Thursday, September 13, 2018

ECMO in the Adult ED

Image Source: Joint Base San Antonio
This post was peer reviewed.
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Author: Tim Montrief, MD, MPH
Emergency Medicine Resident, PGY-2
Jackson Memorial Hospital

Extra Corporeal Membrane Oxygenation (ECMO), more accurately known as Extracorporeal Life Support (ECLS) is a type of prolonged mechanical cardiopulmonary support that began in the 1970s. Its technology, indications, and usage have rapidly evolved over the last two decades; it has now become an essential tool in the care of critically ill adults and children refractory to conventional management who have potentially reversible causes of respiratory/cardiac failure. With the development of ECMO programs across the nation, this technology is making its way to an emergency department (ED) near you.

Thursday, September 6, 2018

The Cruelty of Depression

Image Source: pxhere
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Author: Becky Lee, MS4
University of Maryland School of Medicine
AAEM RSA Wellness Committee

In the middle of a hot August day, excited chatter echoed inside the dome of the columned, 200-year-old medical school building. It was our first day of medical school, and my classmates and I were eager to get started on our long-held dreams of becoming doctors. The next few days of orientation were a blur of information and optimism, all leading up to the first day of anatomy lab, where we paused in solemn silence to thank the donors and their families. I let this feeling sink in – the feeling that I was exactly where I was supposed to be. I had no idea that the next few months would be my darkest days of medical school. By the time winter break loomed around the corner, I couldn’t sleep, I no longer felt like eating, and I stopped talking to my friends and family. I stopped running and reading. In fact, I stopped going outside altogether. I spent most of my time in bed, staring at the ceiling, wondering if things would ever get better, and questioning how I ended up here. Sometimes, the thought occurred to me that I wouldn’t mind if I didn’t wake up the next day.

Thursday, August 30, 2018

Carotid Doppler Ultrasound and Passive Leg Raise to Predict Fluid Responsiveness

Image Credit: Wikimedia
 
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Author: Jake Toy, DO
PGY1 Emergency Medicine, Harbor UCLA Medical Center
Modern Resident Blog Editor-in-Chief

Background
The management of intravascular volume in critically ill patients is a challenge we face daily in the emergency department (ED). Since the beginning of our training, hypotension and shock have often been synonymous with rapid fluid resuscitation. Yet at present, fluid resuscitation remains largely empiric in nature.

Friday, August 17, 2018

Be Aware of the Stoic Man

Image Credit: Pixabay
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Author: Taylor Brittan, MSIV
University of Queensland-Ochsner Clinic
AAEM/RSA Education Committee

Introduction
There are several patient populations to which we are attentive so as not to miss a diagnosis in the context of an atypical presentation. Typical cases include the elderly, female, diabetics, or those with HIV.[1,2,3] I contend that there is another group which we should assess with even more caution—the stoic man.

Thursday, August 9, 2018

Burning Both Ends of the Candle

Image Credit: Common Sense
Author: Faith Quenzer, DO
AAEM/RSA At-Large Board Member
Originally Published: Common Sense July/August 2018

I wasn’t out of the woods yet. After the birth of my first child, my son would keep me up every two to three hours a night. This was not what I imagined life to be as a mother. Additionally, I was out of the department for several months taking time off and doing outside rotations. However, I was struggling to keep things together at home and in the emergency department during shifts. Balancing life inside and outside the home was difficult until my working husband and I got extra help. My mom helped watched my son until he was 10 months old. My husband worked from home two days of the week, but his work was based primarily in San Diego. This still was too much for everyone. So we decided to use my residency income to pay for daycare five days per week. “Finally, a break.” I thought to myself.

Fast forward a year, my father goes to see a cardiologist for his persistent dyspnea he has had for several months. I had bugged him about it for a while and he agreed to see someone at the hospital where I work. Finally, we figure it out; his heart has an ejection fracture of 15%. My hopes could not sink any further than the depths of the sea. The cardiologist decided to take him to cardiac cath lab and I, as the both daughter and the doctor in the family, took a deep breath and braced myself. I noticed the cold temperature of the cardiac cath suite as the cardiologist prepped and draped. Dad is out with a touch of Versed and the dye squirted in and very slowly trickled through the brittle appearing arteries.