Most children who come into the Emergency Department present with pain or experience pain during their ED stay.1,2,3 Pain and distress during a procedure can leave a lasting impact on a child and contribute to mistrust of the medical system and compliance with future procedures.1 ,4,5 Children who use active forms of coping report less pain and distress during a procedure.3 To help with coping, when feasible, involve parents or family, nursing and a child life specialist. If the parents are willing, try to get them involved in all parts of the medical procedure.2,3 This includes positioning the patient with a parent in a secure parental-hugging hold or maintaining close physical contact throughout the procedure.6 This can easily replace immobilization of a child or the use of restraints which can cause increased fear and escalate the degree of anxiety in a child.2
A peer review process, in one form or another, has long been the de facto standard for academic publishing. In 2013, ALiEM was the first FOAM resource to initiate an attributed peer review process for all submitted content–effectively bringing a traditional standard to a new frontier of medical education.1 Since our expert peer review (EPR) program inception, reviewers have published critical appraisals alongside 114 ALiEM posts to date.
Unless you are living under a rock, many healthcare and public media platforms are talking about the insidious problems with burnout in the health professions world. One thought leader out there is especially vocal about wellness, resiliency, and mindfulness — Dr. Zubin Damania (alter ego: ZDoggMD). For instance, do you know the difference between empathy and compassion, and why that is important to differentiate this as a clinician? We were honored to have him join the Wellness Think Tank to field questions that we peppered at him, specifically around resident wellness.
The new emergency medicine (EM) residency application season is upon us! Senior medical students are arranging away EM electives, asking for letters of recommendations, and thinking about what residency programs to apply to. But before we look forward, what lessons can we learn from the 2016 EM Residency Match? In this EM Match Advice series installment, an esteemed panel of program directors reflect on the trends, surprises, and lessons learned from the 2015-16 year.
So much attention is appropriately focused on the anatomy and technique for intraosseous needle placement. In contrast, very little attention is paid to securing the needle. Often this involves a make-shift setup which involves gauze, wraps, and/or tape. This becomes especially important in the prehospital setting where these can be easily dislodged. The following trick stems from a Twitter discussion in 2015 amongst prehospital providers, lamenting this fact.
During your shifts in the pediatric ED, you may encounter a few patients with adrenal insufficiency or adrenal crisis. Some of the most common causes include those patients with Addison disease, pituitary hypothalamic pathology, and those patients on chronic steroids. When these patients get sick or sustain trauma, it is important to consider giving them a stress dose of hydrocortisone. Patients in adrenal insufficiency or crisis can present with dehydration, weakness, nausea, vomiting, confusion, lethargy, and severe hypotension refractory to vasopressors. 1–3