Is your mind like Sherlock Holmes’ or Dr. Watson’s?
“A fool takes in all the lumber of every sort that he comes across, so that the knowledge which might be useful to him gets crowded out, or at best is jumbled up with a lot of other things, so that he has a difficulty in laying his hands upon it. Now the skillful workman is very careful indeed as to what he takes into his brain-attic.” — Maria Konnikova 1 There is a very interesting Royal Society of the Arts (RSA) video featuring the psychologist Maria Konnikova (@mkonnikova), author of the book Mastermind: How to think like Sherlock Holmes. The video is [+]
Ketofol: Is this the “Game Changer” of Procedural Sedation and Analgesia?
When talking about procedural sedation and analgesia, our goal is to minimize pain and anxiety, with the appropriate agent that matches the needs of our patient and the clinical scenario. So what are some qualities of this “ideal agent?” In a perfect world, it would have: Minimal adverse effects Rapid onset and offset of action Pharmocokinetic predictability across a spectrum of patients [+]
First ALiEM journal article: Trial of void for acute urinary retention
A patient may present to the ED after foley catheter placement for acute urinary retention (AUR) a few days ago and now requests catheter removal. Ideally this should be performed in the urologist’s office. However, occasionally patients cannot or do not follow up with the urologist in a timely manner and return to the ED expecting urethral catheter removal. A careful history and physical should be performed along with a consulting urologist. If the eventual decision is to remove the urethral catheter in the ED, what is important to know about a Trial of Void (TOV)? [+]
Patwari Academy videos: Respiratory failure and ventilators
Dr. Rahul Patwari reviews the basics of respiratory physiology, the pathophysiology behind respiratory failure, and ventilator management. What do all the ventilator settings mean? [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital [+]
Be a great speaker: 10 practical pearls (part 1 of 5)
Have you seen how some speakers can seemingly just give AMAZING talks? It actually takes a lot of hard work to make impactful talks look easy and effortless. The CORD Academy for Scholarship in Education in Emergency Medicine recently has started the “Distinguished Educator’s Coaching Program” to help established educators improve their presentation skills. The concept of coaching for mastery is a hot topic, often discussed by Dr. Atul Gawande (surgeon at Brigham and Women’s and professor at Harvard Medical School and the Harvard School of Public Health). [+]
Is it time to trash the stethoscope? The age of ultrasound
Is the physical exam a relic of the past, because our tools are relics of a prior era? It is important to do and teach a thorough physical exam. I cautioned against the overreliance on diagnostic testing in lieu of a physical exam, which can be initially burdensome and prolonged. But perhaps our difficulty with the physical exam is not the exam itself, but the tools that we have at our disposal to perform an exam, rather than the exam itself. [+]
What’s the Code Dose of tPA?
Suppose you have a patient in whom you highly suspect a pulmonary embolism (PE) that devolves into PEA arrest while awaiting a CT angiogram. Or, what about a patient with an ECG showing clear STEMI that loses pulses? [+]
Lytics for sub-massive PE: Ready for primetime?
There was recently a great study published in the American Journal of Cardiology (2012) by Sharifi et al1, questioning whether we should be considering tPA in patients other than those patients with massive pulmonary embolism (PE)? You know the big “Saddle Embolus” we all fear? Well it turns out this is only about 5% of all PEs. Should we be considering tPA in patients with sub-massive PEs? [+]
Welcome new blog team member: Dr. Salim Rezaie
Please help me welcome Dr. Salim Rezaie, a star from the academic world of Emergency Medicine! I have been secretly stalking him on Twitter and finally found an opportunity to meet him and recruit him onto the ALiEM blog team while at the recent Council of Residency Directors (CORD) for EM annual conference. [+]
Trick of the Trade: Ambient noise and creative cognition
For many of us in academia and medical education, we accomplish a tremendous amount of work outside of the workplace. This can be in our home office, on the public transit system, or in the library. Interestingly, creative cognition occurs best with a moderate amount of ambient noise (not too much and not too little), according to a 2012 article from Journal of Consumer Research. [+]