A patient presents to your ED with an all too common complaint – chest pain. After a focused history and physical exam, you have an extremely low clinical suspicion for thoracic aortic dissection, pulmonary embolism, pneumonia, pneumothorax, pericarditis/myocarditis, and Boerhaave’s syndrome. When the labs (including a troponin), an ECG, and chest x-ray yield normal results, questions often arise. Can you discharge her with a single troponin if she is low risk? How do you define low risk? And lastly, does she need urgent provocative testing after discharge?
Dr. Christine Kulstad is an emergency physician and Emergency Medicine Co-Clerkship Director at UT Southwestern in Dallas, Texas. She maintains a sense of balance by keeping fit, eating right, and making time for her family and friends. Her advice on staying focused is something we could all try. Here’s how she stays healthy in EM!
Although umbilical catheterization can be a lifesaving technique in the emergent management of a critically ill neonate, it is performed infrequently in the ED.1 Simulation has emerged as a key teaching modality for residents to gain both proficiency and competency with this important procedure.2,3 Commercially available umbilical catheterization models are available, but costly, and often require an expensive investment (over $1,000 for a single trainer).4 This expense may discourage residency programs from acquiring the trainer and offering it to learners. In an effort to minimize this barrier to learning, a team from Kings County Hospital “home built” their own umbilical catheterization model. Their work was recently published in the Journal of Education and Teaching Emergency Medicine (JETem), and the ALiEM IDEA Series is proud to have recently teamed up with this journal to periodically share their innovations with our readership!
Accidental hypothermia is a life threatening condition that can lead to a challenging resuscitation. The very young, old, and intoxicated patient are at high risk to developing hypothermia, even in temperate climates. The pathophysiologic changes from hypothermia make the standard ACLS approach insufficient to care for the hypothermic patient. This article will discuss the physiology of hypothermia and how you should alter your approach in the hypothermic patient, including early consideration of extracorporeal membrane oxygenation (ECMO).
Many of you are asked to take a leadership role within your department: managing a research team, joining your administration, or spearheading a clinical effort. It is easy to feel unprepared for these roles, and there are many pitfalls waiting to sabotage your team’s productivity. The ALiEM Faculty Incubator has created a series of 10 case-based teaming problems to provide you with evidence-based advice and solutions for tackling some of the more common problems encountered in our professional team experiences.
On behalf of the ALiEM Wellness Think Tank (WTT), we are thrilled to announce our partnership again with Essentials of Emergency Medicine (EEM). On May 13, 2019 during the WTT Resident Wellness Day (an EEM preday event featuring acclaimed author Dr. James Dahle of White Coat Investor fame), we also will launch the first-ever Wellness Innovation Plenary Session focusing on residency-level initiatives. This is your chance, as a resident, to give an oral presentation at a national conference. Deadline: January 7, 2019.
Many residencies and departments in medicine have started or are thinking about starting local wellness newsletters and handouts. In an effort to help reduce redundancy and facilitate more global information-sharing , the resident-driven ALiEM Wellness Think Tank has decided to launch our own email-based newsletter series. Periodically, we will send out a short article discussing personal wellness, tips for maintaining wellness in your professional life, and ideas to promote wellness within a residency program. Sign up below, and feel free to share with your colleagues. If you have ideas and suggestions for content, please feel free to contact us.