G-Advising: Using Google Hangout to advise medical students
Get an advisor. Don’t try to navigate medical school and residency on your own. This is key especially during medical school as you try to get through and around the mounds of reading, paperwork, options, and pitfalls. If you are interested in Emergency Medicine (EM) as a career, that means getting one or several great EM advisors. Don’t rely on non-EM faculty to give you any insight into EM. Inevitably, I have found that they give incomplete or slightly skewed perspectives about the pros and cons of EM. [+]
Trick of the Trade: Nasal cannula oxygenation during endotracheal intubation
You are managing a 300-pound patient with a long history of severe COPD, who now requires intubation because of a pneumonia and COPD exacerbation. You anticipate that the patient may be a difficult airway intubation and may desaturate quickly during laryngoscopy. While you are setting up to orotracheally intubate this patient, you preoxygenate this patient as best as you can with a non-rebreather mask. What can you do to prolong the patient’s time-to-desaturation so that you aren’t as rushed to place the endotracheal tube? [+]
Paucis Verbis: Ventilator settings for obstructive lung disease
Following up with last week's Paucis Verbis card on Ventilator Settings for Acute Lung Injury and ARDS, here is the card on Ventilator Settings for Obstructive Lung Disease. This is for patients who present with acute asthma or COPD exacerbation who require endotracheal intubation. What initial ventilator settings should you set for these patients? Go to ALiEM (PV) Cards for more resources. Thanks to Dr. Jenny Wilson for the card and Dr. Scott Weingart for the original stellar podcast from which this card was derived.
Paucis Verbis: Ventilator settings for acute lung injury and ARDS
A patient presents with severe multilobar pneumonia and refractory hypoxia requiring endotracheal intubation. The respiratory therapist connects your patient to the ventilator. "What settings would you like your patient on?" Back in 2010, Dr. Scott Weingart posted a great podcast on "Dominating the Vent". It's such a fantastic distillation of the practical aspect of ventilator setting management of all intubated patients except those with an acute asthma or COPD exacerbation, Dr. Jenny Wilson and I thought this would be a great Paucis Verbis card to have in your peripheral brain. Note: The tidal volume should be calculated based on Predicted [+]
Remembering Dr. Robert Buckman
For those who trained in Canada (especially Toronto), the name of Dr. Robert Buckman always brought a chuckle. He filled his lectures with his signature British wit and humour. Yet, the message was always loud and clear. Being an oncologist, he had great insight in communication with patients. He was the first to teach us medical students about communication and professionalism: Kindness, empathy, delivering bad news, what to say when you don’t know what to say. A decade later, out of the countless hours of lectures, his stood out. Truly a big loss to the medical educators community. [+]
Trick of the trade: Quieting the shaky EKG tracing
A patient with Parkinson’s disease presents with chest pain to your ED. Her tremors prevent you from getting a good quality EKG because of the movement artifact. How can you eliminate this artifact? (No cheating with rocuronium.) [+]
Paucis Verbis: Neutropenic fever in cancer patients
A 65 y/o man with a history of prostate cancer presents to your ED from home appearing fairly well and a mild cough for 3 days. His vital signs are: Temperature 39 C BP 160/80 HR 60 RR 14 Oxygen saturation 99% on room air His absolute neutrophil count (ANC) comes back at 300 cells/mm3. His chest xray shows a right middle lobe pneumonia and a central line catheter tip ending in the SVC. Is this patient "high" or "low" risk per the Multinational Association for Supportive Care in Cancer (MASCC)? Does this person require inpatient admission? What antibiotics would [+]
Trick of the Trade: Opioids for air hunger
A patient presents with significant shortness of breath from a COPD exacerbation. His room air saturation is 80%, respiratory rate of 30, and is uncomfortably seated in a tripod position. You administer the usual regimen: Oxygen by face mask Nebulized albuterol and atrovent Solumedrol Bipap Set up for possible intubation With the Bipap mask on, the patient’s subjective sense of dyspnea and “air hunger” seems to make it harder for him to tolerate the tight-fitting mask. [+]
Poll: YOU are on the residency selection committee. What would YOU do?
As an attending physician, you are friends with nurses and residents on social media. One day, you are browsing through your social media page. You came across a photo of a student – a candidate applying to your program in fact – scantily clad, inebriated, dancing in a rave. The comments followed agreed on how wild he/she had partied and drank that night. You are on the selection committee. Should this information be part of the assessment of the candidate? Please explain your decision in the comments section. [+]
Trick of the Trade: Needlestick hotline 888-448-4911
You are a fourth-year medical student and super-excited to be doing your first supervised central line procedure on an actual patient. You have done so many central lines on mannequins and simulations. You feel ready. In your excitement, however, you stick yourself with the 22 gauge finder needle after you successfully get a flash-back of the patient’s venous blood. After handing off the procedure to your senior resident, you go into a mild panic. Your patient is a known HIV patient with an unknown CD4 count and viral load. After taking off your gloves and washing your hands, you report [+]