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 [+]
Welcome ALiEM Resident Editor Dr. Natalie Desouza
There are many things that print journals do well. One of the best ideas that I have seen from the Annals of Emergency Medicine is the unique idea of having a Resident Editor on the executive team. This provides the resident exposure to the behind-the-scenes operational processes of running a journal under a mentored environment. Similarly, ALiEM has experienced such rapid growth in the past year with the addition of amazing regular bloggers that we are ready to welcome our first Resident Editor Dr. Natalie Desouza (UCSF-SFGH EM senior resident). [+]
Alcohol Problems Among Older Adults in the ED
The complications of alcohol use can be subtle in older adults, and the effects of alcohol are often incorrectly attributed to aging. Because of its under-recognition, the barriers to screening, and the many subtle ways in which it can present, some have suggested that alcohol misuse has replaced syphilis as the “great masquerader”. If you don’t think alcohol misuse is a problem among older adults in your ED, it may be because it has been hidden in plain sight. [+]
Share your tips: Managing digital information overload
In this digital age, it is somewhat assumed that you know how to manage all the digital information coming at you in the forms of email, Facebook, Twitter, blogs, podcasts, RSS feeds. Even if you only partake in email as your primary communication platform, information still can be quite overwhelming as a trainee or practicing medical provider. At a the annual Bay Area EM residency conference last week, Dr. Charlotte Wills (Highland), Dr. Rebecca Smith-Coggins (Stanford) and I were invited by Dr. Esther Chen (UCSF-SFGH) to share some our personal insights and advice on a panel. We quickly realized that [+]