ALiEM Bookclub: Drive – Synopsis and Discussion
Why do we do what we do? This is the question at the heart of this month’s ALiEM Book Club selection. Drive 1 , by author Daniel Pink, discusses the history of motivational theory before provocatively making the case that we’re doing it wrong. He argues that having met our base desires (food, drink, sex), a reliance on extrinsic motivators (reward and punishment) will stifle intrinsic motivation and prevent us from functioning at our highest capacity. The three features described for optimizing intrinsic motivation are: Autonomy: control over task (what we do), time (when we do it), team (who we [+]
Expertise in Clinical Decision Making
We make decisions every day, all day long. Sometimes we are aware of it and sometimes we are not. Our decision process is affected by many factors. Some are under our conscious control while others are not. In order to sharpen our decision process, we gain knowledge, practice, and then reflect. We are selective and gain knowledge from different sources, practice in the appropriate setting, and reflect alone or with others for feedback. It is important to explore all possible clinical reasoning pathways as we don’t know which process will get us in the right path. [+]
New Cardiology PV Cards available on your phone and tablets!
After getting many requests for more PV cards, we are excited to launch 13 new topics located in the Cardiovascular folder of the Emergency Medicine: PV Cards collection on AgileMD. These new cards were made based off of blog posts from ALiEM’s authors. [+]
Population vs Public Health: A False Dichotomy?
My department chair recently forwarded me a provocative little video regarding how we should conceptualize “population health.” The video encapsulates a number of hot topics in public health, labeled here as “population health”. It appropriately emphasizes the importance of addressing not just prevention among healthy populations, but also improving the health outcomes of high utilizers. [+]
Blood Cultures in Pneumonia
A 75 year old woman is found to have pneumonia. With a CURB-65 of 3 and a PORT score of 95, she is correctly treated her for community acquired pneumonia with Ceftriaxone and Azithromycin, and admitted. Unfortunately, the admitting service points out that no blood cultures were drawn! What is the evidence for this? Originally from Clinical Monster blog [+]
Cyclobenzaprine vs TCA Toxicity
Should we treat a cyclobenzaprine (Flexeril) overdose similar to a tricyclic antidepressant (TCA) overdose? With the only difference between the commonly prescribed muscle relaxant, cyclobenzaprine, and the TCA amitriptyline consisting of a single double bond, should the emergency provider be concerned for life threatening arrhythmias in cyclobenzaprine overdose? [+]
When the PERC Rule Fails
Kline et al developed a clinical decision tool based on parameters that could be obtained from a brief initial assessment to reasonably exclude the diagnosis of pulmonary embolism (PE) without the use of D-dimer in order to prevent unnecessary cost and the use of medical resources. 1 Many of us have used the Pulmonary Embolism Rule-out Criteria (PERC) rule by now, but we should be clear on what it includes. Are we using it appropriately? [+]
AMA: 2 high risk myths and misconceptions
Patients who leave the emergency department against medical advice (AMA) are at an increased risk of having a bad medical outcome, and can be a source of significant medicolegal risk to providers. Earlier we reviewed eight elements to address when signing a patient out AMA. There are two common myths regarding patients who leave AMA that can complicate an already difficult situation. [+]
Where is the pedagogy in flipped classrooms?
As you are aware there has been lots of discussion going on about the concept of flipping the classroom in education these days. ALiEM recently hosted a book club where Salman Khan’s book (The One World School House: Education Reimagined) was featured in a Google Hangout. Khan, an ex-hedge fund manager, started making videos to help his niece with her math homework years ago. These videos ended up on YouTube and became quite popular. It wasn’t until later with the help of Bill Gates that he formed The Khan Academy and popularized the concept of the flipped classroom. [+]
BISAP, EHMRG, ORT: 3 New Medical Scores You’ve Never Heard Of
Let’s face it. You’ve heard about the A-a gradient. And free water deficit. And even the APACHE-II score. But how useful are these in your daily practice? You don’t care that much if a patient has shunt physiology in the first case, nor exactly how much free water they’re lacking in the second. And in the third case, your clinical acumen is probably pretty good at predicting a sick patient’s mortality already. But what about the new medical scores of BISAP, EHMRG, and ORT? [+]