Sunday, April 18, 2021

Chronic Pain and Addiction Patients Need Us Now More Than Ever

Image credit: Pexels
Author:
Shane A. Sobrio, MD
Originally published: Common Sense
March/April 2021

Flashback to 2019. Hong Kong protests were raging on, the U.S. Women’s National Team won the world cup, Donald Trump was being impeached, and the health care battle continued to revolve around the opioid epidemic. It wasn’t necessarily easy, but it was familiar. Practices were being implemented to help prevent reckless opioid prescribing and increase availability of naloxone which, to an extent, were working. Flash forward to 2020, the year of the COVID-19 pandemic. Millions of people worldwide now dead from a novel respiratory virus and opioids are a distant memory, no longer causing the problems they used to, right? Unfortunately, not right at all.

Thursday, April 8, 2021

The Brink of Burnout

Image credit: Pexels
Author:
Ryan P. Gibney, MD
Originally published: Common Sense
March/April 2021

It definitely felt different this new year. The normal buzz around town, packed stores, twinkling lights, and family gatherings uncharacteristically muted as compared to years past. I noticed a profound change in the hospital starting in mid-November: the winter chill was ever present in the air, while families prepped for the upcoming holidays in uncertainty. It started as a trickle three or four critically ill patient’s per day—COVID and others—but quickly became evident that the levee holding back the flood of patients was about to break. Over the course of two weeks, I saw the volume expand from a few sick COVID patients to every other patient coming in at the brink of complete respiratory failure, clinging to each breath, struggling to speak any words. Time and time again, I would ask a single family member to say their goodbyes while I prepared airway equipment and counseled families and patients that I was concerned and this may be the last time they speak to their loved ones. Tears and fear filling the eyes of patients and their family, quivering lips hidden behind flimsy masks, screaming, and hand holding had become the pre-intubation ritual I was now performing countless times per day. It is incredibly difficult. 

Thursday, April 1, 2021

Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

Authors: Taylor M. Douglas, MD; Taylor Conrad, MD MS; Wesley Chan, MD; and Christianna Sim, MD MPH
Editor: Kelly Maurelus, MD FAAEM and Kami Hu, MD FAAEM

Most, if not all, emergency medicine clinicians are familiar with massive transfusion protocols (MTP), which were developed to create a systematic method for the administration of large volume resuscitation for hemorrhagic shock. The evidence behind these protocols and how they were developed, however, are less well known. First seen in military trauma settings, MTPs have been translated to civilian patients with the supporting evidence to do so following behind their application.1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 Here we examine some of the evidence behind the various components of MTPs, specifically calcium and factor VIIa, and the ratios in which the main products of red blood cells, plasma, and platelets should be administered.

Friday, March 26, 2021

EM Away Rotations in a Pandemic

Image credit: Pexels
Author:
Lauren Lamparter – President, AAEM/RSA Medical Student Council
Originally published: Common Sense
March/April 2021

For the third-year medical student, the emergency medicine residency application process starts with applying to away rotations. This year, uncertainty remains around the possibility of aways, but hopefully, as COVID-19 vaccines are distributed more widely, travel and away rotations can become possible. One of the past AAEM/RSA Medical Student Council Presidents, Dr. Michael Wilk, wrote an article, “Seven Tips for Selecting Your EM Away Rotations.” His advice remains true whether you are able to rotate only at your home EM rotation, participate in one of the new virtual EM electives, or travel and participate in an away. So, here are his seven points, with my updated insight and an eighth point, for approaching the EM away rotations in a pandemic world.

Thursday, March 4, 2021

Who Will Be Their Advocate? A Commentary on Facing Illness Alone.

Image credit: Pexels
Author:
Jennifer Gemmill, MD FAAEM
Originally published: Common Sense
January/February 2021

I am a terrible patient. I will refuse medicines prescribed to me. I will pick up my heavy 2-year-old just hours after delivering my newborn while the L&D nurses give me the evil eye. I will remove my own loop recorder in my bathroom at home instead of having it taken out by my unknowing cardiologist (it’s amazing how useful leftover lidocaine and eyebrow tweezers can be). If you are my physician for any reason, I will be a handful. However, I will also be my strongest advocate.