Door to Balloon Time: Are We Measuring the Right Thing?
Door-to Balloon (D2B) time is a time measurement that starts with patient arrival to the emergency department (door) and ends when a catheter crosses a culprit lesion in the cardiac cath lab (balloon). The benefit of prompt primary percutaneous coronary intervention over thrombolytic therapy for acute ST elevation myocardial infarction is very well established. Because of this “time is muscle” strategy, the American College of Cardiology (ACC) launched a national Door to Balloon (D2B) initiative in November 2006. The purpose of this was to recommend a D2B time of no more than 90 minutes. Currently, there is quite a bit [+]
PV Card: Emergency Drug Cards for Adults and Children
Rob Bryant, MD (@RobJBryant13), Amie Hatch, PharmD, BCPS (@Amie_EMPharmD), and Jeremy Bair, PharmD (@bairpharm) from Intermountain Healthcare in Utah have created and adopted a fantastic medication reference card which is used by physicians and nurses in the Emergency Department. The medications were chosen because they are often prone to dosing errors and require time-sensitive ordering. They generously offered to share this incredibly compact resource for free to the Emergency Medicine community as a PV card. If you see them, give them a high-five. [+]
Residencies Embrace Twitter: An Educational Movement
The movement of FOAM and #FOAMed may have started in a pub in Dublin in 2012, but it has become legitimized through widespread acceptance. Residencies are also catching onto the idea and eager to collaborate through social media, in particular Twitter. This is evidenced by the use of Twitter accounts on #EMConf as a way to collect educational learning pearls garnered weekly at resident conferences. “The mind is not a vessel to be filled, but a fire to be kindled.” – Plutarch [+]
The Public Health Model: A Primer for Emergency Care Providers
What is “Public Health”? According to the World Health Organization, ”Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases.” [+]
Patwari Academy videos: PALS
Pediatric Advanced Life Support (PALS) guidelines were most recently reviewed in Circulation 2010 1 based on the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science which includes treatment recommendations. Dr. Rahul Patwari nicely summarizes these findings in this series of 8 videos [+]
MEdIC: The Case of the Difficult Consult – Expert and Community Response
On August 30th I posted the first case of the MEdIC (Medical Education In Cases) series that will be facilitated by Dr. Teresa Chan (@TChanMD) and I (@BoringEM). The Case of the Difficult Consult involved a junior resident in the emergency department who had a consult go bad. Our readers were thrust into the role of an attending physician wanting to help. [+]
Motivation and Self Determination Theory
Motivation is one of those important elements in our personalities that helps us have a drive for improvement. Motivation can come in two flavors internal and external. Self determination theory (SDT) is a psychological term which explains people’s internal motivation and determination to their behavior. Edward L. Deci and Richard M. Ryan explored SDT further and determined there were three basic needs in every human, which are universal, not learned, and seen across gender and culture. [+]
High Sensitivity Troponin Testing
Troponin testing is an important component of the diagnostic workup and management of acute coronary syndromes (ACS). The increasing sensitivity of troponin assays has lowered the number of potentially missed ACS diagnoses, but this has also created a diagnostic challenge due to a decrease in the specificity of the test. From 1995 to 2007, the limit of troponin detection fell from 0.5 ng/mL to 0.006 ng/mL (see below graph). Robert Jesse summed up this frustration with the following quote: When troponin was a lousy assay it was a great test, but now that it’s becoming a great assay, it’s getting [+]
Are Acetaminophen Levels Necessary in All Overdose Patients?
Intentional overdose patients are notorious for giving inaccurate histories. “I took 14 tablets of this and 8 capsules of that. No, wait. It was 3 tablets of this and a handful of capsules of that… This happened about 2 hours ago. Actually, I think it was last night.” Round and round the merry-go-round we go. How should we risk-assess whether acetaminophen is involved? If the patient provides no history of acetaminophen ingestion, do we need to order a level? [+]
Introducing Open, Post-Publication, Expert Peer Review on ALiEM
Today, we are busting open the concept of peer review for publications on blogs! The peer review process has been criticized for its flaws, but is universally accepted as a necessary part of the scientific process. Peer reviewing allows experts in a field to determine the validity of a study or an article so that those of us who are less expert can reap the benefits of their knowledge. Until recently this process was almost universally pre-publication and anonymous. Authors would go through months of review and revision based on feedback of experts whose name they didn’t even know. In the [+]