Thursday, November 8, 2018

FOUR Score for the Evaluation of the Comatose Patient

This post was peer reviewed.
Click to learn more.
Image Credit: MaxPixel

Authors: Justin Rafael De la Fuente, MSII
Medical Student
University of Miami Miller School of Medicine

Tim Montrief, MD MPH
Emergency Medicine Resident Physician
Jackson Memorial Health System
AAEM/RSA Publications & Social Media Committee

Jeffrey M Scott, DO
Attending Physician
Jackson Memorial Health System

A 63-year-old man is brought in to the emergency department by ambulance after being found unresponsive at home by his family. He was last seen normal about four hours prior to arrival. En route, the patient was exhibiting irregular respirations with an oxygen saturation of 85% and was intubated by paramedics. On arrival, he is unresponsive with an oxygen saturation of 92%, bradycardic at 55 beats per minute, and hypertensive with a blood pressure of 160/95 mmHg.

Thursday, November 1, 2018

Emergency Department Boarding: What Can We Do?

This post was peer reviewed.
Click to learn more.
Image Source: PxHere

Authors: Tyler Ericson, MS3
University of Miami Miller School of Medicine

Tim Montrief, MD MPH
Emergency Medicine Resident
Jackson Memorial Health System/University of Miami
AAEM/RSA Publications and Social Media Committee Member

Jeffrey M Scott, DO FACEP EDIC
Assistant Professor of Clinical Medicine, Division of Pulmonary, Critical Care, and Sleep
Medicine, University of Miami Miller School of Medicine

Many emergency departments (EDs) often experience critical overcrowding and heavy demand on scarce emergency resources, hampering the delivery of high-quality medical care and compromising patient safety.[1] The primary cause of overcrowding is boarding—the practice of holding patients in the ED after they have been admitted to the hospital because no inpatient beds are available. Boarding is a prevalent practice in EDs across the country, with nine out of ten hospitals reporting some degree of boarding.[2] Boarding times may vary depending on many factors, including hospital size, time of day, and patient population. Some studies have shown the median boarding time to be 79 minutes, with 32% of admitted patients boarding for longer than two hours.[3]

Thursday, October 25, 2018

Lay Corporations Running Residency Programs

Author: Gabe Stahl, MD
AAEM/RSA Advocacy Committee Co-Chair

Most of you who are reading this are here because you live, breathe, and bleed emergency medicine. EM offers the perfect mix of medicine, procedures, and adrenaline. Unfortunately, not all parties involved do it for the love of emergency medicine. While EM may be one of the youngest specialties, its short history is rife with conflict pitting hospitals against Emergency Medicine practitioners in the form of lay entities incorporated to manage emergency departments even though there are statutes against this practice in many states, and some even run residency programs.[1] A lay entity means that a non-physician owns and operates the emergency department. For an excellent history lesson as told by James Keaney, MD MPH FAAEM, the first president of AAEM, we highly suggest that every medical student and resident interested in EM read The Rape of Emergency Medicine.[2]

Thursday, October 18, 2018

AAEM/RSA FIX Scholarship Winner - Aaryn Hammond

Name: Aaryn Hammond, MD
Residency Program: Johns Hopkins University
Graduation Date: June 2019

RSA is proud to share the following essay from one of the 2017 FemInEM Idea Exchange (FIX) Scholarship winners, Aaryn Hammond, MD. Congratulations, Dr. Hammond! 
“Just go so you can say you went.” I can still hear my mother’s advice echoing in my head 4 years later. Specifically, this was the advice my mom gave me as I contemplated cancelling my interview for residency at Johns Hopkins, as I explained to her all the reasons it wouldn’t be a good fit and therefore a waste of time. I’ve since discovered that my “reasons” were actually disguises for what I now consider to be my personal version of “imposter syndrome” ...the very syndrome that plagued me with thoughts of inadequacy in the face of accomplishments that almost prevented me from achieving my dreams. In considering all the ways the “imposter syndrome” has reared its ugly head, I think back to the high school student that considered forensic science because as a doctor I could potentially hurt someone...the medical student who loved but yet feared Emergency Medicine because I could never be a “Master of all trades”, and finally to the graduate of two historically black universities afraid to interview at Johns Hopkins because why would they want me? This photo reminds me of all that I can do and be when I push myself to persist beyond my fears. This photo, taken on the final day of my intern year, is a constant reminder of what it means to be a black female emergency physician. It is evidence of the victory over fear and a testament of overcoming in pursuit of one’s destiny.

Thursday, October 11, 2018

RSA FIX18 Scholarship Winner - Heather Boynton

Name: Heather Boynton, MD
Residency Program: University of California San Diego Medical Center
Graduation Date: June 2019

RSA is proud to share the following essay from one of the 2018 FemInEM Idea Exchange (FIX) Scholarship winners, Heather Boynton, MD. Congratulations, Dr. Boynton! 

Photo Title: Where My Witches At

On Halloween nine years ago I met my fake husband. I showed up at my best friend’s house dressed as Accident Prone. I had been working at an orthopedic clinic and used the time to craft a costume that included a full leg cast, two short arm casts and a cast hat. Who needs a cast hat? A 30-year-old who had an early midlife crisis, quit her life in foreign policy, broke her clavicle skiing, got out of a terrible relationship and was now going to a Halloween party. It got hot at the party and I took off and lost the cast hat. My fake husband was my best friend’s idea. Long story short, I told her the only not-insulting time I had been hit on was in Germany, when men asked me what books I was reading. She produced a German for the Halloween party. He wore a strange costume. We took a picture with Jesus and Mary, and I thought that was the end of that. Now he’s my fake husband. “Fake” because we never got married. “Husband,” because we have a nice life together, and a 7-year-old daughter who thinks of my EM colleagues as her friends, not mine. Last Halloween my daughter and I dressed as witches. You’d think it would get old, to keep saying, Where my witches at? It doesn’t. It’s the best. It’s like code, for strong and powerful lady people. We were and we are. Wiiiitches.