Article review: Macrocognition in novices and experts in the ED
Expert physicians: These are the ones who effortlessly handle a busy Emergency Department while juggling patient load, learners and consultants. How do they make decisions? How do they get there? This article 1 studied macrocognition differences between novices and experts in the Emergency Department. [+]
Trick of the Trade: Sterile cover for linear ultrasound probe
You decide to use ultrasonography to help you establish peripheral IV access for and obtain blood cultures from your patient. How can you ensure that you get a sterile sampling to avoid blood culture contamination? Do you need to open a full central-line ultrasound probe cover? [+]
Losing faith in evidence-based medicine: Etomidate and sepsis
In an era where evidence-based medicine is the goal, it is vitally important for practitioners to understand how to prioritize and interpret the onslaught of data coming at us. This fact was driven home for me with a recent publication. Several weeks ago an article was published in Critical Care Medicine entitled “Etomidate is associated with mortality and adrenal insufficiency in sepsis: A meta-analysis.”The point of this post is not to debate if etomidate should be used to intubate septic patients. Etomidate very well may kill people with sepsis. I just don’t know from the data currently available. Using this meta-analysis [+]
Patwari Academy videos: ACLS and the Airway
This videos below include a 2-minute introductory video on the ACLS video and the first 2 (Airway) of 11 video discussions on different components of ACLS. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation [+]
PV card: PE Severity Index (PESI) score
Do you send some of your low-risk patients with pulmonary embolism home? This is a controversial issue which warrants a look at risk stratification tools. The primary one used is the validated Pulmonary Embolism Severity Index (PESI) score. In Lancet 2011, the authors looked at whether PESI class I and II (low risk) patients could be managed safely as outpatients. It turns out in their study, regardless of whether their PESI class I and II patients were treated as outpatients and inpatients, all fared equally well from a complications standpoint (recurrent clot, bleeding from anticoagulation). I like the validated PESI [+]
What is debriefing in simulation education?
Medical education high-fidelity simulation allows for deliberate practice in a safe environment. We are able to miss the intubation repeatedly or botch up the management of aspirin overdose without the demise of the patient. At the end of each session, we gather in a pow wow and debrief…. I have been involved with debriefings, and often wonder what residents are thinking: Do they understand what debriefing means? Do they think this is the time where they are scolded for mistakes? Do they think it is a valuable part of the simulation? What does debriefing even mean? [+]
Seth Godin’s TED talk on "Stop Stealing Dreams"
Seth Godin, a marketing guru, discusses his opinion about “what school is for” in this above video. Although this talk or Seth Godin are not directly related to medical education, this is still related to education and can still be applied to today’s medical education curriculum in many aspects. Mr. Godin goes on to explain that school was modeled in the industrial age and has changed little ever since. The video covers such concepts as: Standardized exams in the industrial age were used as a tool to sort students. The person who created the standardized exams later on came to [+]
Take the quiz: Do you know your antihypertensive agents?
Identify the antihypertensive agent: 1. Rapid acting systemic and coronary artery vasodilator with minimal effects on cardiac conductivity or inotropy. Well studied in pregnancy. Caution in patients with left ventricular failure, liver cirrhosis Answer: Nicardipine 2. Predominantly dilates the venous system. Useful in patients with cardiac ischemia, pulmonary edema, or congestive heart failure. Caution in patients with right ventricular failure Answer: Nitroglycerin 3. Drug of choice in eclampsia, pre-eclampsia, and aortic dissection. Contraindicated in patients with congestive heart failure and heart block Answer: Labetalol 4. Decreases peripheral vascular resistance and increases collateral coronary blood flow in an uncontrolled and unpredictable manner and [+]
Eavesdrop into LIVE International EM Faculty Development Conference
Today is the second day of the International EM Faculty Development and Teaching Course hosted at the University of Maryland by Dr. Rob Rogers and Dr. Amal Mattu. Although unable to attend, I have been able to be a virtual participant in real-time for many parts of the large-group didactic sessions. Have you heard of Livestream? [+]
Trick of the Trade: Searching for Comments to a Published Article
One day back in 2005 during my PGY-1 pharmacy practice residency, I remember a conversation with my residency director. He was a Surgical/Trauma ICU pharmacist. There had been a recent article published (I think it may have been one linking ‘tight’ glucose control to decreased mortality in ICU patients). Funny how times change… Anyway, he mentioned all of the ‘discussion’ surrounding the article in terms of comments submitted to the journal. It was my first introduction to the idea that published literature could be challenged through an avenue provided by the journal. Just this past week during EM residency journal [+]