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12 episodes with Academic Emergency Medicine
4 episodes with Academic Emergency Medicine
4 episodes with Academic Emergency Medicine
3 episodes with Academic Emergency Medicine
2 episodes with Academic Emergency Medicine
3 episodes with Academic Emergency Medicine
2 episodes with Academic Emergency Medicine
2 episodes with Academic Emergency Medicine
3 episodes with Academic Emergency Medicine
Train the Best. Change EMS.Howdy, y'all, I'm Dr Jeff Jarvis, and I'm the host of the EMS lighthouse project podcast, but I'm also the medical director for the new EMS system we're building in Fort Worth Texas. We are looking for an experienced critical care paramedic who is an effective and inspiring educator to lead the initial and continuing training and credentialing of a new team of Critical Care Paramedics who will be responding to our highest acuity calls. The salary is negotiable but starts between $65,000 and $80,000 a year for this office position. Whether y'all wear cowboy boots or Birkenstocks, Fort Worth can be a great place to live and work. So if you're ready to create a world-class EMS system and change the EMS world with us, give us a call at 817-953-3083, take care y'all.The next time you go to intubate a patient, should you give the sedation before the paralytic or the paralytic before the sedative? Does it matter? And what the hell does Bayes have to do with any of this? Dr Jarvis reviews a paper that uses Bayesian statistics to calculate the association between drug sequence and first attempt failure. Then he returns to Nerd Valley to talk about how to interpret 95% confidence intervals derived from frequentists statistics compared to 95% credible intervals that come from Bayesian statistics. Citations:1. Catoire P, Driver B, Prekker ME, Freund Y: Effect of administration sequence of induction agents on first‐attempt failure during emergency intubation: A Bayesian analysis of a prospective cohort. Academic Emergency Medicine. 2025;February;32(2):123–9. 2. Casey JD, Janz DR, Russell DW, Vonderhaar DJ, Joffe AM, Dischert KM, Brown RM, Zouk AN, Gulati S, Heideman BE, et al.: Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2019;February 28;380(9):811–21.3. Greer A, Hewitt M, Khazaneh PT, Ergan B, Burry L, Semler MW, Rochwerg B, Sharif S: Ketamine Versus Etomidate for Rapid Sequence Intubation: A Systematic Review and Meta-Analysis of Randomized Trials. Critical Care Medicine. 2025;February;53(2):e374–83.
Looking to connect with a community of physician podcasters? We provide the tools, connections, and resources you need to amplify your voice and grow your audience. Be part of something exciting as we prepare to launch. Join the Doctor Podcast Network today!—--------In this episode, Dr. Gita Pensa advocates for physicians navigating the storm of malpractice lawsuits. She opens up about the emotional and psychological toll of physicians being sued. She shares her own journey through litigation and how it inspired her to help others facing similar struggles. Dr. Pensa helps refine doctors' mindset during litigation, providing insightful guidelines to help defend themselves with confidence and clarity during depositions and trials. She recommends two goals for everyone in deposition; one is to accept the situation. Letting go of the emotions rather than argue over reality. At best grief, but don't suffer guilt. Secondly, that physicians be good defendants for themselves. She stresses that the physician's overall objective is to get the jury into their thought process, since they are not medical practitioners themselves.She believes that by supporting each other and advocating for systemic change, physicians can not only survive litigation but grow stronger through it. She also encourages doctors to push back against the unrealistic expectation of perfection in medicine, reminding them that they're humans. BIODr. Gita S. Pensa, M.D. is a speaker, educator, coach, and creator of Doctors and Litigation: The L Word. An associate Professor of Emergency Medicine, Clinician Educator, and Associate Director of the Emergency Digital Health Innovation program at Alpert Medical School of Brown University. She is the editor/host of the Academic Emergency Medicine podcast series, AEM Early Access. She podcasts and speaks nationally on litigation and litigation stress, and most recently won the 2019 Rhode Island ACEP chapter's Special Service Recognition Award for 'Courageous Public Advocacy of Rhode Island Emergency Medicine Colleagues.'She is widely recognized as one of the nation's leading experts on malpractice litigation, stress, and physician litigation support. She gives practical and psychological preparation necessary for malpractice litigation defendants. She's been featured in forums such as Time Magazine, South by Southwest, NPR, and a new PBS documentary, A World of Hurt, How Medical Malpractice Fails Everyone. She helps good doctors manage the stressors of adverse events, litigation, and burnout. Website: doctorsandlitigation.comLinkedIn: https://www.linkedin.com/in/gita-pensa-m-d-693557189Twitter (X): https://x.com/GitaPensaMDDoctors and Litigation: The L Word Did you know…You can also be a guest on our show? Please email me at brad@physiciansguidetodoctoring.com to connect or visit www.physiciansguidetodoctoring.com to learn more about the show!Socials:@physiciansguidetodoctoring on FB@physicianguidetodoctoring on YouTube@physiciansguide on Instagram and Twitter Visit www.physiciansguidetodoctoring.com to connect, dive deeper, and keep the conversation going. Let's grow! Disclaimer:This podcast is for informational purposes only and is not a substitute for professional medical, financial, or legal advice. Always consult a qualified professional for personalized guidance.
Date: November 13, 2024 Reference: Lee WH, et al. Study of Pediatric Appendicitis Scores and Management Strategies: A Prospective Observational Feasibility Study. Academic Emergency Medicine. Dec 2024 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine physician at Children's National Hospital in Washington, DC. He's also the host of SGEMPeds. Case: A 10-year-old boy […] The post SGEM#461: If You're Appy and You Know It…Do You Need a Clinical Prediction Score? first appeared on The Skeptics Guide to Emergency Medicine.
How can the science of expertise inform our ability to attain excellence in resuscitation?Additional content and educational resources at ICUedu.orgReferences for the papers mentioned in the episode: Kovacs & Croskery. Clinical Decision Making: An Emergency Medicine Perspective. Academic Emergency Medicine, 1999; 6(9): 947-952The Neuroscience of Expertise. Bilalic (2017), Cambridge University PressJeon et al. What does “being an expert” mean to the brain? Functional specificity and connectivity in expertise. Cerebral Cortex, 2017; 27(12): 5603-5615Gobet & Simon. Recall of random and distorted chess positions: Implications for the theory of expertise. Memory & Cognition, 1996; 24(4): 493-503 Gold & Ciorciari. A Review on the Role of the Neuroscience of Flow States in the Modern World. Behav Sci (Basel), 2020;10(9):137
It was an honor and a privilege to record an episode with Dr. Mark Piehl and Dr. Peter Antevy. They came on to discuss prehospital blood product administration and their recent letter to the editor in Academic Emergency Medicine.
The most commonly used equation that determines someone's kidney function includes a binary male-female sex coefficient. But what does this mean for the care of transgender, gender-diverse, and nonbinary people? Cameron Whitley, an associate professor with kidney failure experience, and researchers Keila Turino Miranda, a PhD student, and Dr. David Collister, a nephrologist, shed light on this important topic. Dr. David Collister (he/him) is a Kidney Doctor, Clinician-Scientist and Assistant Professor at the University of Alberta. He has a PhD in Health Research Methodology from McMaster University. His research program is funded by the Canadian Institutes of Health Research and the Kidney Foundation of Canada and focuses on randomized controlled trials of interventions for uremic symptoms, cannabinoids, the responsiveness of uremic symptoms to the initiation of dialysis, metabolomics, proteomics and the intersection of gender diversity and kidney disease. Keila Turino Miranda (she/her) is a first year PhD Student in the Cardiovascular Health and Autonomic Regulation Laboratory at McGill University. Ms. Turino Miranda's work focuses on understanding and addressing the unique healthcare needs and disparities faced by transgender, gender-diverse, and non-binary (TGD) individuals in the realms of nephrology and cardiology using a patient-oriented approach. Cameron T. Whitley, Ph.D. (he/they) is an Associate Professor in the Department of Sociology at Western Washington University. He studies issues concerning the environment, human-animal relationships, and transgender-affirming medicine. He got involved with studying transgender-affirming medicine when he was diagnosed with kidney failure and received a kidney transplant while writing his dissertation. Through this process, he coauthored one of the first articles addressing the discrepancies in evaluating kidney function for transgender people. He has over five dozen publications featured in places like Proceedings of the National Academy of Sciences, Academic Emergency Medicine, Clinical Chemistry, and Annual Review of Sociology. Additional resources: Kidney Function in a Gender Diverse Landscape Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts.
Teams and teamwork were the themes for our November Journal Club. In this special episode, Ben and Vic were joined by Eve Purdy to review four articles that took us on a deep dive into team science, team training using simulation and researching teamwork. This is the first of a series on teamwork that we will be releasing over the next 12 months at Simulcast. Our motivation is to give simulation practitioners a deeper understanding of teamwork and to enable more nuanced conversations about team performance and improvement in the debriefing room and beyond. We want to go beyond simple concepts and buzzwords about teamwork. Relax though, if you are not a teamwork nerd……in 2024 our Simulcast Journal Club will run every month with our usual eclectic mix of literature, and our teamwork thread episodes will be additional. So, this month we embarked on the journey with some classics: Rosenman et al. Changing Systems Through Effective Teams: A Role for Simulation. Academic Emergency Medicine 2017 Hicks and Petrosoniak. The Human Factor Optimizing Trauma Team Performance in Dynamic Clinical Environments. Emerg Clin N America 2018 Bolton et al. Revisiting Relational Coordination: A Systematic Review. Journal of Applied Behavioural Science 2021 Anderson et al. Understanding adaptive teamwork in health care: Progress and future directions. Journal of Health Services Research and Policy 2021 We also reflected on some great offerings from Eve and Ben with their talks on Relational Coordination and transactive memory systems at DFTB22. Also – don't forget – Simulation Reconnect is on again. Wednesday November 15th at Bond University. Registrations open now! Happy listening vb
Episode Notes Drs. Zack Nelson (@zacroBID), Alison Dittmer, and Michael Pulia (@DrMichaelPulia) join Dr. Jillian Hayes (@thejillianhayes) to discuss the ins and outs of antimicrobial stewardship in one of the busiest parts of the hospital: the emergency department! Tune in for a discussion on communication considerations in the ED, the role of lipoglycopeptides for common gram-positive syndromes, and a rapid-fire round discussing common stewardship interventions. This podcast was supported by an educational grant from Melinta Therapeutics. References: Pulia M, et al. Antimicrobial Stewardship in the Emergency Department. Emerg Med Clin N Am 2018;36(4):853-872. doi: 10.1016/j.emc.2018.06.012. PMID: 30297009. Rech, Megan A et al. “PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study.” Critical Care Explorations 2021;3(4):e0406. doi:10.1097/CCE.0000000000000406. PMID: 33912836. Sacdal JPA, Cheon E et al. Oritavancin versus oral antibiotics for treatment of skin and skin structure infections in the emergency department. Am J Emerg Med 2022;60:223-224. Jenkins TC, Jaukoos JS et al. Patterns of use and perceptions of an institution-specific antibiotic stewardship application among emergency department and urgent care clinicians. Infection Control and Hospital Epidemiology 2020;41:212-215. Dretske D, Schulz L, Werner E, Sharp B, Pulia M. Effectiveness of oritavancin for management of skin and soft tissue infections in the emergency department: A case series. The American Journal of Emergency Medicine 2021;43:77-80. doi: 10.1016/j.ajem.2021.01.050. PMID: 33545550. Paul M, Pulia M, Pulcini C. Antibiotic stewardship in the emergency department: not to be overlooked. Clin Microbiol Infect 2021;27(2):172-174. doi: 10.1016/j.cmi.2020.11.015. PMID: 33253938. Baxa J, McCreary E, Schulz L, Pulia M. Finding the niche: An interprofessional approach to defining oritavancin use criteria in the emergency department. Am J Emerg Med. 2020;38(2):321-324. doi:10.1016/j.ajem.2019.158442. Pulia MS, Hesse S, Schwei RJ, Schulz LT, Sethi A, Hamedani A. Inappropriate Antibiotic Prescribing for Respiratory Conditions Does Not Improve Press Ganey® Patient Satisfaction Scores in the Emergency Department. Open Forum Infect Dis 2020;7(6): ofaa214. doi:10.1093/ofid/ofaa214. Pulia MS, Lindenauer PK. Annals for Hospitalists Inpatient Notes - A Critical Look at Procalcitonin Testing in Pneumonia. Ann Intern Med. 2021;174(6):HO2-HO3. doi:10.7326/M21-1913. Redwood R, Knobloch MJ, Pellegrini DC, Ziegler MJ, Pulia M, Safdar N. Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute care settings. Antimicrob Resist Infect Control. 2018;7. doi:10.1186/s13756-017-0278-9. Pulia MS, Schwei RJ, Hesse SP, Werner NE. Characterizing barriers to antibiotic stewardship for skin and soft-tissue infections in the emergency department using a systems engineering framework. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e180. doi:10.1017/ash.2022.316. May L, Gudger G, Armstrong P, et al. Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. Infect Control Hosp Epidemiol. 2014;35(9):1114-1125. doi:10.1086/677637. May L, Cosgrove S, L'archeveque M, et al. A Call to Action for Antimicrobial Stewardship in the Emergency Department: Approaches and Strategies. Ann Emerg Med 2013;62(1):69-77.e2. doi: 10.1016/j.annemergmed.2012.09.002. PMID: 23122955. Schoffelen T, Schouten JA, Hoogerwerf JJ, et al. Quality indicators for appropriate antimicrobial therapy in the emergency department: a pragmatic Delphi procedure. Clin Microbiol Infect 2021;27(2):210-214. doi: 10.1016/j.cmi.2020.10.027. PMID: 33144204. Yadav K, Stahmer A, Mistry RD, May L. An Implementation Science Approach to Antibiotic Stewardship in Emergency Departments and Urgent Care Centers. Academic Emergency Medicine 2020; 27(1):31-42. doi: 10.1111/acem.13873. PMID: 31625653. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.
This episode is sponsored by Charm Economics– data-driven solutions for digital health & MedTech businesses. Dr. Block and his guest, Dr. Ken Milne, delve into the concept of knowledge translation and the time it takes for new information to be integrated into clinical practice. They reference a famous paper that found it takes an average of 17 years for clinically relevant information to reach the patient's bedside. However, the hosts believe that this time frame can be shortened with the help of social media and evidence-based medicine. They emphasize the importance of evidence-based medicine but also note that it should not be the only factor in decision-making. The hosts also discuss their checklist for evaluating the validity of studies and how they use their podcast to share new information with their audience. Overall, the hosts believe that shortening the time it takes for new information to be integrated into clinical practice can lead to improved patient outcomes. The episode also touches on the potential benefits of vitamin C in treating sepsis patients. One study conducted at Dr. Paul Merrick's Institution showed a significant mortality benefit in patients who were given a cocktail of thiamine, Vitamin C, and hydrocortisone. However, the study was not a randomized control trial and was before-and-after observational, leading to skepticism about the conclusions. Over the next few years, properly designed randomized control trials were conducted and found that vitamin C had no significant impact on sepsis patients. Therefore, while there was initial interest in the potential benefits of vitamin C in treating sepsis, further research has shown that it is not an effective treatment. Looking for something specific within the show? Here you go! [00:00:00] Evidence-based medicine in practice. [00:05:27] Knowledge translation takes 17 years. [00:07:26] Randomized control trial questions. [00:10:59] Shared decision-making in medicine. [00:14:53] Evidence-based medicine in emergency room. [00:18:18] Physicians' big egos. [00:22:20] TXA: The Duct Tape. [00:24:01] Health interventions and cost. [00:27:46] Subgroup analysis in studies. [00:31:12] Epistemology and scientific bias. [00:34:32] Vitamin C and its benefits. [00:38:17] Losing to get better. Guest bio: Dr. Milne is a staff physician at Staff at South Huron Hospital Association in Exeter, Ontario, Canada. He has been doing medical research for over 35 years publishing on a variety of topics. Dr. Milne has been working clinically for 25 years and is an adjunct professor in the Department of Medicine (Division of Emergency Medicine) and Department of Family Medicine at the Schulich School of Medicine and Dentistry. He teaches evidence-based medicine, clinical epidemiology, critical appraisal and biostatistics at Western University in London, Ontario. Dr. Milne is passionate about skepticism and critical thinking. He is the creator of the knowledge translation project, The Skeptics' Guide to Emergency Medicine (TheSGEM). Ken is married to Barb and has three amazing children. Dr. Milne serves as a senior editor of Academic Emergency Medicine. He has no funding from the pharmaceutical or biomedical device industry. He is on faculty for the Center for Medical Education and EMRAP. Dr. Milne does partake in medical malpractice reviews and does hold a patent on a pediatric resuscitation device. Connect with Dr. Milne on his LinkedIn. Did ya know… You can also be a guest on our show? Please email me at brad@physiciansguidetodoctoring.com to connect. Socials: @physiciansguidetodoctoring on FB @physicianguidetodoctoring on YouTube @physiciansguide on Instagram and Twitter
Developed by the SAEM Education Committee, this podcast features interviews with leaders in academic emergency medicine as they discuss their roles, the paths they've taken to reach their current positions, and their future career plans.
Developed by the SAEM Education Committee, this podcast features interviews with leaders in academic emergency medicine as they discuss their roles, the paths they've taken to reach their current positions, and their future career plans.
The Pharm So Hard Podcast: An Emergency Medicine and Hospital Pharmacy Podcast
EMPoweRx Conference The Society for Academic Emergency Medicine is pleased to host EMPoweRx at SAEM23. The Emergency Medicine Pharmacotherapy with Resuscitation (EMPoweRx) Conference is an annual international, multidisciplinary conference dedicated to celebrating advancements in research and practice of emergency medicine pharmacotherapy. While still new, emergency medicine pharmacists and pharmacotherapy has not had its own platform […] The post Episode 100. Charlatan So Hard: Dispelling Myths and Shaping the Future appeared first on The Pharm So Hard Podcast.
Date: April 26, 2023 Reference: Han et al. The effect of telemental versus in-person mental health consults in the emergency department on 30-day utilization and processes of care. AEM April 2023 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Case: You are moonlighting at the Veterans […] The post SGEM#402: Call Me – On the Telemental Health Line first appeared on The Skeptics Guide to Emergency Medicine.
It's the last episode of Season 2 and we're discussing “semi-focus”. Can we banish it completely and where do we start? We look into the research for you and chat to Australian teachers about their experiences.If you've enjoyed Season 2, please share your favourite episode with other teachers you think would love to listen. We want to reach as many teachers as possible and appreciate every rating, subscription or review, so don't hold back. Each of these actions mean a lot to us, but also means new listeners are likely to find out about us.Get in touch with us hereYou can hear more of Staś over at his podcast, Education Bookcast or learn more here.The Pedagogue-cast is proudly powered by Maths PathwayShow notes: Rogers, William A. (2011). You know the fair rule : strategies for positive and effective behaviour management and discipline in schools. Camberwell, Vic : ACER PressHow to become a Straight-A student by Cal Newport (2006).“Long term” & “Working memory” definitionsWhy Don't Students Like School? By Dan Willingham (2021)“Learning is the residue of thought” actually “memory is the residue of thought” quote - Daniel Willingham.Why Don't Students Like School? By Dan Willingham (2021)“Marva Collins” infoMarva Collins' Way by Marva Collins and Civia Tamarkin (1990)“John Wooden” infoYou Haven't Taught Until They Have Learned by Swen Nater and Ronald Gallimore (2010)“Deliberate practice” (work hard, but then deliberately rest - “100% on + 100% off”)Ericsson, K. A. (2008) Deliberate practice and acquisition of expert performance: a general overview. Academic Emergency Medicine.Rest by Alex Soojung-Kim Pang (2018)Doug Lemov: “rehearsing different things that could happen in the classroom” inc classroom management (and using gestures). Be clear in your instructions Teach Like a Champion 3.0 by Doug Lemov (2021)Bill RogerS INFO (Anecdote - it's important to have plan for behavioural management, visual indicator of what the rules are “right now” in the classroom (3 boxes and a magnet would move between the boxes - silent listening, silent working, quiet working)“Direct Instruction”Engelmann, S., Becker, W. C., Carnine, D. W., & Gersten, R. (1988). The Direct Instruction Follow Through Model: Design and outcomes. Education and Treatment of Children, 11(4), 303–317.One Million Children: Success for All by Robert Slavin and Nancy Madden (2000)Theory of Instruction by Siegfried Engelmann and Douglas Carmine (1982)“Montessori Method”Montessori: The Science Behind the Genius by Angeline Stoll Lillard (2016)Please rate and subscribe so you're first to know when the next episode drops. You can hear more of Staś over at his podcast, Education Bookcast The Pedagogue-cast is proudly powered by Maths Pathway
The Pharm So Hard Podcast: An Emergency Medicine and Hospital Pharmacy Podcast
The Society for Academic Emergency Medicine is pleased to host EMPoweRx at SAEM23. The Emergency Medicine Pharmacotherapy with Resuscitation (EMPoweRx) Conference is an annual international, multidisciplinary conference dedicated to celebrating advancements in research and practice of emergency medicine pharmacotherapy. PACUPrep's BCEMP Q-Bank is the leading edge of emergency medicine and critical care exam preparation. Our […] The post Episode 96. Literature Review on Lidocaine vs Amiodarone in IHCA appeared first on The Pharm So Hard Podcast.
This week we're diving into classroom engagement and “Flow”. What does it look like when students are highly engaged in class? How does it make you feel as a teacher? What does the research say? Let's unpack it.If you're enjoying Season 2, please share an episode with other teachers you think would love to listen. We want to reach as many teachers as possible and appreciate every rating, subscription or review, so don't hold back. Each of these actions mean a lot to us, but also mean new listeners are likely to find out about us.Get in touch with us hereYou can hear more of Staś over at his podcast, Education Bookcast or learn more here.The Pedagogue-cast is proudly powered by Maths PathwayShow notes: On Flow, as a concept:Flow by Mihalyi Csikszentmihalyi (2008)On Japan and genki:Educating Hearts and Minds: Reflections on Japanese Preschool and Elementary Education by Catherine C. Lewis (1995)Building a Better Teacher by Elizabeth Green (2014)On deliberate practice:Ericsson, K. A. (2008) Deliberate practice and acquisition of expert performance: a general overview. Academic Emergency Medicine.Ericsson K. A., Hoffman R. R., Kozbelt A., & Williams A. M. (Eds). The Cambridge Handbook of Expertise and Expert Performance (2018).Please rate and subscribe so you're first to know when the next episode drops. You can hear more of Staś over at his podcast, Education Bookcast The Pedagogue-cast is proudly powered by Maths Pathway
Register to attend live or view the recording February 23 from 1:00 pm - 2:00 pm ET Presented by Morgan Wright (Customer Marketing Manager) and Greg Jacobson, MD (co-founder and CEO), from KaiNexus. This webinar serves as an introduction to the science of habits and how to form them. Future webinars in this series will take a deeper look into how to design Habit Loops for the different types of people in your organization. Key Learning Objectives: Building a culture of continuous improvement The Importance of Habits in continuous improvement (CI) The science behind forming Habits Introducing Habit Loops How Habit Loops can transform your organization About the Presenters: Morgan Wright, Customer Marketing Manager, KaiNexus Morgan Wright is the Customer Marketing Manager at KaiNexus. In her role, Morgan partners with customers to develop and execute on a communication strategy to engage their organization in KaiNexus. Morgan is from Austin, Texas, and graduated from Baylor University with a degree in Marketing. Greg Jacobson, Co-Founder & CEO, KaiNexus Greg graduated from Washington University in St Louis in 1997 with a BS in Biology. He attended Baylor College of Medicine from 1997 to 2001. From 2001 to 2004, he completed a residency in Emergency Medicine at Vanderbilt University Medical Center, where he then stayed on as faculty. Starting in 2004, it was his observation and research of operational inefficiencies and unrealized continuous improvement opportunities that resulted in the founding of KaiNexus. Jacobson is co-author of "Kaizen: A Method of Process Improvement in the Emergency Department, published in the journal Academic Emergency Medicine."
Dr. Ken Milne has been working clinically as an emergency physician for 27 years and is an Associate Professor in the Department of Medicine (Division of Emergency Medicine) and Department of Family Medicine. Dr. Milne is passionate about skepticism and critical thinking. He is the creator of the knowledge translation project, The Skeptics' Guide to Emergency Medicine (TheSGEM). He teachesa evidence-based medicine, clinical epidemiology, critical appraisal and biostatistics at Western University in London, Ontario, and serves as a senior editor of Academic Emergency Medicine. He has no funding from the pharmaceutical or biomedical device industry. Citations · Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2. doi: 10.1136/bmj.312.7023.71. PMID: 8555924; PMCID: PMC2349778. · Every-Palmer S, Howick J. How evidence-based medicine is failing due to biased trials and selective publication. J Eval Clin Pract. 2014 Dec;20(6):908-14. doi: 10.1111/jep.12147. Epub 2014 May 12. PMID: 24819404. · Ioannidis JP. Evidence-based medicine has been hijacked: a report to David Sackett. J Clin Epidemiol. 2016 May;73:82-6. doi: 10.1016/j.jclinepi.2016.02.012. Epub 2016 Mar 2. PMID: 26934549. · Guyatt G. Dave Sackett and the ethos of the EBM community. J Clin Epidemiol. 2016 May;73:75-81. doi: 10.1016/j.jclinepi.2016.02.008. Epub 2016 Mar 2. PMID: 26934550. · Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016 Aug;21(4):125-7. doi: 10.1136/ebmed-2016-110401. Epub 2016 Jun 23. PMID: 27339128; PMCID: PMC4975798. · Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ. 2003 Dec 20;327(7429):1459-61. doi: 10.1136/bmj.327.7429.1459. PMID: 14684649; PMCID: PMC300808. · Hayes MJ, Kaestner V, Mailankody S, Prasad V. Most medical practices are not parachutes: a citation analysis of practices felt by biomedical authors to be analogous to parachutes. CMAJ Open. 2018 Jan 15;6(1):E31-E38. doi: 10.9778/cmajo.20170088. PMID: 29343497; PMCID: PMC5878948. · Yeh RW, Valsdottir LR, Yeh MW, Shen C, Kramer DB, Strom JB, Secemsky EA, Healy JL, Domeier RM, Kazi DS, Nallamothu BK; PARACHUTE Investigators. Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial. BMJ. 2018 Dec 13;363:k5094. doi: 10.1136/bmj.k5094. Erratum in: BMJ. 2018 Dec 18;363:k5343. PMID: 30545967; PMCID: PMC6298200. --- Support this podcast: https://anchor.fm/healingispossible/support
The Pharm So Hard Podcast: An Emergency Medicine and Hospital Pharmacy Podcast
EMPoweRx Conference The Society for Academic Emergency Medicine is pleased to host EMPoweRx at SAEM23. The Emergency Medicine Pharmacotherapy with Resuscitation (EMPoweRx) Conference is an annual international, multidisciplinary conference dedicated to celebrating advancements in research and practice of emergency medicine pharmacotherapy. While still new, emergency medicine pharmacists and pharmacotherapy has not had its own platform […] The post Episode 93. Alternative Dosing Strategies for N-acetylcysteine in Acetaminophen Overdose appeared first on The Pharm So Hard Podcast.
The Pharm So Hard Podcast: An Emergency Medicine and Hospital Pharmacy Podcast
EMPoweRx Conference The Society for Academic Emergency Medicine is pleased to host EMPoweRx at SAEM23. The Emergency Medicine Pharmacotherapy with Resuscitation (EMPoweRx) Conference is an annual international, multidisciplinary conference dedicated to celebrating advancements in research and practice of emergency medicine pharmacotherapy. While still new, emergency medicine pharmacists and pharmacotherapy has not had its own platform […] The post Episode 92: EMPoweRx Conference And PACUPrep Updates appeared first on The Pharm So Hard Podcast.
If one is good, two must be better, right? If it applies to cookies and ice cream, why not defibrillators? That's the question the DOSED-VF trial set out to answer. We've covered this topic in episodes 12 and 27, including going over the pilot trial of DOSED-VF. But now the full meal deal is available. And you may have heard it was stopped early because… well, you'd best listen to find out. And, as a special bonus, Dr. Jarvis explains the difference between odds and risk after he fell off into the statistical rabbit hole. Remember, this podcast also has a YouTube version complete with graphs and charts (oh, my!): https://www.youtube.com/@FlightbridgeedHEMS/playlists Citation: 1. Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022;387(21):1947-1956. doi:10.1056/NEJMoa2207304 Other papers discussed in this episode: 2. Mapp JG, Hans AJ, Darrington AM, et al. Prehospital Double Sequential Defibrillation: A Matched Case–Control Study. Braithwaite SA, ed. Academic Emergency Medicine. 2019;26(9):994-1001. doi:10.1111/acem.13672 3. Beck LR, Ostermayer DG, Ponce JN, Srinivasan S, Wang HE. Effectiveness of Prehospital Dual Sequential Defibrillation for Refractory Ventricular Fibrillation and Ventricular Tachycardia Cardiac Arrest. Prehosp Emerg Care. 2019;23(5):597-602. doi:10.1080/10903127.2019.1584256 4.Cabanas JG, Myers JB, Williams JG, De Maio VJ, Bachman MW. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. Prehosp Emerg Care. 2015;19(1):126-130. doi:10.3109/10903127.2014.942476 5. Cheskes S, Dorian P, Feldman M, et al. Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation. 2020;150:178-184. doi:10.1016/j.resuscitation.2020.02.010 6. Ranganathan P, Aggarwal R, Pramesh C. Common pitfalls in statistical analysis: Odds versus risk. Perspect Clin Res. 2015;6(4):222. doi:10.4103/2229-3485.167092See omnystudio.com/listener for privacy information.
The Podcasts of the Royal New Zealand College of Urgent Care
What actually is Rovsing sign and is it useful? Check out the papers mentioned. Prosenz J, Hirtler L. Rovsing Signs Revisited - Effects of an Erroneous Translation on Medical Teaching and Research. Journal of Surgical Education, 2014-9/01, Vol 71, Issue 5, pages 738-742 https://pubmed.ncbi.nlm.nih.gov/24776856/ Benabbas R, Hanna M, Sinert R. Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Pont-of-care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta-analysis. Academic Emergency Medicine 2017; 24: 523– 551. https://onlinelibrary.wiley.com/doi/10.1111/acem.13181 Niels Thorkild Rovsing Obituary. Br Med J. 1927 Feb 5; 1(3448):265 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2454133/?page=1 www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all times. For personal medical advice always consult your usual doctor
Dr. Monica Saxena JD, MD joins us to discuss the recent overturning of Roe v. Wade. How will this affect access to abortions, particularly for marginalized communities? What relevance does this ruling have to the role of the EM physician in caring for emergencies in pregnancy? What role with the emergency department play in states that allow and don't allow abortions? What actions may we take for our patients, in the ED and outside the ED? Objectives 1. Explore the changing landscape of safe abortion access in the US 2. Learn how your practice in the emergency department may be affected by the decision to overturn Roe v. Wade, including implications for pregnancy related complaints that include terminataion of pregnancy as treatment (for both states where abortions remain legal and where they do not). 3. Learn what resources exist for you and your patients to navigate safe abortion access in the post-Roe era 4. Learn how you can help restore access to safe abortions Take Home Points 1. The Supreme Court decision means that regulations or lack of regulation around abortion will be left up to the states. This creates a lot of variation as well as uncertainty. 2. Termination of pregnancy is the indicated medical procedure for many complications of pregnancy. In states where termination of pregnancy is banned after a certain amount of weeks or band altogether, the emergency physician may have to wait to intervene until her patient is unstable or may have to transfer her. 3. EMTALA is a federal law which supersedes any state law, however it necessitates the stabilization of patients. In some interpretations, a woman with an emergency related to her pregnancy may have to be unstable prior to the physician intervening. 4. The legality around abortion is changing rapidly. The result is that medical decisions are sometimes being legislated in the emergency department. This is dangerous for patients and physicians. 5. These laws promote health equity and social injustice as they differentially affect states where there is a larger population of people of color and indigenous peoples. 6. Physicians interested in helping can do so in the following three ways: a) Advocate for a change with your national college. For us that is the American College of Emergency Physicians and the Society of Academic Emergency Medicine b) familiarize yourself with what options your patients have and where they can turn to for resources. It may be possible to get training in medical abortion depending on where you live c) states where abortion remains legal will see an Increasing volume of patients seeking termination of pregnancy. There may be scope to to set up innovative programs for medical termination in the emergency department Resources Abortion providers near you: https://abortionfinder.org/ Teleabortions: https://mychoix.co/ Emergency Medicine and Reproductive Health in a Post-Row Landscape Kelli L. Jarrell et al Monica Saxena: saxenam@stanford.edu Guest Monica Saxena is an assistant professor of Emergency Medicine at Stanford School of Medicine. She is also a JD who has been involved in reproductive rights and women's health for more than a decade. Dr. Saxena initiated an ED protocol for elective termination of first trimester pregnancy in the ED. Contributors: Payal Modi
Dr. Jimmy Pruitt founded Pharmacy and Acute Care University (PACU). During our conversation, we talk about the features of Pharmacy and Acute Care University. Who is it for? What do students learn? How much does it cost? And, more. My Back-to-School Series features interviews with 9 pharmacists who teach online courses. Since it's back-to-school time for my kids, I created a Back-to-School series for my podcast! Check out the series, and get inspired to either learn or create! Bio: Jimmy L. Pruitt III, PharmD, BCPS, BCCCP Dr. Jimmy Pruitt is originally from Orlando, FL, and is combination of nerd and athlete, having a background as division 1 cornerback then turned Doctor of Pharmacy from Presbyterian College School of Pharmacy in 2017. He completed a PGY-1 Pharmacy Residency at Florida Hospital Orlando, and then went on to Grady Health System in Atlanta GA for his PGY2 Emergency Medicine Residency. Dr. Pruitt is currently an Emergency Medicine Clinical Pharmacy Specialist at the Medical University of South Carolina in Charleston, SC. Dr. Pruitt was awarded the Grady Pharmacist of the Year in 2019 as a PGY2 EM resident, which was a first in the programs 30+ year history. In 2020, Jimmy obtained Board Certified Pharmacotherapy Specialist (BCPS) and Board Certified Critical Care Pharmacist (BCCCP) recognition. Also, in 2020, Jimmy won the Society of Academic Emergency Medicine's (SAEM) Got Talent competition for his educational series “Pharmacy Friday Pearls” which was the first time a pharmacists won the event. In 2021, Dr. Pruitt was honored with the Excellence in Diversity from MUSC College of Pharmacy, Presbyterian College School of Pharmacy (PCSP) Alumni of the Year, and keynote speaker for the 2021 PCPS graduation. Dr. Pruitt's professional interests include cardiac arrest, shock syndromes, trauma, and hosting his podcast Pharm So Hard. Thank you for listening to episode 168 of The Pharmacist's Voice ® Podcast! To read the full show notes, visit https://www.thepharmacistsvoice.com. Click on the podcast tab, and search for episode 168.
In this episode of CUBIST, Amanda, and Don discuss the article, “Accuracy of a rapid GFAP/UCH-L1 test for the prediction of intracranial injuries on head CT after mild traumatic brain injury” by Jeff Bazarian and colleagues, and published in Academic Emergency Medicine, August 2021. Article Citation: Bazarian, J. J., Welch, R. D., Caudle, K., Jeffrey, C. A., Chen, J. Y., Chandran, R., McCaw, T., Datwyler, S. A., Zhang, H., & McQuiston, B. (2021). Accuracy of a rapid glial fibrillary acidic protein/ubiquitin carboxyl-terminal hydrolase L1 test for the prediction of intracranial injuries on head computed tomography after mild traumatic brain injury. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine, 28(11), 1308–1317. https://doi.org/10.1111/acem.14366 Article LINK: https://pubmed.ncbi.nlm.nih.gov/34358399/ CUBIST is a podcast for health care providers produced by the Traumatic Brain Injury Center of Excellence. We discuss the latest research on traumatic brain injury (TBI) most relevant to patient care. For more about TBI, including clinical tools, go to www.Health.mil/TBICoE or email us at dha.ncr.j-9.mbx.tbicoe-info@mail.mil. The views, opinions, and/or findings in this podcast are those of the host and subject matter experts. They should not be construed as an official Department of Defense position, policy, or decision unless designated by other official documentation. Our theme song is “Upbeat-Corporate' by WhiteCat, available and was used according to the Creative Commons Attribution-Noncommercial 4.0 license.
Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Yelise Foon, Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Goyal, M., Chamberlain, J., Webb, M., Grundmeier, R., Johnson, T., & Lorch, S. et al. (2020). Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Academic Emergency Medicine, 28(9), 949-956. https://doi.org/10.1111/acem.14142.Presenter: Yelise Foon.Summary: Delay in the diagnosis of appendicitis is associated with perforation and significant subsequent morbidity. Currently the pre-operative perforation rate for appendicitis is 30%. Some known risk factors for a delayed diagnosis for appendicitis include a young age, female gender, African-American race, non-English speaking backgrounds and government insurance factors (predominantly in the US). This was a multi-centre retrospective cohort study conducted over 3 years utilizing the PECARN registry, which aimed to compare the rate of appendiceal perforation, delayed diagnosis of appendicitis and diagnostic imaging use among different ethnicities. Of the 7298 children diagnosed with appendicitis where race/ethnicity data was collected, 34.9% of non-Hispanic white children had a perforated appendix, compared with 36.5% of non-Hispanic black children. Non-Hispanic black children also had higher rates of delayed diagnosis (defined as having a relevant emergency visit in the week prior to diagnosis): at 4.7% compared with 2.0% for non-Hispanic white children. Further non-Hispanic black children with a delayed diagnosis of appendicitis were less likely to undergo definite imaging (including MRI, ultrasound, or CT) compared with their non-Hispanic white counterparts (with 28.2% versus 46.2% undergoing imaging). However, given that this study came out of the US, the generalisability of this study to Australian emergency departments is unclear. Health literacy is likely to be a large contributor to delayed presentation of appendicitis and something to be carefully considered when treating any child (and their family). There are tools such as the Paediatric Appendicitis Score (PAS) and the Alvarado Score which may assist in objectively quantifying the possibility of appendicitis (particularly for junior staff). Take-Home Points:It is important for us to consider how we can minimise racial and ethnic disparities and make sure we are conscious of them. Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects Feel Me by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. In The Eyes by Peyruis | https://soundcloud.com/peyruis, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. It's All Good by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Love Trip by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Mamacita by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~
You get called to a code blue medical in the maternofetal assessment unit of your labour ward. A pregnant woman at 35 weeks has presented in severe respiratory distress. Her BP is 220/110, her heart rate 120/min, oxygen sats 88% despite high flow oxygen. She has a history of hypertension, diabetes and amphetamine abuse. You grab the nearby obstetric ultrasound (because it is there) and quickly scan her lungs with the curvilinear probe - all the lung fields are full of B-lines..... Hi everyone join Graeme and I as we discuss the acute management of this condition, variously known as SCAPE (sympathetic crashing acute pulmonary oedema), flash pulmonary oedema, or hypertensive pulmonary oedema. Links Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society of Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group. J Card Fail. 2016 Aug;22(8):618-27 A critical appraisal of the morphine in the acute pulmonary edema: real or real uncertain? J Thorac Dis. 2017 Jul;9(7):1802-1805. https://emcrit.org/pulmcrit/scape-2/#:~:text=SCAPE%20%28Sympathetic%20Crashing%20Acute%20Pulmonary%20Edema%29%20is%20a,SCAPE%20in%20articles%20and%20chapters%20about%20heart%20failure.
AEM Podcast - December 2021
Date: December 13th, 2021 Reference: Lee et al. Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine. AEM December 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: At the completion of her 1-month elective in your rural emergency department […]
In this episode of CUBIST, Amanda, and Don discuss the article, “Accuracy of a rapid GFAP/UCH-L1 test for the prediction of intracranial injuries on head CT after mild traumatic brain injury” by Jeff Bazarian and colleagues, and published in Academic Emergency Medicine, August 2021. Article Citation: Bazarian, J. J., Welch, R. D., Caudle, K., Jeffrey, C. A., Chen, J. Y., Chandran, R., McCaw, T., Datwyler, S. A., Zhang, H., & McQuiston, B. (2021). Accuracy of a rapid glial fibrillary acidic protein/ubiquitin carboxyl-terminal hydrolase L1 test for the prediction of intracranial injuries on head computed tomography after mild traumatic brain injury. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine, 28(11), 1308–1317. https://doi.org/10.1111/acem.14366 Article LINK: https://pubmed.ncbi.nlm.nih.gov/34358399/ CUBIST is a podcast for health care providers produced by the Traumatic Brain Injury Center of Excellence. We discuss the latest research on traumatic brain injury (TBI) most relevant to patient care. For more about TBI, including clinical tools, go to www.Health.mil/TBICoE or email us at dha.ncr.j-9.mbx.tbicoe-info@mail.mil. The views, opinions, and/or findings in this podcast are those of the host and subject matter experts. They should not be construed as an official Department of Defense position, policy, or decision unless designated by other official documentation. Our theme song is “Upbeat-Corporate' by WhiteCat, available and was used according to the Creative Commons Attribution-Noncommercial 4.0 license.
Yves Duroseau, MD, MPH is the current Chair of the Department of Emergency Medicine at Lenox Hill Hospital (LHH), NS/LIJ. As Chair, Dr. Duroseau provides overall leadership of the department, with responsibility for strategic planning, development, clinical services, quality, professional performance, and medical education. Dr. Duroseau is also the Co-Chair of the Performance Improvement Coordinating Group (PICG) for Lenox Hill Hospital. The PICG is responsible for overseeing all quality initiatives for the hospital.Dr. Duroseau joins LHH from the Kings County Hospital Center in Brooklyn, NY, where he was the Director of Service in the Department of Emergency Medicine. Prior to his post at Kings County Hospital Center, Dr. Duroseau served as the Medical Director of the Department of Emergency Medicine and as an Attending Physician at St. Vincent's Hospital in New York City. He has also served as a per diem physician with North-Shore LIJ since 2011.He has held several academic appointments. Most recently as an Assistant Clinical Professor at the State University of New York, and has held academic appointments with New York Medical College and New York University Medical Center. He is a Peer Reviewer for the Academic Emergency Medicine journal. He has published on his experience and successes with the use of Lean methodologies in transforming Kings County Hospital's Emergency Department.Dr. Duroseau's commitment to service is demonstrated through his founding of the mentorship programs, Doctors as Mentors at St. Vincent's Hospital and Bridging the Gap at New York University and New York University Medical School, both intended to support minority students interested in or pursuing careers in medicine. He has also served in numerous hospital and academic committee roles centered on quality, information technology, philanthropy, Lean management, hospital programming, and other initiatives.Dr. Duroseau earned his medical degree and Master of Public Health degree as well as completed his residency in emergency medicine and internship in internal medicine at The George Washington University School of Medicine and Health Sciences in Washington, D.C. He has completed postdoctoral research in Medical Informatics at The National Institutes of Health in Bethesda, MD. He is a Diplomate of the American Board of Emergency Medicine.- ELabNYC#menshealth #blackmenshealth #eattolive #exercise #medicine #healthcare #healthinsurance #dangersofethnicfoods #diet #blackmaledoctors #pushenboundaries #medicaladvice #dangersofsugar #dangersofhighbloodpressure #healthyliving #Itsmorethanexercise #NYChealthcare #whatmendontknow #PCP #choosingadoctor #doctorconversations #mentalk #mencare #sugar #highbloodpressure #heartdisease
In this episode of Organic Thoughts Podcast, Machi sits down with Dr. Jimmy Pruitt III, host of Pharm So Hard Podcast, PharmD, BCPS, BCCCP. In this episode we talk about Jimmy's ascent from football into the pharmaceutical industry, his impact on other around him, what its like to work as a pharmacist in the Emergency Room, how that's shaped his care for others, and finally the impact of COVID-19 and the vaccine. Tune in now! "Dr. Jimmy Pruitt is originally from Orlando, FL, received his Doctorate of Pharmacy from Presbyterian College School of Pharmacy in 2017. He completed a PGY-1 Pharmacy Residency at Florida Hospital Orlando, and then went on to Grady Health System in Atlanta GA for his PGY2 Emergency Medicine Residency. Dr. Pruitt is currently an Emergency Medicine Clinical Pharmacy Specialist at the Medical University of South Carolina in Charleston, SC. Dr. Pruitt is a member of the South Carolina Society of Health-System Pharmacists (SCSHP), American College of Clinical Pharmacy (ACCP), American Society of Health-System Pharmacists (ASHP), and Society of Critical Care Medicine (SCCM). Dr. Pruitt was awarded the Grady Pharmacist of the Year in 2019 by Emory Department of Emergency Medicine as a PGY2 EM resident. In 2020, Jimmy obtained Board Certified Pharmacotherapy Specialist (BCPS) and Board Certified Critical Care Pharmacist (BCCCP) recognition. Also, in 2020, Jimmy won the Society of Academic Emergency Medicine's (SAEM) Got Talent competition for his educational series “Pharmacy Friday Pearls.” In 2021, Dr. Pruitt was honored with the Excellence in Diversity from MUSC College of Pharmacy, awarded Alumni of the Year, and was the keynote speaker for Presbyterian College School of Pharmacy Graduation. Dr. Pruitt's professional interests include cardiac arrest, shock syndromes, trauma, and hosting his podcast “Pharm So Hard”." --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
Contributor: Adam Barkin, MD Educational Pearls: Multi-center open-label non-inferiority trial looked at treatment of pneumothorax with a small-bore chest tube versus conservative management with exceptional follow up 316 patients ages 14-50 with moderate to large pneumothorax (>32% measured on CXR) were randomized into one of the two treatment arms 15% of the conservative group required further intervention as determined by prespecified protocols 94.4% of the intervention group had resolution at 8 weeks, whereas 98.5% of the conservative group had resolution at 8 weeks These data were affected by poor follow up CXR resolution average of 16 days in the intervention group and 30 days in the conservative group Symptom resolution was similar between the two groups (median 15 days vs. 14 days) Recurrence at 12 months was 17% in interventional group vs 8% in conservative group 41 adverse events in intervention group and 13 adverse events in conservative group References Brown SGA, Ball EL, Perrin K, et al. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. N Engl J Med. 2020;382(5):405-415. doi:10.1056/NEJMoa1910775 Franzen, D. (2019, November). Pneumothorax. Society of Academic Emergency Medicine. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-respiratory/pneumothorax. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!
Today's episode is with Dr. Samuel Ayala. He is an Emergency Medicine Physician in New York City and has over 12 years of experience in the medical field. And he currently holds the following positions: 1. Emergency Medicine Specialist - NewYork-Presbyterian Brooklyn Methodist Hospital 2. Faculty Member and Medical Student Director - Weill Cornell Medical College, Cornell University Education and Training: - Brown University - Undergraduate Education - University of Massachusetts, School of Medicine, in 2009 - Albert Einstein College of Medicine - Residency Training ............................................................................................................................................................................ Links to various websites & resources mentioned in each episode will be linked below: SAEM (Society for Academic Emergency Medicine) https://www.saem.org/ ACEP (American College of Emergency Physicians) https://www.acep.org/ AAMC (Association of American Medical Colleges) https://www.aamc.org/ AMA (American Medical Association) https://www.ama-assn.org/ NewYork-Presbyterian Brooklyn Methodist Hospital https://www.nyp.org/brooklyn/volunteer-opportunities And finally, Dr. Ayala's email: (please don't spam him y'all, please don't) Saa9089@nyp.org Lol, hope you enjoyed this session. More on the way. See you on the next episode.
Have you ever sat down with someone after an opioid overdose? Ever wondered what people are worried about after they have an overdose and end up in an Emergency Department? In this episode, we review this paper from Academic Emergency Medicine in 2021: "A qualitative study of Emergency Department patients who survived an opioid overdose: Perspectives on treatment and unmet needs." The authors interviewed patients in the ED after an opioid overdose to hear their perspectives. You'll may be surprised by what patients identify as the most important issues after an overdose.
Dr. Linelle Campbell is a Chief Resident in Emergency Medicine at Jacobi/ Montefiore Medical Center in Bronx, New York. Dr. Campbell received her medical degree from Howard University College of Medicine. She is the former Chair for the Diversity and Inclusion Committee of the Emergency Medicine Residents Association and the Chair of the Resident Committee for the Academy of Diversity and Inclusion in Emergency Medicine of the Society of Academic Emergency Medicine. She is the Resident Lead of the Jacobi/ Montefiore Social Emergency Medicine Committee as well as its Medical Justice Alliance, which reviews medical cases and advocates for the early relief of prisoners during Covid-19. She is also currently a fellow for the New York City Health and Hospitals' Healthcare Administrative Scholars Program, where her focus has been achieving health equity through the lens of quality improvement, patient safety, and community engagement. This was a jam back episode with a lot of information. Trust me you will learn something from this great conversation. #hospitals #patientsafety #patient #doctor #physician #mentalhealth #society #society #quality #diversityandinclusion #research #covid #community #university #health #engagement #patients #medicine #radiology #covid19outbreak
Theme: Bonus Episode. Participants: Dr Pramod Chandru, Kit Rowe, Shreyas Iyer, Caroline Tyers and, Samoda Wilegoda Mudalige. Discussion 1:Chandru, P., Priyambada Mitra, T., Dutt Dhanekula, N., Dennis, M., Eslick, A., Kruit, N., & Coggins, A. Out of hospital cardiac arrest in Western Sydney: an analysis of outcomes and estimation of future eCPR eligibility - not yet available online. Take-Home Points: This paper was a prospective observational study of consecutive out-of-hospital of cardiac arrests (OOHCAs) at Westmead Hospital over a 3-year period. It looked at the feasibility of setting up an ECMO service for refractory OOHCAs (i.e. for patients who have received CPR for 20 minutes or longer, between the ages of 18 and 70 years, and had a VF arrest). This study had 17 patients who would have qualified as true refractory OOHCAs (none of whom survived to hospital discharge). This proportion of patients was similar to other studies that have been undertaken on this topic, which also demonstrated a survival to hospital discharge with good neurological recovery of around 35-40% with the use of ECMO CPR. The 2CHEER study performed out of Melbourne is also a good reference for this subject - this was one of the first RCTs for the use of ECMO CPR in a pre-hospital setting (see reference below). Westmead Hospital will be one of the centers involved in the upcoming RESET trial looking at the implementation of ECMO CPR. Discussion 2:Bima, P., Pivetta, E., Nazerian, P., Toyofuku, M., Gorla, R., & Bossone, E. et al. (2020). Systematic Review of Aortic Dissection Detection Risk Score Plus D‐dimer for Diagnostic Rule‐out of Suspected Acute Aortic Syndromes. Academic Emergency Medicine, 27(10), 1013-1027. https://doi.org/10.1111/acem.13969. Take-Home Points: This meta-analysis suggested a sensitivity of 97.6-99.9% for an aortic dissection risk score of 0-1 and a negative D-dimer (
Purpose: Learn the importance of treatment studies (RCTs) in EBM Understand and interpret methods and results of treatment based studies Become familiar with critically appraising treatment based studies Hosts: Dylan Collins Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069 EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf Episode takeaway RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.
Purpose: Learn the importance of treatment studies (RCTs) in EBM Understand and interpret methods and results of treatment based studies Become familiar with critically appraising treatment based studies Hosts: Dylan Collins Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069 EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf Episode takeaway RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.
Purpose: 1. Learn the importance of treatment studies (RCTs) in EBM 2. Understand and interpret methods and results of treatment based studies 3. Become familiar with critically appraising treatment based studies Hosts: Dylan Collins Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf Episode takeaway 1. RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables 2. Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question 3. Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. 4. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.
Purpose: 1. Learn the importance of treatment studies (RCTs) in EBM 2. Understand and interpret methods and results of treatment based studies 3. Become familiar with critically appraising treatment based studies Hosts: Dylan Collins Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf Episode takeaway 1. RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables 2. Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question 3. Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. 4. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.
Theme: POCUS. Participants: Oliver Archer (ED resident and previous cardiac sonographer), Hung Diep (ED advanced trainee), Dr Richard McNulty, Dr Kenny Yee, Dr Pramod Chandru, Kit Rowe, Shreyas Iyer, Caroline Tyers and Samoda Wilegoda Mudalige.Discussion 1:Presenter - Oliver Archer.Starting - 02:00. Atkinson, P., Beckett, N., French, J., Banerjee, A., Fraser, J., & Lewis, D. (2019). Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators. Cureus. https://doi.org/10.7759/cureus.4456.Take-Home Points: This study showed that visualizing cardiac activity on ultrasound resulted in increased duration and effort of resuscitation, and was associated with improved clinical outcomes. It is difficult to know whether the improved clinical outcomes were secondary to increased resuscitation efforts or due to identification (with ultrasound) of those with a better prognosis. Ultimately, ultrasound should be used as an adjunct to your clinical decision-making, but should not get in the way of the established standard ALS protocol. The COACHRED protocol (referenced below) assists in incorporating POCUS into the arrest algorithm. Discussion 2:Presenter - Hung Diep.Starting - 29:10.Daley, J., Dwyer, K., Grunwald, Z., Shaw, D., Stone, M., & Schick, A. et al. (2019). Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. Academic Emergency Medicine, 26(11), 1211-1220. https://doi.org/10.1111/acem.13774.Take-Home Points: This study shows that focused cardiac ultrasound (FOCUS): involving right ventricular dilation, McConnell's sign, septal flattening, tricuspid regurgitation, and tricuspid annular plane systolic excursion (TAPSE), maybe a useful adjunct in the workup of patients with a high pre-test probability of PE. The most sensitive component of the FOCUS was TAPSE. The most specific components of the FOCUS were McConnell's sign and septal flattening. However, it is important to remember that illnesses associated with chronic right heart strain such as COPD would also yield a positive FOCUS. At this stage, there is not enough evidence for FOCUS in diagnosing PE to alter clinical decision-making. Discussion 3:Presenter - Pramod Chandru.Starting - 01:03:35. Chartier, L., Bosco, L., Lapointe-Shaw, L., & Chenkin, J. (2016). Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis. CJEM, 19(2), 131-142. https://doi.org/10.1017/cem.2016.397Take-Home Points: This study looked at the use of POCUS to assist with both the diagnosis and reduction of long bone fractures (radius, ulna, humerus, tibia, fibula, and femur). POCUS use had reasonable sensitivity and specificity in the diagnosis of fractures, particularly paediatric forearm fractures and adult ankle fractures - however, it may not provide all the information required regarding a fracture once identified. In the absence of fluoroscopy, using POCUS to delineate the satisfactory nature of a reduction in ED (such as of the wrist) may reduce the risks associated with recurrent reductions and the need for operative fixation, however, further research with randomized controlled trials is needed. All in all, it is hard to see how ultrasound would replace x-ray as the imaging modality of choice for fractures, but there is an argument to be made for the use of ultrasound in assessing for the adequacy of reduction particularly in specific populations and this would be an interesting area for future studies. Interlude Segment:Starting - 56:10.Ioannidis, J. (2005). Why Most Published Research Findings Are False. PLoS Medicine, 2(8), e124. https://doi.org/10.1371/journal.pmed.0020124.Other References:Finn, T., Ward, J., Wu, C., Giles, A., & Manivel, V. (2019). COACHRED: A protocol for the safe and timely incorporation of focused echocardiography into the rhythm check during cardiopulmonary resuscitation. Emergency Medicine Australasia, 31(6), 1115-1118. https://doi.org/10.1111/1742-6723.13374.Credits:The discussions were mediated by ED consultant and ultrasound guru Dr Kenny Yee, ED consultant and clinical toxicologist Dr Richard Mc Nulty, and ED consultant Dr Pramod Chandru.This episode was produced by the Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Another Time by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Cross Over by Sapajou | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US Esperanza by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Mega Epic by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/ Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Piano Rock Instrumental by Hyde - Free Instrumentals | https://soundcloud.com/davidhydemusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Ragga Groove by Peyruis | https://soundcloud.com/peyruis, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sea Current by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US Smile by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Wasting Time by Sapajou & Yorgo H | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.
Dr. Catherine Patocka is an emergency physician in Calgary, and a Clinical Assistant Professor at the Cumming School of Medicine at the University of Calgary. She completed her BSc Honours in pharmacology at the University of Alberta, followed by medical school and 5-year Royal College residency in emergency medicine at McGill University. She is the Program Director of the emergency medicine specialty residency training program at the University of Calgary and is actively involved in medical education research. She completed her Masters in health profession education at Maastricht University examining the impact of spaced learning on long-term retention of pediatric resuscitation skills. Beyond her research interests, she is broadly engaged in the emergency medicine community locally, nationally (where she is a board member and treasurer of the Canadian Association of Emergency Physicians) and internationally (as a task force member for the International Liaison Committee on Resuscitation [ILCOR]) Show notes available at northernexposurepodcast.ca
SAEM RAMS Who's Who in Academic Emergency Medicine - Kat Ogle, MD by SAEM
In this episode we’re speaking with Dr. Lisa Calder, CEO of the Canadian Medical Protective Association, known as the CMPA. She stepped into the role in August last year and is the CMPA’s first female CEO. Dr. Calder studied medicine at the University of Western Ontario and did an Emergency Medicine residency at the University of Ottawa. She has a Master of Science degree in Epidemiology and was an Associate Professor at the University of Ottawa in the Department of Emergency Medicine. Dr. Calder pursued her passion for patient safety by completing two additional fellowships: the Patient Safety Fellowship in Emergency Medicine from the Society for Academic Emergency Medicine and the Emergency Medicine Patient Safety Foundation, and the American Hospital Association’s Fellowship in Patient Safety Leadership. She spent more than a decade practising as an emergency physician before joining the CMPA in 2015 as the Director of Medical Care Analytics. When Covid 19 hit, Dr. Calder and her leadership team moved quickly, using a variety of tools to support their physician members during this tumultuous year. She credits her own experience as an emergency physician for teaching her disaster training and how to live with unpredictability. Today Dr. Calder says the mission of the CMPA has never been more important - to protect the professional integrity of physicians and promote the safety of medical care. Quotables “There are things that we can see that are right in front of us, and are being reported in terms of numbers, but there are impacts that are more subtle – on our well-being, on the way we work together, and those are the ones that I find tricky to put my finger on and understand.” – LC “We have a phone line which is available to our membership and we receive up to 200 calls a day from our physicians asking for advice.” – LC “We’re always, when we look at medico-legal data looking back in time. We’re limited by what’s actually documented and that’s a significant limitation because we know that a lot happens in the moment when physicians are making critical decisions that does not get documented.” – LC “I’ve seen a real shift, which I think is hugely positive to a more of a personal tone to the communication, more of a ‘sharing struggles’ and a willingness to be humble and authentic on the part of leaders.” – LC “I want to know from employees, what does it mean when we say ‘We are here for you? What does that translate for you in tangible terms in your day-to-day work?’” – LC “I’m fiercely protective of my lunch break every day. I need time away from my computer and I use that time to go for a quick walk around the block and then to meditate.” – LC “At HIROC we introduced the Collision Chats, where we pair up staff randomly and they meet up for 5-10 minutes and that’s a way of having those hallways conversations online if possible.” – PAD “The challenges ahead for the healthcare system are huge and so we will need more collaborative approaches to address these. I don’t think siloing organizations – everyone doing their own thing –is going to advance us where we need to be.” – LC Mentioned in this Episode: CMPA University of Ottawa – Faculty of Medicine Dr. Mamta Gautam Access More Interviews with Healthcare Leaders at HIROC.com/podcast Follow us on Twitter, and listen on iTunes. Email us at Communications@HIROC.com.
SAEM RAMS Who's Who in Academic Emergency Medicine - Ali S. Raja, MD by SAEM
Quick Summary Low Dose Ketamine for Acute Pain in the ED - Article A look at an article in Academic Emergency Medicine comparing low dose ketamine and morphine for the treatment of acute pain in the ED (SRMA).
#026 - In this episode I'm going to talk with Dr. Jeremy Ackerman, a Tactical Physician and an academic Emergency Medicine physician in Atlanta. In this episode we will learn what it is really like to work in his profession and discuss how he got into health care.
Retornamos com o TdC Lab, dessa vez para falar sobre Troponina! Raphael, João e Guilherme Moura falam desse exame precioso na sala de emergência. Quer fazer alguma sugestão ou critica? Entra em contato com a gente através do e-mail tadeclinicagem@gmail.com ou pelo Instagram @tadeclinicagem MINUTAGEM (2:46) o que é troponina? (4:27) Valor de referência (7:22) Troponina ultra sensível (10:10) o que faz q troponina subir (11:50) injúria miocárdica (16:30) Tipo de infartos (18:15) Injúria miocárdica x infarto do tipo II (20:20) Troponina acima do p99 mas que não curva (20:45) Fatores que aumentam a troponina (21:17) cinética da troponina (22:58) Valor prognóstico (23:38) Escore de Heart (25:05) Quando não pedir (27:26) Resumo (28:31) CKMB (29:28) salves (30:46) Resposta do desafio anterior (32:00) Desafio da semana REFERÊNCIAS 1- UPTODATE Jul 2020. Troponin testing: Analytical considerations. Allan S Jaffe, David A Morrow, Juan Carlos Kaski 2- FDA Warns that Biotin may interfere with Lab Tests: FDA Safety Communication ( https://www.fda.gov/medical-devices/safety-communications/update-fda-warns-biotin-may-interfere-lab-tests-fda-safety-communication) 3- UPTODATE JUL 2020. Troponin testing: Clinical Use. Allan S Jaffe, David A Morrow, Juan Carlos Kaski, Gordon Saperia. 4- THYGESEN, Kristian et al. Fourth universal definition of myocardial infarction (2018). Journal of the American College of Cardiology, v. 72, n. 18, p. 2231-2264, 2018. mn 5- WANG, Alfred Z. et al. Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting?. Academic Emergency Medicine, v. 27, n. 1, p. 6-14, 2020. 6- WU, Alan HB et al. Clinical laboratory practice recommendations for the use of cardiac troponin in acute coronary syndrome: expert opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. Clinical chemistry, v. 64, n. 4, p. 645-655, 2018. 7. Site com valores de referência da Troponina. http://www.ifcc.org/executive-board-and-council/eb-task-forces/task-force-on-clinical-applications-of-cardiac-bio-markers-tf-cb.
Resa speaks with Angela Rasmussen PhD and Esther Choo MD MPH. Esther is an emergency physician and professor of emergency medicine at the Oregon Health & Science University. She is a researcher, an educator, and a writer. She is a popular science communicator, who has used social media to talk about racism and sexism in healthcare. She was the president of the Academy of Women in Academic Emergency Medicine and is a member of the American Association of Women Emergency Physicians. She is a founding member of TIMES UP Healthcare. View some of her publications HERE. Angie is a PHD virologist who "uses systems biology techniques to interrogate the host response to viral infection. She has studied a huge range of viral pathogens, from the “common cold” (rhinovirus) to Ebola virus to highly pathogenic avian influenza virus to SARS-CoV-2/COVID-19. View some her publications HERE. The discussion ranges from COVID19 to viruses in general, to Vaccines, to the Eloquent Rage of equity, social media, and being women in STEMM.
This week we are talking with Doctor Kat Ogle on discrimination in healthcare. From medical students to doctors and naturally the patients in between, how common is racism in the medical community and what can be done to end it? Dr. Ogle doesn't hold back on this important topic! Dr. Kat Ogle| Washington DC Emergency Medicine Physician Author Dr. Ogle is a board-certified Emergency Medicine physician, currently practicing at The George Washington University Hospital, Washington VA Medical Center and United Medical Center in Washington, DC. She is a first-generation college graduate and physician and began her career with seven years as a registered nurse, nearly six of which were spent in critical care. She attended the George Washington University School of Medicine & Health Sciences for medical school, Emergency Medicine residency and finally an Emergency Ultrasound fellowship. In 2014, she furthered her passion for medical education by completing Master Teacher Leadership Development Program at GW. She has been on the faculty since 2013. As an Assistant Professor of Emergency Medicine at the George Washington University School of Medicine & Health Sciences and is actively engaged in medical student, resident and fellow education. She is the Emergency Ultrasound Fellowship Director, Executive Chair of the Clinical Competency Committee for the residency. She directs the Medical Education and Leadership Scholarly Concentration at the medical school level and leads Teaching and Learning Knowledge and Skills, a senior elective during which students learn concepts and tools which will facilitate their growth as clinician educators. She has fostered engagement with the women faculty within her department and co-founded their professional development group, GW Emergency Medicine Females or GWEMFEM. Through this group, she encourages and inspires amplification and promotion of her women physician peers. On a national level, she has served in several leadership roles: as the Didactics committee chair for the Academy for Women in Academic Emergency Medicine for the last three years and has been elected as the Vice President of Education for AWAEM in the summer. She is also an elected counselor, serving on the Society of Clinical Ultrasound Fellowships Board. Within AWAEM, she served co-chair of the Task Force on Starting a Women’s Group within AWAEM, a group embarking upon the development of the AWAEM Toolkit 2020 Edition, released early this year. She has been engaged in education and speaking at both national and international levels and she incredibly proud being selected as one of the speakers for FIX19 in which she shared a very personal story about the intersection of alcoholism, intimate partner violence and child abuse. Dr. Ogle's professional interests include point of care ultrasound, both undergraduate and graduate medical education, mentorship, female leadership and promotion as well as wellness. She balances her academic and professional responsibilities with her role as a single mother and co-parent.
Ira Pastor, ideaXme life sciences ambassador and founder of Bioquark, interviews Dr. Debra Houry, MD, MPH, the Director of the National Center for Injury Prevention and Control (NCIPC) at the U.S. CDC. Ira Pastor comments: On the U.S. Center’s for Disease Control (CDC) "Ten Leading Causes of Death" list, right beneath the two major categories of heart disease and cancer, there is a category called "Unintentional Injuries" which cumulatively took the lives of over 167,000 Americans in 2018. This category consists of a variety of subcategories such as poisoning, traffic accidents, falls, suffocation, drownings, and fire, just to name a few. When one goes to visit a parallel list, the "Ten Leading Causes of Non-Fatal Emergency Department Visits" (a non-fatal injury defined as bodily harm resulting from severe exposure to an external force or substance, including mechanical, thermal, electrical, chemical, or radiant, or a submersion), the numbers go through the proverbial roof, with over 25 million cases reported in the U.S. alone in 2018, with combined direct and indirect costs approaching ¾ Trillion dollars per year. Globally these numbers are equally staggering. Preventing Injury, Violence and Fatalities: Dr. Debra Houry, MD, MPH, is the Director of the National Center for Injury Prevention and Control (NCIPC) at the U.S. CDC. In this role, Dr. Houry leads innovative research and science-based programs to prevent injuries and violence and to reduce their consequences. Prior to joining CDC, Dr. Houry previously served as Vice-Chair and Associate Professor in the Department of Emergency Medicine at Emory University School of Medicine and as Associate Professor in the Departments of Behavioral Science and Health Education and in Environmental Health at the Rollins School of Public Health. Dr. Houry also served as an Attending Physician at Emory University Hospital and Grady Memorial Hospital and as the Director of Emory Center for Injury Control. Her prior research has focused on injury and violence prevention in addition to the interface between emergency medicine and public health, and the utility of preventative health interventions and screening for high-risk health behaviors. Dr. Houry has received several national awards for her work in the field of injury and violence prevention. She was recently elected as a member of the National Academy of Medicine (NAM), received the first Linda Saltzman Memorial Intimate Partner Violence Researcher Award from the Institute on Violence, Abuse, and Trauma, and the Academy of Women in Academic Emergency Medicine’s Researcher Award. She is past president of the Society for Academic Emergency Medicine, the Society for Advancement of Violence and Injury Research, and Emory University Senate. Dr. Houry has served on numerous other boards and committees within the field of injury and violence prevention. Dr. Houry has authored more than 90 peer-reviewed publications and book chapters on injury prevention and violence. Dr. Houry received her MD and MPH degrees from Tulane University and completed her residency training in emergency medicine at Denver Health Medical Center. On this episode we will hear from Dr. Houry about: Her background and how she developed an interest in science, medicine and emergency medicine, and her journey towards her leadership role at U.S. CDC. A general discussion surrounding the "pandemic scale" of injury, both intentional and unintentional, both fatal and non-fatal, and the structures set up at CDC to address these amazing prevalence figures. The CDC's role in combating the opioid epidemic. The CDC's role in combating Unintentional Falls (representing 8+ million of the above-mentioned Nonfatal Emergency Department Visits) and some discussion related to the technological themes of "aging in place" and "smart home care" for the elderly that can help reduce these cases. She will also discuss the CDC's role in combating Sexual Violence and Child Abuse and combating U.S. Gun Violence. This interview is in American English. Credits: Ira Pastor interview video, text, and audio. Follow Ira Pastor on Twitter: @IraSamuelPastor If you liked this interview, check out our interview about suicide prevention with Dr. Christine Moutier! Follow ideaXme on Twitter: @ideaxm On Instagram: @ideaxme Find ideaXme across the internet including on iTunes, YouTube, SoundCloud, Radio Public, TuneIn Radio, I Heart Radio, Google Podcasts, Spotify and more. ideaXme is a global podcast, creator series and mentor programme. Our mission: Move the human story forward!™ ideaXme Ltd.
Host: Dr. Isaac Agboola, MD, MS Guest: Dr. Sheryl Heron, MD, MDP, FACEP Assistant Dean of Medical Education and Student Affairs at Emory University School of Medicine Vice Chair of Administrative Affairs Professor of Emergency Medicine Overview: On today’s episode, Drs. Agboola and Heron discuss the intricacies of cognitive bias and cultural competency and the roles it plays in the emergency department. They discuss ways that individuals and residency programs alike can approach ensuring that they are rendering more culturally competent care. Additionally, they spend time addressing communities that are at risk for such biases such as undomiciled populations, individuals from lower socioeconomic status, and racial minorities. Key Resources: EMRA Diversity and Inclusion Committee Key Points: Cognitive bias, microaggressions and cultural humility should compel us to think more deeply on how we can deconstruct the “-isms”. It is important to create and nurture an environment that allows for open dialogue in a safe space. As a health care provider there are critical steps that need to be taken: Appreciate and understand that we are all different - diversity is a good thing! Be prepared to “call the card” if you experience a discriminatory comment/action. It is important to address it. Do not ignore it. Eliminating bias is not an individual effort; it is institutionally and systemically driven. Patient populations with common negative biases include those with cardiovascular disease, high utilizers/low socioeconomic status, and the incarcerated. There is a large amount of research that demonstrates disparities and inequities in care but more work is still left to be done. References: Martin ML, Heron SL, Moreno-Walton L, Strickland M. Diversity and Inclusion in Quality Patient Care: Your Story/Our Story: a Case-Based Compendium. Cham: Springer; 2019 Dehon E, Weiss N, Jones J, Faulconer W, Hinton E, Sterling S. A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making. Academic Emergency Medicine. 2017;24(8):895-904. doi:10.1111/acem.13214. ACEP Implicit Bias and Cultural Sensitivity Paper
SAEM RAMS Who's Who in Academic Emergency Medicine - Scott Weingart, MD by SAEM
"If I do an ultrasound before an LP on an infant, would that increase my success rate?"On the show today, we sit down with Dr. Jeffrey Neal from Boston Children's Hospital to talk about The Effect of Bedside Ultrasonographic Skin Marking on Infant Lumbar Puncture Success: A Randomized Controlled Trial. Contact at Tama.The@gmail.comWorks cited:Neal JT, Kaplan SL, Woodford AL, Desai K, Zorc JJ, Chen AE. The Effect of Bedside Ultrasonographic Skin Marking on Infant Lumbar Puncture Success: A Randomized Controlled Trial. Annals of emergency medicine. 2017Kessler D, Pahalyants V, Kriger J, Behr G, Dayan P. Preprocedural Ultrasound for Infant Lumbar Puncture: A Randomized Clinical Trial. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2018; 25(9):1027-1034. Gorn M, Kunkov S, Crain EF. Prospective Investigation of a Novel Ultrasound-assisted Lumbar Puncture Technique on Infants in the Pediatric Emergency Department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2017; 24(1):6-12.
SAEM RAMS Who's Who in Academic Emergency Medicine - Dara A. Kass, MD by SAEM
SAEM RAMS Who's Who in Academic Emergency Medicine - Seth Trueger, MD, MPH by SAEM
SAEM RAMS Who's Who in Academic Emergency Medicine - Richard M. Cantor, MD by SAEM
Listen NowThis past June 4th the 9th Circuit Court heard oral arguments concerning Juliana v. the US, a case filed in 2015 by 21 children seeking a jury verdict on whether the US government, by failing to address the climate crisis, is protecting the plaintiff's rights to life, liberty and the pursuit of happiness. In its defense the US is arguing these children, now young adults, have “no fundamental constitutional right” to a “climate system capable of sustaining human life.” In a May 30th essay published in The New England Journal of Medicine Dr. Salas and two colleagues agreed with the plaintiffs concluding , “As the Juliana plaintiffs argue - and we agree - climate change is the greatest public health emergency in our time and is particularly harmful to fetuses, infants, children and adolescent.” (Listeners may be aware this is my 7th climate crisis related interview since October.)During this 26 minute interview Dr. Salas discusses her related research work, the amicus brief she and her colleagues forwarded in support of Juliana plaintiffs and other related litigation filed world wide. Moreover, Dr. Salas explains the numerous adverse health effects children are suffering via the climate crisis including various birth defects, heart, lung and neurodevelopment illnesses, vector-borne diseases, harms from high heat and wildfire exposure, cognitive, behavioral and mental health effects, contaminated water, and numerous others. She discusses what parents need to know or can do to protect their children and the extent the health care industry needs to (better) address its own contribution to greenhouse gas emissions/pollution or global warming. Dr. Renee Salas is Affiliated Faculty and a Burke Fellow at the Harvard Global Health Institute. Her research addresses how climate change is impacting the healthcare system and developing evidence-based adaptation.She is also a practicing physician in the Department of Emergency Medicine at Massachusetts General Hospital and on faculty at Harvard Medical School. Dr. Salas served as the lead author on the 2018 Lancet Countdown on Health and Climate Change U.S. Brief and will again in 2019. She lectures on climate and health nationally and internationally, has published in numerous scholarly journals and is the founder and past Chair of the Climate Change and Health Interest Group at the Society of Academic Emergency Medicine. Dr. Salas received her Doctor of Medicine from the Cleveland Clinic Lerner College of Medicine with a Master of Science in Clinical Research from the Case Western Reserve University School of Medicine. She also holds a Master of Public Health from the Harvard T.H. Chan School of Public Health with a concentration in environmental health.Renee Salas, Wendy Jacobs and Frederica Perera's New England Journal of Medicine essay, "The Case of Juliana v US - Children and the Health Burdens of Climate Change," is at: https://www.nejm.org/doi/full/10.1056/NEJMp1905504 The video of the 9th Circuit Juliana v the US oral argument is at: https://www.ca9.uscourts.gov/media/view_video.php?pk_vid=0000015741&fbclid=IwAR3K3vnHCO4M2KlcMZ1NSQ4ua1ZZhpdyA-hONwyj6N7uS0u1X5ojmuVVkCcThe amicus brief filed in support of the Juliana plaintiffs by 13 medical societies and over 65 medical professionals is at: http://clinics.law.harvard.edu/environment/files/2019/03/Juliana-Public-Health-Experts-Brief-with-Paper-Copy-Certificate.pdf. Again, my related essay, "Can the Climate Crisis Continue to Go Begging?" is at: https://www.3quarksdaily.com/3quarksdaily/2019/06/can-the-climate-crisis-continue-to-go-begging.html. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
SAEM RAMS Who's Who in Academic Emergency Medicine - Dr. Reuben Strayer by SAEM
Capturing Emergency Department Discharge Quality With the Care Transitions Measure: A Pilot Study Dr. Chana Rich interviews Dr. Amber Sabbatini about this pilot study in the June issue of Academic Emergency Medicine.
Dr. Dara Kass, winner of Advancement of Women in Academic Emergency Medicine award is interviewed by Dr. Jim Miner, followed by a plenary breakdown of the Canadian TIA score by Dr. Jeffrey Perry.
SAEM RAMS Who's Who in Academic Emergency Medicine - Megan L. Ranney, MD, MPH by SAEM
SAEM RAMS Who's Who in Academic Emergency Medicine - Amal Mattu by SAEM
Unsere dritte Folge mit Themen zu Immobilisation im Rettungsdienst, Katecholamine, Dialyse auf der ITS, der Antiinfektiven Therapie des Monats, Journal Club und vielem mehr. Details in den Shownotes. News und Ergänzungen https://nerdfallmedizin.blog/tag/gerinnung/ Yadav, Krishan, et al. „Predictors of Oral Antibiotic Treatment Failure for Nonpurulent Skin and Soft Tissue Infections in the Emergency Department.“ Academic Emergency Medicine (2019). Iversen, Kasper, et […] Der Beitrag Podcast März – Folge 3 erschien zuerst auf pin-up-docs - don't panic.
A wide-ranging discussion with Dr. Jeff Kline, Vice Chair of Research in emergency medicine and a professor of physiology at Indiana University School of Medicine. He is the present Editor In Chief of Academic Emergency Medicine and Academic Emergency Medicine Education and Training. Among other things, he and Dr. Meltzer discuss the impact of the patient satisfaction survey era, time spent with patients, amount of CT scans, expansion of the ER, and the role of the ER doctor in the continuity of care. This podcast was produced and edited by Andrew Petrus.
In this episode, Dr. Tiffany Proffitt talks with Dr. Esther Choo about tangible ways to view and address gender disparities in emergency medicine. Description: Recorded at ACEP 2018 on the Expo floor. A discussion with Dr. Esther Choo on overcoming gender disparities in medicine as well as advice to residents and core faculty for implementation of techniques to encourage change and advancement. Introduction to Dr. Choo’s new start up Equity Quotient. Content of Show Notes: Dr. Choo’s Top 3 for Overcoming Gender Disparities in Medicine: Find your support network - there are local and national groups! You are NOT alone! Continue to work to improve the problem as you move up. Just a Few Support Networks: Your own hospital’s women’s group – if it doesn’t exist, reach out to your faculty and start one! EMRA Academy for Women in Academic Emergency Medicine American Association of Women Emergency Physicians FemInEM: Dr. Choo Citations for Any Relevant Articles Anna S. Mueller, Tania M. Jenkins, Melissa Osborne, Arjun Dayal, Daniel M. O'Connor, and Vineet M. Arora. Gender Differences in Attending Physicians' Feedback to Residents: A Qualitative Analysis. Journal of Graduate Medical Education: October 2017; 9(5): 577-585. Dayal A, O’Connor DM, Qadri U, Arora VM. Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training. JAMA Intern Med. 2017;177(5):651–657. Host Tiffany Proffitt, DO Lakeland Health PGY3 @ProMammaDocEMRA CAST EpisodesEMResident Articles Guest Dr. Esther Choo, MD Associate Professor of Emergency Medicine at the Oregon Health & Science University (OHSU) Former president of AWAEM FemInEM Advisory Board member Co-founder of Equity Quotient @choo_ek
Author: Sam Killian, MD. Educational Pearls: Computer interpretation has a very good negative predictive value of a normal EKG (99%). Of 222 interpreted as “normal,” 13 were deemed to have some abnormality by a cardiologist in a recent study. Those 13 EKG’s were read by 2 ER docs, and only 1 missed interpretation warranted a move from triage to a bed. References Katie E. Hughes KE., Scott M. Lewis SM., Laurence Katz and Jonathan Jones Safety of Computer Interpretation of Normal Triage Electrocardiograms. 2017. Academic Emergency Medicine 24(1):120-124. http://onlinelibrary.wiley.com/doi/10.1111/acem.13067/full.
Narcan and Synthetic Opioids: vive la résistance? Probably not. Read this absolutely brilliant piece from The Tox & The Hound here. (They did all the hard work and we stole their sources.) Opioid "resistance" to naloxone is most likely not a thing, per se. The reported effect from synthetic and novel opioids are unlikely to be due to the agent's binding affinity for receptors within the brain, but rather from an ability to rapidly permeate the blood brain barrier much faster than "traditional" opioids such as heroin. Even in cases where a synthetic opioid agent was identified, the vast majority of cases did not need more than 4mg of naloxone to achieve reversal. Synthetic opioids don't bind any more "tightly" to receptors than naloxone. Synthetic opioids will usually cross the blood brain barrier faster than traditionally encountered agents. Most available evidence shows that synthetic opioid toxicity does not require significantly more naloxone to achieve clinically significant effect. Ergo, the traditional serial naloxone dosing algorithm does not need much modification. 0.04mg -> 0.4mg -> 2mg -> 4mg -> 8mg -> 10mg Not all that "overdoses" is an opioid. Consider all other causes of altered mental status or coma. Namely: hypothermia, hypoxia, and hypercarbia. Acidosis may potentiate the effect of opioids, highlighting the demand for timely and effective ventilation. Polypharmacy or adulteration is increasingly common. Consider intoxication by additional agents. Anchoring bias is a dangerous phenomenon: don't get burned! The Nose Knows. Or does it? Intranasal (IN) naloxone is popular among many EMS agencies as well as law enforcement, fire departments, and bystanders. IN naloxone has been shown to be effective in several randomized controlled trials for successful reversal of opioid intoxication. However... There are important pitfalls to be cognizant of when choosing this option for delivering naloxone. Intranasal naloxone has poor bioavailability when compared to IV or IM dosing, so higher doses may be required to achieve clinical effect. This is further potentiated by the maximum volume able to be absorbed by the nasal mucosa (around 0.5mL). Patients administered intranasal naloxone may have a variable or delayed response in achieving reversal. Protect Ya Neck Standard isolation precautions are adequate protection against the overwhelming majority of overdose scenes. In the rare instance where respiratory or splash exposure is a concern, a properly fitted N95 mask and goggles will be sufficient. To date, there has yet to be a laboratory confirmed case where a first responder or emergency healthcare provider has suffered a clinically significant opioid intoxication (bradypnea, hypoxia ) as the result of an occupational exposure to fentanyl or its analogues. TotalEM Podcast: https://www.totalem.org/emergency-professionals/podcast-73-ppe-in-opiate-overdoses References 1) Wax, P. M., Becker, C. E., & Curry, S. C. (2003). Unexpected “gas” casualties in Moscow: A medical toxicology perspective. Annals of Emergency Medicine, 41(5), 700–705. https://doi.org/10.1067/mem.2003.148 2) Stolbach, A. (2018). Is This Anything? Naloxone-resistant opioids. Retrieved from https://emcrit.org/toxhound/is-this-anything/ 3) Sutter, M. E., Gerona, R. R., Davis, M. T., Roche, B. M., Colby, D. K., Chenoweth, J. A., … Albertson, T. E. (2017). Fatal Fentanyl: One Pill Can Kill. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 24(1), 106–113. https://doi.org/10.1111/acem.13034 4) Klar, S. A., Brodkin, E., Gibson, E., Padhi, S., Predy, C., Green, C., & Lee, V. (2016). Furanyl-Fentanyl Overdose Events Caused by Smoking Contaminated Crack Cocaine — British Columbia, Canada, July 15–18, 2016. MMWR. Morbidity and Mortality Weekly Report, 65(37), 1015–1016. https://doi.org/10.15585/mmwr.mm6537a6 5) Uddayasankar, U., Lee, C., Oleschuk, C., Eschun, G., & Ariano, R. E. (2018). The Pharmacokinetics and Pharmacodynamics of Carfentanil After Recreational Exposure: A Case Report. Pharmacotherapy. https://doi.org/10.1002/phar.2117 6) George, A. V., Lu, J. J., Pisano, M. V., Metz, J., & Erickson, T. B. (2010). Carfentanil--an ultra potent opioid. The American Journal of Emergency Medicine, 28(4), 530–2. https://doi.org/10.1016/j.ajem.2010.03.003 7) Melichar, J. K., Nutt, D. J., & Malizia, A. L. (2003). Naloxone displacement at opioid receptor sites measured in vivo in the human brain. Eur J Pharmacol, 459(2–3), 217–219. https://doi.org/10.1016/S0014-2999(02)02872-8 8) Cole, J. B., & Nelson, L. S. (2017). Controversies and carfentanil: We have much to learn about the present state of opioid poisoning. American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2017.08.045 9) Connors, N. J., & Nelson, L. S. (2016). The Evolution of Recommended Naloxone Dosing for Opioid Overdose by Medical Specialty. Journal of Medical Toxicology, 12(3), 276–281. https://doi.org/10.1007/s13181-016-0559-3 10) ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders. (2016). https://doi.org/10.1007/s13181-017-0628-2 11) Casale, J. F., Mallette, J. R., & Guest, E. M. (2017). Analysis of illicit carfentanil: Emergence of the death dragon. Forensic Chemistry, 3, 74–80. https://doi.org/10.1016/j.forc.2017.02.003 12) Zuckerman, M., Weisberg, S. N., & Boyer, E. W. (2014). Pitfalls of intranasal naloxone. In Prehospital Emergency Care (Vol. 18, pp. 550–554). https://doi.org/10.3109/10903127.2014.896961 13) Chou, R., Korthuis, P. T., McCarty, D., Coffin, P. O., Griffin, J. C., Davis-O’Reilly, C., … Daya, M. (2017). Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings. Annals of Internal Medicine, 167(12), 867. https://doi.org/10.7326/M17-2224 14) Rzasa Lynn, R., & Galinkin, J. (2018). Naloxone dosage for opioid reversal: current evidence and clinical implications. Therapeutic Advances in Drug Safety, 9(1), 63–88. https://doi.org/10.1177/2042098617744161 15) Kim, S., Wagner, H. N., Villemagne, V. L., Kao, P. F., Dannals, R. F., Ravert, H. T., … Civelek, a C. (1997). Longer occupancy of opioid receptors by nalmefene compared to naloxone as measured in vivo by a dual-detector system. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, 38(11), 1726–31. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9374341
Session 67 Dr. Elaine Reno is an academic Emergency Medicine physician in Denver. She talks about why she choose academics, her work-life balance and more. First off, check out all our other podcasts on MedEd Media. If you're a premed student, be sure to take a listen to The Premed Years podcast, covering test prep, applications, essay writing and personal statement writing, interview prep and so much more. And if you have a suggestion for a guest here on the podcast, kindly shoot me an email at ryan@medicalschoolhq.net. Back to today's guest, Elaine has a subspecialty in Wilderness Medicine, which is really not that big of a practice. Rather, today we focus on academic emergency medicine and why Elaine chose this. Back in Session 2, we covered emergency medicine from a community perspective. In that podcast, we had Dr. Freess talking about community-based emergency medicine. This week, Elaine talks about being an academic emergency medicine, why she chose it, and much more. [02:10] An Interest in Emergency Medicine As a medical student, she did all the rotations but two things drew her which were Emergency Medicine and OB/GYN. She thinks they're both pretty similar being 90% routine and 10% acute crisis. Until she realized she likes the variety of Emergency Medicine. She also didn't like the operating room very much. If you think Emergency Medicine is all about gunshot wounds and adrenalin rush, Elaine says that most chest pains are not heart attacks or that in most car accidents, the people are fine. Or that most weakness or tingling sensation is not a stroke. "A lot of my day is much more routine than what most people think." [04:05] Traits that Make a Good Emergency Medicine Doctor Elaine explains that you're always going to need help, you're always going to need to talk to your specialty consultants. So you have to be a good communicator, and you have to be able to work with your specialty consultants. That being said, Elaine says how Emergency Medicine is like a team game where you have to be able to work in a team, with physicians, nurses, etc. "Emergency medicine is like an extreme team sport I think honestly more than any other medical specialty. You have to be able to work in a team." [06:00] Types of Patients and Typical Week They see anything and everything on a day to day basis. The common things they see are flu, respiratory illness, chest pain, abdominal pain, headaches - the bread and butter of emergency medicine. People come in with symptoms rather than diseases and it's your job to figure out what's going on and what you need to do to manage it. A typical week for them basically varies and she likes the variety of it even if other people hate that. Every week, her schedule is different and she likes it a lot. As an ER doctor, she mans the doors of the emergency room so she deals with everything that rolls in whatever it is during her shift. They do an extreme variety of cases everyday from chest pains coming from heart attacks and strokes from trauma patients, to cancer patients with infections or miscarriages or broken bones. [08:05] Academic vs. Community-Based or Private Practice What she likes about the Academics is primarily the teaching aspect of it. She likes working with the residents and teaching class for undergrad students. She likes teaching the course. She also describes the residents as very smart and if you can't keep up with them, you'd be on your toes. Nevertheless, she likes the learning and education that come with academics. "I just like the academic flavor, there's constant ongoing learning every single day. I feel like it challenges me everyday to learn more and to be a better doctor." [09:20] Is Emergency Medicine a Good Fit for You? Elaine explains that they do a lot of procedures. They're not surgeons but more of like intensivists in the level of procedures they do. Although gastroenterologists and cardiologists do more procedures than them. Family medicine doctors do less. But they do central lines and arterial lines. Occasionally, they also do intubation. That said, if you hated procedures, Elaine doesn't think emergency medicine is the specialty for you. "If you really like the flavor of emergency medicine but didn't like the big procedures, you could do something like urgent care." [10:20] Taking Calls and Work-Life Balance Although they sometimes cover for doctors who call in sick, they don't really have to take calls outside of shift. No one calls them about patient care duty. And she likes the aspect of this a lot. When it comes to shifts, she explains it's different for every doctor in every clinical practice. They work a certain number of shifts whether they work full time and whether they need to do other things like research or education so you would have to do less clinical shifts. This is a huge part of emergency medicine but specifically for academic emergency medicine and if you're interested in doing research, you can just work less clinical shifts. Having no patient population like a primary care doctor, you're able to do this. Elaine just had a baby and when she was pregnant, she was forced to stop a little bit after having a difficult pregnancy. So she feels she has enough time with him on a day to day basis. She'd also do a whole day where she doesn't see him and then he'd have the next day off so she can spend time with him. "I do feel like it's actually very conducive towards a family life. You have to be creative about how you make it work." Nevertheless, Elaine thinks Emergency Medicine is very conducive towards a family life as long as you're creative. And if you feel like if you're working too much and that you're not having enough time with family, then you can always just step down and not work full time. In terms of making quality time, it's about making that quality time. She will always work nights, weekends, or holidays. Someone has to be on the ER on Christmas and Thanksgiving or New Years. This will be a part of her job for the rest of her life. And she's okay with it. But by the time she's with her family, they turn off their phones and prioritize being together. [14:14] The Residency Path to Become an Academic EM Doctor Elaine explains that EM is a three-year or four-year residency depending on where you go. Most of them are becoming four-year residencies. And most of those going into academics go through a four-year residency. During your first year, you rotate through different specialties. You learn a little bit of everything and then spend more and more time in the emergency room as you progress through residency training. She also describes the training as getting more and more competitive due mainly to it being conducive for having a good quality of life and having other interests. So she thinks it's getting more and more competitive every year. Having been involved in the admissions side of things for the emergency medicine residency, Elaine's advice for students to be competitive to match into EM is about having that whole package. You want to be getting good grades and excel in your clerkships. Do well not just in the one subspecialty you want to go into but in all of your clerkships. They also look at your extracurriculars, research, letters of recommendation, etc. [16:18] Bias Towards DOs and Special Opportunities Elaine thinks that the DO and MD match is becoming one soon. She works with DOs and she thinks the bias is slowly fading away. She adds that if the match merges, she thinks this is the right way moving forward. There will still be some inherent bias, she thinks, but she really doesn't think this is a big thing in where she's at or in her residency programs. After residency training, there's also fellowships in Emergency Medicine like Toxicology, Global Health, Admin, Education, Ultrasound. Elaine did Wilderness Medicine with little Global Health. For those EM doctors who do fellowships, a lot of them end up in academics. So if you do an education fellowship, you end up doing education work. For Toxicology, they end up being a consult service. With her diploma in Tropical Medicine and Hygiene, she works part-time at a travel clinic and does pre-travel advising coordination. She basically works with a pediatric infectious disease doctor where they work together to provide care for the whole family. [20:00] Working with Primary Care and Other Specialties Elaine thinks that if you want to send a patient to the emergency room, communication is key. They won't always know why primary care doctors would send their patients but she thinks the most important thing here is coordination, which must work both ways. Coordination is very important since they won't get to manage the patient long term and this provides the best care for the patient. "A lot of times in emergency medicine, it's like a stop point in time. I'm treating that acute exacerbation of your COPD... but I'm not going to be managing this long term." Other specialties they work the closest with include trauma, cardiology, intensive care units, etc. Special opportunities outside clinical medicine for EM doctors available would be education, research, ED doctors, full time researchers, administrative work, EMS directors. [23:18] What She Wished She Knew that She Knows Now Elaine wished she knew how much it would have affected her sleep having brutal rotating schedules which could be brutal on your circadian rhythm. She would have still chosen the same specialty. But she could have started taking melatonin earlier. What she likes the most about being an EM doctor is the variety. And the least thing she likes is the circadian rhythm disruption. [24:45] Major Changes in the Future of Emergency Medicine Elaine personally thinks there's a greater goal of keeping patients out of the hospital. So they train with their social worker, physical therapists, mental health counsellors, case managers. They talk about what they can do to keep patients at home. "The push to keep patients out of the hospital and away fro hospital-born illnesses and away from the complications that come with hospitalization is definitely there." Right now, there is that protest against discharging diagnosis to deny payments. So if you're discharged diagnosis from the ER, they feel it's not an acute, life-threatening emergency and they'll deny payment. And this is something she's really advocating against. She thinks this is very unfair to patients. In an ideal situation, everyone has a great primary care doctor that they can trust and they can call and get access to the continuity of care. Ultimately, if she had to do it all over again, she would still have chosen Emergency Medicine. Finally, her last words of wisdom for premed students and medical students out there is that medicine is a great profession but it has to be what you want to do. Make sure it's what you want, and not familial pressure or peer pressure. At the end of the day, you're the one doing this so make sure you're pursuing something you want to do. And if you don't know or are not ready yet, don't apply and just take the year off. Travel, work. "Medicine is a marathon and it's like the longest marathon. It is not a sprint. It doesn't matter if you start med school when you're 22 or 25... make sure it's the right choice." Links: MedEd Media The Premed Years PMY 02: What Is Emergency Medicine?
We speak to lead author Dr. Christian Toarta and final/senior author Dr. Venkatesh Thiurganasambandamoorthy about their upcoming Academic Emergency Medicine article entitled "Syncope Prognosis Based on Emergency Department Diagnosis: A Prospective Cohort Study." They are interviewed by Dr Tess Wiskel, a PGY-4 in Emergency Medicine at Brown.
Recorded at Essentials of Emergency Medicine 2017, Greg Moran, MD reviews current thinking on cellulitis diagnosis and management. Greg is a professor of emergency medicine at Olive View-UCLA medical center who, in addition to emergency medicine, is fellowship trained in infectious disease and has over 100 publications in journals including: New England Journal of Medicine, British Medical journal, JAMA, Lancet, and Annals of Emergency Medicine. Greg is a thought leader in the field of emergency infectious disease and a super nice guy. In this segment, Greg covers: a common cellulitis mimic; admit vs discharge of patients with cellulitis; what bugs cause cellulitis and, taking that into account, what antibiotic should I use- double coverage, single coverage? The great cellulitis mimic: Stasis Dermatitis Similar in appearance to cellulitis Often bilateral (where cellulitis is usually unilateral) Risk factors include venous stasis, lymphedema Fluid goes into the interstitial space -> into the dermis -> and then causes superficial redness and irritation Treatment Many recommendations out there, many of them consensus, opinion or based on weak data Elevation Compression if the patient can tolerate it Wet dressings if there is crusting and exudative eczema Topical steroids (medium to high potency) such as triamcinolone, fluocinonide, fluticasone ointments If you think there could be infection at play, consider a short course of oral antibiotics (also consider topical if there’s a break in the skin or part of the leg is looking particularly red and angry) Admit or go home? Inpatient mortality for cellulite is low (somewhere in the low single digits percent) No validated decision instruments regarding admission or discharge 2014 study Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients With Uncomplicated Cellulitis found that fever, chronic leg ulcers, edema, lymphedema, cellulitis at a wound site or recurrent in the same area were risk factors for outpatient treatment failure Does this mean that patients with these risk factors need mandatory admission? It doesn’t, but it gives an inkling of who might do poorly or at least fail outpatient antibiotics Bottom line: no clear consensus on who can be discharged but low inpatient mortality suggests we may be over-admitting A nice review of the admit or discharge cellulitis question can be found here Single or double antibiotic coverage Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis. JAMA May 2017 PMID:28535235 500 patients with cellulitis Treated cephalexin alone or cephalexin plus TMP/Sulfa No significant difference in outcome Comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clinical infectious diseases 2013 PMID:23457080 150 patients with cellulitis Treated cephalexin alone or cephalexin plus TMP/Sulfa No significant difference in outcome Bottom line: In uncomplicated cellulitis without abscess or significant co-morbidities, current evidence suggests no advantage of adding TMP/Sulfa to cephalexin Check out Essentials of Emergency Medicine. Well, I guess if you're against fun education and hate puppies, then disregard that recommendation. References Weng, Qing Yu, et al. "Costs and consequences associated with misdiagnosed lower extremity cellulitis." Jama dermatology 153.2 (2017): 141-146. PMID:27806170 Weiss, Stefan C., et al. "A randomized controlled clinical trial assessing the effect of betamethasone valerate 0.12% foam on the short-term treatment of stasis dermatitis." Journal of drugs in dermatology: JDD 4.3 (2005): 339-345. PMID:15898290 Talan, David A., et al. "Factors associated with decision to hospitalize emergency department patients with skin and soft tissue infection." Western Journal of Emergency Medicine 16.1 (2015): 89. PMID:25671016 Peterson, Daniel, et al. "Predictors of failure of empiric outpatient antibiotic therapy in emergency department patients with uncomplicated cellulitis." Academic Emergency Medicine21.5 (2014): 526-531. PMID:24842503 Khachatryan, Alexandra, et al. "Skin and Skin Structure Infections in the Emergency Department: Who Gets Admitted?." Academic Emergency Medicine 21 (2014): S50. Abstract from 2014 SAEM Carratala, J., et al. "Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis." European Journal of Clinical Microbiology and Infectious Diseases 22.3 (2003): 151-157. PMID:12649712 Pallin, Daniel J., et al. "Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial." Clinical infectious diseases 56.12 (2013): 1754-1762. PMID:23457080 Moran, Gregory J., et al. "Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis: A Randomized Clinical Trial." Jama 317.20 (2017): 2088-2096. PMID:28535235 Original Kings of County Analysis of Admit or Discharge Cellulitis
With growing attention being paid to health care costs, Dr Todd Lyons and his colleagues recently studied risk factors, patterns, and costs associated with patients whose care is fragmented across multiple emergency departments. Dr Anu Ganapathy interviews Dr Lyons about his group's findings and their recent article in Academic Emergency Medicine.
Show description/summary:1) Neurology® Clinical Practice: Barriers and Facilitators to ER Physician Use of the Test and Treatment for BPPV2) What’s Trending: New crowd-funding research initiative from ABFIn the first segment, Dr. Jim Siegler talks with Dr. Kevin Kerber and Dr. William Meurer about their Neurology® Clinical Practice article on ER physician use of the test and treatment for benign paroxysmal positional vertigo. In the second part of the podcast, Dr. Andy Southerland focuses his interview with Dr. Robert Griggs and Jane Ransom on the new crowd-funding research initiative from the American Brain Foundation. Disclosures can be found at Neurology.org.DISCLOSURES: Dr. Siegler serves on the Resident and Fellow Section Team for Neurology, and has received research support from NIH (U10 StrokeNet grant, 2017-2018).Jane Ransom is Executive Director of the American Brain Foundation.Dr. Kerber received funding for travel from Elsevier Inc. and the American Academy of Neurology; receives royalties from the publication of the book Clinical Neurophysiology of the Vestibular System, 4th edition; is a consultant for the American Academy of Neurology, University of California San Francisco (including work on a project funded by AstraZeneca), and Best Doctors, Inc.; receives research support from the NIH; received speaker honoraria from American Academy of Neurology and University of California San Francisco and loan repayment award from the NIH; reviewed legal records of Phil Pearsons, MD, JD and National Medical Consultants.Dr. Meurer serves as Decision Editor for the Annals of Emergency Medicine; serves as Methodology Statistics Reviewer for Academic Emergency Medicine; and has received research support from the Massey Foundation for TBI research. Dr. Griggs has served on scientific advisory boards for National Hospital Queen Square, Marathon Pharmaceuticals, Taro Pharmaceuticals, and Sarepta Pharmaceuticals; has served on the data monitoring and safety board for PTC Therapeutics, Inc.; serves on the editorial board for NeuroTherapeutics and Current Treatment Opinions in Neurology; serves as Correspondence Editor for Neurology; receives publishing royalties from Andreoli and Carpenter’s Cecil Essentials of Medicine (Eighth Edition, Elsevier), Cecil Textbook of Medicine (multiple editions, Elsevier), and Evaluation and Treatment of Myopathies (2014, Oxford); has consulted for Marathon, PTC Therapeutics, Sarepta, Taro Pharmaceuticals, Idera Pharmaceuticals, and Strongbridge Pharmaceuticals; receives data royalties and research support from Taro Pharmaceuticals and Marathon Pharmaceuticals; has received research support from NINDS (T32 NS07338, 5U01NS061799, 1R13NS084687), the FDA (R01 FD003923), Parent Project Muscular Dystrophy, Inc., and the Muscular Dystrophy Association; and is the recent past Chair of Executive Committee of the Muscle Study Group.
This is the first of a new series of Roadside to Resus podcasts. We've been joined by James Yates, a Critical Care Paramedic with the Great Western Air Ambulance to make it a truly multidisciplinary team. Each monthly episode we'll be discussing acute presentations, including the latest and most influential evidence base surrounding them. We really want to break down some barriers between pre-hospital and in hospital teams and it soon becomes evident in this first podcast that many of the problems we face are shared throughout the patient journey and across disciplines! We're starting off with Acute Heart Failure and in the podcast we run through; The underlying physiology and help explain the different problems we may find in each subset The keys to diagnosis, including the most predictive parts of history and examination We discuss the evidence base for treatment and the trends of use both pre and in-hospital We talk about CPAP and whether the evidence supports it's use Finally, the direction that further treatment in the UK may move Once again we hope you find the podcast useful. Get in touch with any comments, questions or suggestions for further topics. Most of all don't take our word for it, but make sure you delve into the references yourself and make up your own mind. Enjoy! Simon, Rob & James References & Further Reading Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine Understanding cardiac output. Jean-Louis Vincent. Crit Care. 2008. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure The pathophysiology of hypertensive acute heart failure. Viau DM. Heart. 2015 Meta-analysis: Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema. Weng. Annals Int Med. 2010 Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure? Charlie S.JAMA 2005 Diagnosing Acute Heart Failure in the Emergency Department; A Systematic Review and Meta-analysis. Martindale. Academic Emergency Medicine. 2016 Noninvasive ventilation in acute cardiogenic pulmonary edema. Gray A. N Engl J Med. 2008 Life in the Fast Lane; severe heart failure management Emergency Medicine Cases; acute congestive heart failure REBEL.EM; morphine kills in acute decompensated heart failure EMCRIT 1; Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
This podcast is a joint effort between the editors of Academic Emergency Medicine and the Brown University Emergency Medicine Residency Program. Each month, a selected article will be discussed and released online in advance of publication. The article will be available in an open access digital format for a limited period of time. Visit www.brownemblog.com for a link to this article (open access through 6/9/17), as well as an article summary and links to additional related educational content. May 2017: Discussing "Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes" Naveen Poonai MD, Frank Myslik MD, Gary Joubert MD, Josiah Fan MD et al. Guest/Author: Dr. Naveen Poonai MSc MD FRCPC, Schulich School of Medicine and Dentistry, London, Ontario Host: Dr. Gita Pensa, MD, Brown University Emergency Medicine Residency Program Keywords: POCUS, Ultrasound, Pediatrics, Orthopedics, Emergency Medicine
A recent study in Academic Emergency Medicine by Hughes and colleagues, looks at the potential clinical relevance of having emergency physicians sign ECGs read "normal" by the computer software. FOAM reviews of this article can be found here: Dr. Smith's ECG blog Emergency Medicine Literature of Note REBEL EM Then we review ischemia on ECGs, including STEMIs as well as a dive into ischemic T waves Check out FOAMcast.org for more show notes and images. Thanks for listening! Lauren Westafer and Jeremy Faust
Dr. Pouya Khankhanian describes his experience with "worst headache of life." A harbinger of head pathology, thunderclap headache should be quickly and meticulously addressed in order to prevent life-threatening neurologic disease. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Roderick Spears. REFERENCES 1. Schwedt TJ, Matharu MS and Dodick DW. Thunderclap headache. The Lancet Neurology. 2006;5:621-31. 2. Linn FH, Wijdicks EF, van der Graaf Y, Weerdesteyn-van Vliet FA, Bartelds AI and van Gijn J. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet. 1994;344:590-3. 3. Sames TA, Storrow AB, Finkelstein JA and Magoon MR. Sensitivity of new-generation computed tomography in subarachnoid hemorrhage. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 1996;3:16-20. 4. van der Wee N, Rinkel GJ, Hasan D and van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? Journal of neurology, neurosurgery, and psychiatry. 1995;58:357-9. 5. Vergouwen MD and Rinkel GJ. Clinical suspicion of subarachnoid hemorrhage and negative head computed tomographic scan performed within 6 hours of headache onset--no need for lumbar puncture. Ann Emerg Med. 2013;61:503-4. 6. Edlow JA and Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. The New England journal of medicine. 2000;342:29-36. 7. Vermeulen M, Hasan D, Blijenberg BG, Hijdra A and van Gijn J. Xanthochromia after subarachnoid haemorrhage needs no revisitation. Journal of neurology, neurosurgery, and psychiatry. 1989;52:826-8. 8. Muehlschlegel S, Kursun O, Topcuoglu MA, Fok J and Singhal AB. Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol. 2013;70:1254-60. 9. Misra UK, Kalita J, Chandra S, Kumar B and Bansal V. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2012;19:1030-6.
A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. On arrival, he was in compensated shock, with tachycardia. He decompensates and needs blood. How do we manage his hemodynamics and when do we perform massive transfusion? Pediatric Massive Transfusion 40 mL/kg of blood products given at any time within the first 24 hours. Adolescents and Adult Massive Transfusion 6-8 units of packed red blood cells (PRBCs) Adults have about 5 L of circulating blood. Not including plasma, one could replace all circulating erythrocytes with about 10 units of PRBCS The best ratio of PRBCs:Plasma:Platelets is unknown, but consensus is 1:1:1. 1 unit of PRBCS is typically 300 mL of volume. The typical initial transfusion of PRBCs in children is 10 mL/kg. Massive transfusion in children is defined as 40 mL/kg of any blood product. Once you start to give a child with major trauma the second 10 mL/kg dose of PRBCs – start thinking about other blood components, and ask yourself whether you should initiate your massive transfusion protocol. The goal is to have the products ready to use in the case of the dynamic trauma patient. The Thromboelastogram (TEG) Direct measures the four components of clot formation. When there is endolethial damage and bleeding, the sequence that your body takes to address it is as follows: Platelets migrate and form a plug Clotting factors aggregate and reinforce the platelets Fibrin arrives an acts like glue Other cells migrate and support the clot. R time – reaction time – the initial line in the tracing that shows time to beginning of clot formation. Treated with platelets K factor – kinetics of the clot –how much the clot allows the pin to move, or the amplitude. Treated with cryoprecipitate Alpha angle – the slope between the R and K measurements – reflects how quickly the fibrin glue is working. Treated with cryoprecipitate Ma – maximum amplitude – reflects the overall strength of the clot. Treated with platelets LY30 – the clot lysis at 30 min – is the decrease in strength of the clot’s amplitude at 30 min. Treated with an antifibrinolytics (tranexamic acid) Shape Recognition Red wine glass: a normal tracing with a normal reaction time and a normal amplitude. That patient just needs support and monitoring. Champagne glass: a coagulopathic TEG tracing – thinned out, with less amplitude. This patient needs specific blood products. Puffer fish or blob: a hyperfibrinolytic tracing. That patient will needs clot-stablizer. TEG – like the FAST – can be repeated as the clinical picture changes. The Trauma Death Spiral Lethal triad of hypothermia, acidosis, and coagulopathy. Keep the patient perfused and warm. Each unit of PRBCs contains 3 g citrate, which binds ionized calcium, causing hypotension. In massive transfusion, give 20 mg/kg of calcium chloride, up to 2 g, over 15 minutes. Calcium chloride is preferred, as it is ionically readily available – just use a larger-bore IV and watch for infiltration. Calcium gluconate could be used, but it requires metabolism into a bioavailable source of calcium. Prothrombin complex concentrate (PCC) Prothrombin complex concentrate (PCC) is derived from pooled human plasma and contains 25-30 times the concentration of clotting factors as FFP. Four-factor PCCs contain factors II, VII, IX and X, while 3-factor PCCs contain little or no factor VII. The typical dose of PCC is 20-50 units/kg In the severely hemorrhaging patient – you don’t have time to wait for the other blood products to thaw – PCC is a powder that is reconstituted instantly at the bedside. Tranexamic acid (TXA) Tranexamic acid (TXA), is an anti-fibrinolytic agent that functions by stopping the activation of plasminogen to plasmin, and the degradation of fibrin. The Clinical Randomisation of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) investigators revealed a significant decrease in death secondary to bleeding when TXA was administered early following trauma. Based on the adult literature, one guideline is to give 15 mg/kg loading dose of TXA with a max 1 g over 10 minutes followed by 2 mg/kg/h for at least 8 h or until bleeding stops. Resuscitative Pearls Our goal here is damage control. Apply pressure whenever possible. Otherwise, resuscitate, identify the bleeding source, and slow or stop the bleeding with blood products or surgery. How Children are Different in Trauma In adults, we speak of “permissive hypotension” (also called “balanced resuscitation” or “damage control resuscitation”). The idea is that if we bring the adult patient’s blood pressure up to normal, we may be promoting clot rupture. To avoid this, we target a MAP of 65 and look for clinical signs of sufficient perfusion. Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. In children, this is simply not the case. Hypotension in children is a sign of pre-arrest. Remember, they compensate with an increased systemic vascular resistance and tachycardia to maintain blood pressure. We should not allow children to become hypotensive – severe tachycardia alone should prompt us to resuscitate. In other words, permissive hypotension is not permissible for children. FAST is not sensitive enough to rule-out abdominal trauma. Fox et al in Academic Emergency Medicine found a sensitivity of 52%; with a 95% confidence interval [CI] = 31% to 73%. Often children even with high-grade splenic and liver lacerations can be managed non-operatively. If they are supported adequately, they are observed in the ICU and can avoid surgery in many cases. Unfortunately, a negative FAST cannot help with detecting or grading the laceration for non-operative management. In other words, feel free to use ultrasound – especially for things that we in the ED will react to and intervene on – but CT may help to manage the traumatized child non-operatively. General Guideline for Imaging in Pediatric Trauma CT Head and Neck, non-contrast: in concerning mechanisms of injury, patients that are difficult to assess (especially those under 3 months), those with a GCS of 13 or lower. CT Chest, IV contrast: for suspicion of vascular injury that needs exploration, especially in penetrating trauma. Otherwise, chest xray will tell you everything you need to know in children – especially in blunt trauma. Hemo or pneumothoraces are readily picked up by US or CXR. Rib fractures on CXR predict pulmonary contusions. If you are concerned about great vessel injury, then CT Chest may be helpful; otherwise consider omitting it. CT Abdomen and Pelvis, IV contrast: helpful in grading splenic and liver lacerations with goal to manage non-operatively. Abdominal tenderness to palpation, significant bruising, or a seat belt sign are concerning and would generally warrant a CT. Also, consider in liver function test abnormalities, or hematuria. Extremity injuries: in general can be evaluated with physical exam and plain films. However, some injuries in high-risk anatomically complex areas such as the hand and wrist, tibial plateau, and midfoot may be missed by plain films, and CT may be helpful here. Remember: you can help to mitigate post-traumatic stress and risk for adult healthcare aversion. Summary Massive transfusion in children is at 40 mL/kg of total blood products. Think about it if you are giving your second transfusion to the traumatized child. Do everything you can to support perfusion and avoid the death spiral of hypothermia, coagulopathy, and acidosis. Keep the child perfused with blood as needed, correct coagulopathy, avoid too much crystalloid, and make sure to use the least high-tech of all of these interventions – keep him dry and covered with warm blankets. Do a careful physical exam, and use CT selectively with an end-point in mind – the default is not the pan-scan – evaluate possible injuries depending on your suspicions from history, physical, and lab tests. Become familiar with the relatively new modalities in trauma such as TXA, cryoprecipitate and the emerging technology of thromboelestogram – red wine is good for you, champagne is weak, and a puffer fish is trouble. Selected References Dehmer JJ, Adamson WT. Massive transfusion and blood product use in the pediatric trauma patient. Semin Pediatr Surg. 2010 Nov;19(4):286-91. doi: 10.1053/j.sempedsurg.2010.07.002. Fox JC, Boysen M, Gharahbaghian L, Cusick S, Ahmed SS, Anderson CL, Lekawa M, Langdorf MI. Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011 May;18(5):477-82. Harvey V, Perrone J, Kim P. Does the use of tranexamic acid improve trauma mortality? Ann Emerg Med. 2014 Apr;63(4):460-2. Holscher CM, Faulk LW, Moore EE, Cothren Burlew C, Moore HB, Stewart CL, Pieracci FM, Barnett CC, Bensard DD. Chest computed tomography imaging for blunt pediatric trauma: not worth the radiation risk. J Surg Res. 2013 Sep;184(1):352-7. Nosanov L, Inaba K, Okoye O, Resnick S, Upperman J, Shulman I, Rhee P, Demetriades D. The impact of blood product ratios in massively transfused pediatric trauma patients. Am J Surg. 2013 Nov;206(5):655-60. Ryan ML, Van Haren RM, Thorson CM, Andrews DM, Perez EA, Neville HL, Sola JE, Proctor KG. Trauma induced hypercoagulablity in pediatric patients. J Pediatr Surg. 2014 Aug;49(8):1295-9. Scaife ER, Rollins MD, Barnhart DC, Downey EC, Black RE, Meyers RL, Stevens MH, Gordon S, Prince JS, Battaglia D, Fenton SJ, Plumb J, Metzger RR. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg. 2013 Jun;48(6):1377-83. This post and podcast are dedicated to Larry Mellick, MS, MD, FAAP, FACEP. Thank you for your dedication to medical education, and sharing your warm bedside manner, extensive knowledge and talents, and your patient interactions with the world. Powered by #FOAMed — Tim Horeczko, MD, MSCR, FACEP, FAAP
This podcast is the audio portion of the Peer Reviewed Lectures series from the Academic Emergency Medicine journal, featuring the Academy for Women in Academic Emergency Medicine's (AWAEM) series on Professional Development. Reproduced with permission by the journal. Abbuhl S., McGregor AJ., Wolfe J., Hit the Ground Running: A Guide for the First Two Years of Your Academic Career. AWAEM Professional Development Series. Peer-Reviewed Lectures. Academic Emergency Medicine. https://vimeo.com/97269472 Nov 2014. 21 (11) 1286.
This podcast is the audio portion of the Peer Reviewed Lectures series from the Academic Emergency Medicine journal, featuring the Academy for Women in Academic Emergency Medicine's (AWAEM) series on Professional Development. Reproduced with permission by the journal. Wolfe J, McGregor AJ, Part Time Academic EM: Possibilities, Pitfalls and Pearls. AWAEM Professional Development Series. Peer-Reviewed Lectures. Academic Emergency Medicine. https://vimeo.com/97437711 Nov 2014. 21 (11) 1290-1291.
This podcast is the audio portion of the Peer Reviewed Lectures series from the Academic Emergency Medicine journal, featuring the Academy for Women in Academic Emergency Medicine's (AWAEM) series on Professional Development. Reproduced with permission by the journal. Hansoti B, McGregor AJ, Wolfe J, Networking: Why, How and Where to Connect with Peers and Mentors in Academic EM. AWAEM Professional Development Series. Peer-Reviewed Lectures. Academic Emergency Medicine. https://vimeo.com/97358437 Nov 2014. 21 (11) 1287.
My guest for episode #149 is Gregory Jacobson, MD, the co-founder and CEO at KaiNexus (www.KaiNexus.com). We'll be talking about his early work with Kaizen in emergency medicine settings - how did he get introduced to Kaizen principles and how did get train others in getting started? Bio: Greg graduated from Washington University in St Louis in 1997 with a BS in Biology. He attended Baylor College of Medicine from 1997 to 2001. From 2001 to 2004, he completed a residency in Emergency Medicine at Vanderbilt University Medical Center where he then stayed on as faculty. Starting in 2004, it was his observation and research of operational inefficiencies and unrealized improvement opportunities that resulted in the creation of a rudimentary software tool at VUMC and, ultimately, the founding of KaiNexus. Jacobson is co-author of Kaizen: A Method of Process Improvement in the Emergency Department published in the journal Academic Emergency Medicine. Conflict of interest: I have been on the management team at KaiNexus since 2011 and I am a part owner. To point others to this, use the simple URL: www.leanblog.org/149. Please leave a comment and join the discussion about the podcast episode. For earlier episodes of the Lean Blog Podcast, visit the main Podcast page at www.leanpodcast.org, which includes information on how to subscribe via RSS or via Apple iTunes. You can also listen to streaming episodes of the podcast via Stitcher: http://landing.stitcher.com/?vurl=leanblog If you have feedback on the podcast, or any questions for me or my guests, you can email me at leanpodcast@gmail.com or you can call and leave a voicemail by calling the "Lean Line" at (817) 776-LEAN (817-776-5326) or contact me via Skype id "mgraban". Please give your location and your first name. Any comments (email or voicemail) might be used in follow ups to the podcast.
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