Friday, November 22, 2019

Resident Journal Review: Diagnosis and Treatment of Cellulitis in the Emergency Department

Authors: Taylor M. Douglas MD, Taylor Conrad, MD, Ted Segarra, MD, Rithvik Balakrishnan MD, Christianna Sim, MD, MPH
Editors: Kelly Maurelus MD FAAEM, Kami Hu MD FAAEM
Originally published: Common Sense
November/December 2019

Skin and soft tissue infections (SSTIs) result in over two million visits to the emergency department (ED) every year. While this term encompasses infections ranging from erysipelas to necrotizing fasciitis, this article focuses on superficial cellulitis. Due to the lack of good data, there is no true consensus in the medical community regarding standard of care, i.e. whether intravenous (IV) antibiotics are required or what clinical presentations mandate admission. The Infectious Disease Society of America (IDSA) makes recommendations for treatment duration (five days), when to cover methicillin-resistant Staphylococcus aureus (MRSA) [penetrating wounds, intravenous drug use, systemic inflammatory response syndrome (SIRS), nasal colonization, evidence of other MRSA infection] and outpatient management (for those without SIRS, altered mental status, or hemodynamic instability) 1. Most of these guidelines, however, are based on retrospective studies. Studies in the surgical field have attempted to identify grading systems to help guide management without success.2 Without consensus, emergency physicians are left with the following questions on how to best treat and disposition our patients with cellulitis to ensure their infection resolves.

Thursday, November 14, 2019

The Future of Wellness

Authors: Andrea Purpura, MD; Robert Lam, MD; and Ryan DesCamp, MD
AAEM/RSA Wellness Committee
Originally published: Common Sense September/October 2019


If you feel like you are suffering symptoms of burnout, you are not alone. Most prevalence studies show that more than 65% of all emergency physicians are experiencing symptoms of burnout.1 Most physicians find they are no longer able to mitigate the challenges of an increasingly frustrating work environment with individual resilience practices alone. This frustration mirrors the shift in our current understanding of burnout and physician well-being.


Thursday, November 7, 2019

Thriving in Third Year

Image credit: Pexels
Author: David Fine, Medical Student Council President
Originally published: Common Sense  September/October 2019


The beginning of the year brings new residents and medical students to the floors. A question that all new learners have on their minds is, “How can I succeed?” Personally, I can’t speak to the resident experience, but any medical student knows that there is not just a single way to do well. Over the course of the year you will be challenged with new concepts, different practicing styles, and inconsistent expectations. There is not just a single method that will be successful in your unique training environments, but I believe that there are a few key pieces of advice that will help you thrive and adapt throughout the year.

Monday, November 4, 2019

Becoming a Night Shift Jedi: Do or Do Not, There is No Try.

Image credit: Pexels
Author: Patrick Wallace, DO
AAEM/RSA Education Committee 
Originally published: Common Sense
September/October 2019


Emergency medicine (EM) physicians will inevitably work night shifts during their career. With transitions of days and nights occurring as frequently as once a week, it is imperative to maximize the quality of sleep and recovery time. Abundant research has been done on various aspects of sleep hygiene and effective techniques to combat difficulties surrounding night shift-work. This article will address some of those key factors including napping, caffeine, sleep environment, and long-term health consequences.




1. Preparing
Acquisition of sleep debt during the transition to and from night shift often arises from staying awake the entire day leading up to the first night.1 By minimizing sleep debt going into night shift, performance can be improved and recovery hastened.2


Thursday, October 24, 2019

An Argument for the Enforcement of Electronic Health Record Cross-Communication

Image credit: Pexels
Author: Haig Aintablian, MD
AAEM/RSA President
Originally published: Common Sense September/October 2019


A 77-year-old patient comes into the ED for a complaint of shortness of breath x 6 months. This is the first time the patient has come to this hospital and there are no medical records in the EHR. The patient doesn’t remember what problems they have, but they know they’re on some sort of medication for their heart. They deny any kidney problems. You optimize the patient in the ED, see no acute ECG changes, no troponin elevations, but a creatinine of 2.3 and a BNP that is mildly elevated. You admit for heart failure and AKI. Multiple renal and cardiac studies are done in house because his records can’t be retrieved. Once they are retrieved you see that his BNP and Cr are within baseline and the patient did not require admission.