Chad Kessler (Univ of Illinois-Chicago) who was interested in bringing medical education more to the forefront of EM. We brainstormed about building a “thinktank” of like-minded educators interested in pushing education to the 21st century. There is so much to be learned in the literature outside of EM and medicine in general. I suggested building a dynamic database somewhere to list the ongoing educational projects and research in EM. We too often work in silos. Collaboration is key in educational research. Any ideas how to build a database that everyone would participate in?

2. As a member of KidsCareEverywhere (KCE), I am headed off to Vietnam this month to help teach a conference jointly hosted by our organization and UCSF. This conference will assess pediatricians’ knowledge before and after learning a new decision-support software PEMSoft. The members of the KCE team met for the last time for a dry-run of the conference and a brainstorming session to anticipate potential hiccups.

One problem which I’m still a little worried about is the access to laptops and electricity. Because we are testing the participants on their ability to navigate the new technology, we need everyone to have their own laptop. We doubt that participants will all have laptops, but we have backup plans to share. We’re more concerned about poor battery life for the existing laptops and something as seemingly simple as access to electrical outlets. I have a feeling we’ll be buying long extension cords while in Vietnam.

Check out our new 1 GB USB thumb drives that just came in! We are giving out to the participants, preloaded with the PEMSoft user manual, hospital-specific documents, and the lecture slides.

3. For our residency program, I’m running the Education Area of Distinction (AOD). There are a variety of AODs available, which allow our residents to “specialize” in a niche in EM. I have two rock star residents in the Education AOD – Liz Brown and Eric Silman. We met to discuss how we were going to take the education world by storm. It always helps to do this over a BBQ meal.

iPhone photo of the inaugural meeting at Baby Blues BBQ. Sorry it’s so blurry – Digital SLR cameras apparently do don’t well when dropped on the floor. In the Canon shop.

The first project, spearheaded by Eric, involves posting interesting cases onto this blog. I’m going to open up a Saturday slot called “A Case Presentation from UCSF-SFGH”. Every Saturday, a short case from the residency program’s Follow-Up Conference series will be highlighted to illustrate key clinical pearls.

We have many Research Associate volunteers who staff the SF General Emergency Department collecting research data. They are often ask “what did you mean when you said…” or “what does that mean on the patient census whiteboard”. When I answer their questions, they often chuckle. This then made me realize that we routinely use terms and phrases that aren’t part of the usual medical vocabulary and are unique to the SF General ED.

• HACito: For acutely agitated patients (often under the influence of one or more intoxicants), we commonly use Haldol, Ativan, and Cogentin in a single syringe to inject intramuscularly. This is commonly referred to as HAC. For smaller patients or those who just need only slight chemical restraint, we use a smaller dose of HAC, or a “mini-HAC” or “HACito” .
• Syncopize: Many medical nouns are converted into new verbs when we speak to each other. “Syncopize” describes one who has had an episode of syncope. “Hematemesize” describes one who has vomited blood.
• MTF: Many of our patients present because they are under the influence of alcohol, heroin, methadone, cocaine, amphetamines, or a combination of them all. After several hours, these patients wake up and are discharged assuming nothing else is wrong with them. For these patients, we write “MTF” on the whiteboard next to their name, meaning that we are waiting for them to “metabolize to freedom”.
• The eagle has landed: Some mornings, often a nurse or institutional police officer buys several dozen donuts for the ED staff. Instead of sending out an overhead annoucement that donuts are in the break room, the code words are “the eagle has landed”.
• Trauma Alpha: All of our severely-injured trauma patients fall under code names, chronologically arranged in alphabetical order. These pre-printed medical charts have pre-registered medical record numbers to allow us to immediately start ordering labs and other diagnostic tests. There’s Trauma Alpha, Trauma Beta, Trauma Charlie, etc. You know it was a bad trauma day when the ED cycles the entire alphabet in a 12-hour shift.
• Med Pack Whale: Similarly for our acutely ill non-trauma patients who need tests started immediately, we have pre-registered, pre-printed medical chart packets for them. These are also arranged in alphabetical order, except we use animal names. I always feel bad that we have a Medical Packet Whale, especially if the patient happens to be a little overweight. Some of my favorite are Med Pack Giraffe and Med Pack Yak, FYI, I have really bad luck with Med Pack Kangaroo. For me, it is an independent predictor for intubation. My intubation rate is about 80% on them!
• Platinum CT scan: Are you getting pan-scans for more and more of your trauma patients, despite the recent irradiation risk literature? I’ve started calling the head, cervical spine, chest, and abdomen/pelvis CT set as the Platinum scan. If we don’t need the chest CT, I call it the Gold scan.
• IP: The Institutional Police are a omnipresent staple in our ED. Stationed only the ED, they are extremely protective of our ED staff whenever patients become unruly, potentially dangerous to the staff, or refuse to be discharged from the ED. Until recently, we had an IP officer named Frank who was amazingly adept at convincing patients to calm down and be respectful. I suppose having a gun on your belt helps at being convincing. You would often hear an overhead page calling for “Uncle Frank”. I describe our IP officers as “motivational speakers”.

Question: What unique phrases/terms do you have at your ED?