ALiEM Bookclub: Risk Savvy
The full title of Gerd Gigerenzer’s book is Risk Savvy: How to Make Good Decisions [Amazon], which is exactly what makes this book so relevant, not just to the everyday reader, but to the medical reader. We make decisions every day in the medical field that range from the complex of intubating someone with low reserve or difficult airway anatomy to the less life-and-death decision of when to best time a quick food break between seeing patients. Of course, we also help our patients make very complex decisions, especially in the ED when time is short but risk can be high. And it certainly is not [+]
Esmolol Use in Cardiac Arrest
There is an abundance of sympathetic stimulation in patients who present in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) whether endogenously released as a stress response or exogenously administered in a resuscitation attempt.1 The hope is that sympathetic stimulation will increase the coronary and cerebral perfusion pressure of the patient and aid in resuscitation. However, there are numerous detrimental effects associated with epinephrine such as an increase in myocardial oxygen demand leading to increased ischemia.2 Contrary to traditional teaching, interesting evidence exists in both animal models as well as in limited reports in human subjects that show a potential [+]
The Training of an EM Pharmacist
At the 2014 American College of Emergency Physicians Scientific Assembly, ACEP passed Resolution 44, officially recognizing Emergency Medicine Pharmacists as valuable members of the EM team. Nadia Awad (@Nadia_EMPharmD) summarized the importance of the resolution’s passage on the EMPharmD blog. The role of an EM Pharmacist has been outlined by the American Society of Health-System Pharmacists (ASHP). In addition, Zlatan Coralic (@ZEDPharm), one of ALiEM’s regular contributors, framed the EM Pharmacist as the ‘ultimate consult service.’ The intent behind this post is not to discuss the role of the EM Pharmacist, but to highlight the rigorous training process through which most [+]
Palliative Care in the ED – The Time is Now
“Don’t delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit.” This statement was one of ACEPs 2013 Choosing Wisely recommendations. How palliative care can be effectively and practically integrated into the ED, and which patients are likely to benefit from it is still being worked out at many institutions.1–4 However, it is clear that the time for palliative care in the ED has come. [+]
I am Dr. Mike Stone, Division Chief of Emergency Ultrasound at Brigham & Women’s: How I Work Smarter
Dr. Mike Stone (@BedsideSono) is well known in the medical education world especially in the field of bedside ultrasonography. In addition to being a professor for the Ultrasound Leadership Academy and Ultrasound Podcast team member, he also runs the Emergency Ultrasound Division at the Brigham & Women’s Hospital. Like Dr. Mike Mallin who tagged him from a previous How I Work Smarter post, many of us have been amazed at Mike’s ability to juggle so many roles and responsibilities at once. Here are some his secrets to success. [+]
MEdIC Series | The Case of the Ebola Outbreak Ethics – Expert Review and Curated Commentary
The Case of the Ebola Outbreak Ethics prompted some great discussion around the ethics of care for a patient who possibly has an Ebola infection. As usual, I was extremely impressed by the rich discussion that evolved over the week. We are now proud to present to you the Curated Community Commentary and 2 our two expert opinions. Thank-you again to all our experts and participants for contributing again this week to the ALiEM MEdIC series. [+]
ALiEM-Annals of EM Journal Club: Satisfaction Scores and ED Analgesic Medications
This ALiEM-Annals of EM Global Journal Club features the Annals of EM journal club by Schwartz et al. entitled “Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications.” We hope you will participate in an online discussion based on the clinical vignette and questions below from now until Dec 5 2014. Please respond by commenting below or tweeting using the hashtag #ALiEMJC. In a few months, a summary of this journal club will be published in Annals of EM. On Dec 4, 2014 at 1300 PST (1600 EST), we will host a live Google Hangout with the authors Drs. [+]
I am Dr. Michael Bond, Residency Director and Book Editor: How I Work Smarter
Dr. Michael Bond (@DocBond007), who has probably one of the coolest Twitter handles, is a well-respected and well-established educator in the field of Emergency Medicine (EM). Because many of us are perplexed how he is able to publish a book on Orthopedic Emergencies [Amazon link] alongside co-editors Drs. Andrew Perron and Michael Abraham as well as serve as the EM residency director at the University of Maryland. So we were thrilled from Dr. Rob Rogers tagged Mike on a previous How I Work Smarter post. Mike was kind enough to send along his responses. [+]
MEdIC Series | The Case of Ebola Outbreak Ethics
The news has been rampant with discussions about Ebola lately, but many centers are handling the integration of learners into their disaster plans differently. This month’s ALiEM MEdIC series case hopes to elicit our community’s considerations on the ethical and educational principles behind education during a possible outbreak scenario. Join us as we discuss this topic! [+]
Trick of the Trade: Pediatric video laryngoscope for ear foreign bodies
It is near the end of your shift and one of the nurses asks you to see a fellow ED staff member’s nine-year old daughter who has accidentally put a foreign body into her ear. You go see her and the otoscope reveals a small shiny jewel within the ear canal however flushing does not work to get it out. Next you try using the otoscope, while exposing the ear canal and holding the forceps to grasp the object. Unfortunately, it is difficult to get your assistant to align the light, and the otoscope speculum is limited in view and access. [+]