Sunday, July 23, 2017

How to Be an Effective Leader in the ED

Image Credit: Pixabay
Author: Meaghan Mercer, DO
2013/2014 AAEM/RSA President
Originally Published: Common Sense November/December 2013

Leadership is creating a way for people to contribute to making something happen, developing an environment that allows cohesion and a drive toward a common goal. Leadership affects our lives on a constant basis and our role in the hierarchy changes as we shift from one environment to another: parent, boss, teacher, mentor. Leadership is a skill and learned behavior that becomes second nature over time and is important to cultivate, especially when working in the emergency department. In the ED we orchestrate the movement and flow of patients, staff, and resources, in a delicate yet chaotic balance. As we progress through residency, we gain the leadership skills to manage all the pieces until we unconsciously and fluidly become leaders in the field.

Thursday, July 20, 2017

Putting the Focus Back on Diagnosis

Image Credit: Pixabay
Author: Leana S. Wen, MD MSc
AAME/RSA 2010 Resident Editor
Originally Published: Common Sense September/October 2010

Last week, Jerry got the scare of his life. Jerry is a 48-year old mechanic who is in good health. His parents are healthy, and he recently got a “clean bill of health” during his annual check-up. Over the weekend, he helped his brother move across town. Monday morning, he woke with tightness in his chest. He described it as a “spasm” and thought that he might have pulled something while he was lifting the sleeper sofa. But someone in his neighborhood had a heart attack recently, and Jerry’s wife persuaded him to go to the ED to get it checked out.

Sunday, July 16, 2017

Getting the Most Out of Residency

Image Credit: Pixabay
Author: Meaghan Mercer, DO
2014-2015 RSA President
Originally Published: Common Sense September/October 2014

As I enter my third year of residency, the end of training is becoming more of a reality every day. I have received many pearls of wisdom along my path from medical students to residents to soon-to-be-attendings. With less than a year to go, I remind myself every day that I should make the most of each day of my education — and I hope you will do the same. A huge thank you to the members of AAEM/RSA, who really have been with me all the way. Reflecting on these past few years, I want to share some advice that has helped me succeed.

Thursday, July 13, 2017

Haney Mallemat on Technology’s Role in EM Education and Training

Image Credit: Pixabay
Author: Ali Farzad, MD, AAEM/RSA Publications Committee Chair
Author: Linda J. Kesselring, MS, ELS, Copyeditor
Originally published: Common Sense July/August 2013

This article marks the last of a series that has aimed to highlight how you can use simple technology to make your learning more efficient and effective. In previous interviews with leaders in emergency medicine (EM) education — Drs. Mel Herbert, Amal Mattu, and Scott Weingart — we learned the value using free websites, blogs, podcasts, and ECG videos to stay current with medical information and save more lives. Continuing that theme, I recently had the pleasure of interviewing Haney Mallemat, MD FAAEM (@criticalcarenow), an EM/IM-trained critical care specialist who works in the adult emergency department at the University of Maryland Medical Center as well as the critical care ICUs in the R Adams Cowley Shock Trauma Center in Baltimore, Maryland.

Sunday, July 9, 2017

A Real Case of Broken Heart: Takotsubo Cardiomyopathy

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

Author: Alexandria Gregory, MS3
Saint Louis University School of Medicine
AAEM/RSA Social Media Committee 
Author: Eric Goedecke, DO  
Milford Regional Medical Center

An 80-year-old female with a history of chronic obstructive pulmonary disease (COPD), high cholesterol, and hypertension presented to the emergency department (ED) with a two-day history of shortness of breath. She also reported mild left-sided chest pain, but had no cough, fever, or calf pain. She had no history of deep vein thrombosis (DVT) or pulmonary embolism (PE), though she recently traveled from Massachusetts to Florida via airplane, and returned on the day her symptoms began. The patient had quit smoking over ten years prior to her presentation in the ED. She had been using her inhalers, prescribed for COPD, frequently with minimal improvement.

Thursday, July 6, 2017

Board Review: Rabies Exposure

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

Author: Alexandria Gregory, MS-3
Saint Louis University School of Medicine
AAEM/RSA Social Media Committee

A 16-year old male presents to the emergency department (ED) after a potential exposure to a bat while sleeping in a barn. He believes his friend may have been bitten by the bat, but did not have any known contact with the bat himself. The bat could not be found after the incident. The patient has not noticed any skin changes and has no other physical complaints.

Thursday, June 29, 2017

Recognizing and Treating Exertional Heat Stroke

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

Author: Patrick M. Brown, MSIV
Western University of Health Sciences College of Osteopathic Medicine of the Pacific


An otherwise healthy 25 year old male is brought to the emergency department (ED) by emergency medical services (EMS) after witnesses saw him collapse while hiking in Arizona on a humid 38.3°C (101°F) summer day. His friends state that he was feeling well and behaving normally before hiking and add that they found his full water bottle in the car on the way to the ED. On physical exam, his temperature is 40.6°C (105.2°F), pulse is 134, blood pressure is 82/60, O2 saturation is 88% on room air and respirations are 21 breaths/min and labored. BMI is 29.3. He currently is unable to answer questions appropriately and appears restless. He is diaphoretic and hot to the touch. Eye exam reveals pupils that are 3mm and reactive to light bilaterally. Crackles are heard bilaterally on lung auscultation. Neurological exam reveals no abnormalities in tone or reflexes and the neck is supple. There are no obvious signs of trauma. His friends state that he is a regular smoker, social drinker and smokes marijuana recreationally. Labs significant for hemoglobin of 17.2, hematocrit of 51.0, WBC of 16.9, BUN of 43, creatinine of 0.9, and 2+ ketones in urine.

Sunday, June 25, 2017

Critical Care Pearl: Metabolic Acidosis: Bicarbonate Drips and Alternative Options

Image Credit: Pixabay
Authors: Victoria Weston, MD; Kevin Bajer, PharmD; and Randy Orr, MD
Northwestern University
Originally Published: Modern Resident, June/July 2013

The focus of this critical care pearl is to discuss the use of bicarbonate drips for severe metabolic acidosis, as well as alternative options, which are available. Given the current nature of medication shortages, it is valuable to learn about the alternative options available for use in some of our most critically ill patients.

When approaching a patient with metabolic acidosis, it is important to consider the cause of their acidosis (e.g., increased generation of acids as in lactic acidosis, ketoacidosis and ingestions vs. loss of bicarbonate or decreased acid excretion). As this is a relatively broad topic, this critical care pearl will focus on the treatment of lactic acidosis, as treatment of ingestions may vary with the substance ingested.

Thursday, June 22, 2017

Image of the Month (From August/September 2011 Issue of Modern Resident)

Author: Casey Grover, MD
Stanford/Kaiser Emergency Medicine
Originally Published: Modern Resident August/September 2011

A 17 month old female is brought to the ED by her mother for emesis and fever. The mother thinks that her daughter may have swallowed something last night because the child had made a "wheezing sound" while breathing and appeared uncomfortable. There was no witnessed ingestion. The child appears well with normal vital signs and is playful and interactive. Her physical exam, including pulmonary examination, is normal.

You order a PA and lateral chest X-ray. What does it show?

Image Credit: Modern Resident
  1. A coin in the esophagus
  2. A coin in the trachea
  3. A bottle cap in the esophagus
  4. A button battery in the esophagus
Click here for the answer.

Sunday, June 18, 2017

Tell Me More: The Basics of Child Forensic Interviewing

Image Credit: Pixabay
This post was peer reviewed.
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Author: Michelle Mitchell, MD, PGY-1
Duke University Medical Center

Posterior rib fractures in infants. Burns on the buttocks and legs. Mechanism of injury that is not consistent with developmental age. Most physicians will recognize these potential red flags of child abuse. However, many emergency medicine physicians have received little training on how to interview children who present with injuries concerning for child abuse. As physicians, we are not expected to definitively determine if child abuse has occurred. Instead, we often report suspected cases and leave the investigation to the authorities. It is thus important to obtain and document a thorough history in the medical record as it may be used in future court proceedings.

It is imperative that physicians have general knowledge about forensic child interviewing, as the method of interviewing may greatly impact the information that a child provides. Most models of child forensic interviewing have three stages.

Thursday, June 15, 2017

Unexpected Patient Demise in the Emergency Department

Image Credit: Pixabay
Author: Victoria Weston, MD
2015-2016 RSA President
Originally published: Common Sense January/February 2016

I could hear the wails of grief coming from our trauma bay. It was the start of my shift, and the prior team had recently terminated an unsuccessful resuscitation. The patient had been chronically ill and had collapsed while checking in at our triage desk. Although the patient had cancer and had been unwell for years, his family was shocked and devastated by their sudden, unexpected loss.

Sunday, June 11, 2017

Image of the Month (From August/September 2013 Modern Resident)

Author: Michael Gottlieb, MD
Cook County Emergency Medicine Residency
Originally Published: Modern Resident August/September 2013

An 81-year-old man with PMHx of HTN, DM, HL and OA s/p right hip replacement presents to the ED with acute onset CP and SOB x 1 day. While watching TV earlier, he developed a sudden inability to catch his breath, as well as some poorly localized, pleuritic chest tightness on the right side of his chest. He initially attributed this to reflux, but when it did not improve he drove himself to the ED.

His initial vitals are: Temp: 98.2, HR: 56, BP: 132/78, RR: 28, O2 Sat: 89%. Upon examination, he is in moderate distress, appreciably tachypneic and has to stop halfway through his sentences to catch his breath. The remainder of his exam is significant only 2+ pitting edema bilaterally. Labs are pending, a chest X-ray is ordered and his ECG is shown below.

Thursday, June 8, 2017

Photo of the Month (From Apr/May 2013 Issue of Modern Resident)

Author: ENS Dylan Hendy, MSIV
Arizona College of Osteopathic Medicine
Author: LT Christopher D. Helman, DO
Naval Medical Center Portsmouth
Originally Published: Modern Resident, April/May 2013

Patient Vignette
Twenty-nine-year-old male was sent to the ED by a community clinic for a syncopal episode. The patient originally visited the clinic for a headache that resulted from a shelf falling on the back of his head while working in his garage two days earlier. The patient denies losing consciousness, amnesia, disorientation or N/V. However, upon further questioning the patient described an unwitnessed episode of “blacking out” while sitting in his car today. He states this episode may have lasted for 30-60 minutes. The clinic subsequently sent the patient to the ED for further workup. In the ED the patient explained that he has a history of chronic headaches and that his headache at present is similar with regards to onset, location and duration. However, to the best of his knowledge, today’s unwitnessed syncopal episode was a first time occurrence. Further ROS were negative. The patient has no other pertinent PMH and is taking no medications. Complete physical exam was unremarkable. A workup for a closed head injury and syncopal episode was performed. Laboratory data was WNL. Non-contrast CT head and CXR were both unremarkable. The following ECG was obtained:

Image Credit: Modern Resident

Thursday, June 1, 2017

Bark Scorpion Stings

This post was peer reviewed.
Click to learn more.

Author: Ashley Grigsby, DO, PGY-3
Indiana University combined Emergency Medicine/Pediatrics

Centruroides sculpturatus, also known as the bark scorpion, is a type of venomous scorpion found in the Southwestern United States, i.e. Arizona, Nevada, New Mexico and Texas. The majority of these stings occur in Arizona, with a reported 3,498 emergency department (ED) visits in 2010.[1] The bark scorpion’s venom is a neurotoxin that works at axonal sodium channels causing excessive acetylcholine release in the neuromuscular junction. The clinical syndrome is most pronounced in young children, especially under 10 years old, who are most susceptible to the toxin. From 2005-2015, there were 185,000 scorpion calls to the poison centers nationally, 68% from Arizona.[1] Multiple other southwestern states were included in these calls; however, Arizona had the highest rate of neurologic and respiratory symptoms, and hospital admission.

Blog Staff, Reviewers, & Mentors

Thank you to our 2017-2018 peer review & editorial team!

AAEM/RSA Leadership:

Ashely Alker, MD
AAEM/RSA President
University of California San Diego Medical Center

Mike Wilk, MD
AAEM/RSA Vice President
Brown University

Michael Hight, MD
AAEM/RSA Secretary-Treasurer
Naval Medical Center San Diego

Mary Haas, MD
AAEM/RSA Immediate Past President
University of Michigan

AAEM/RSA Blog Leadership:

Aaron Tyagi, MD
Blog Editor-in-Chief
Social Media Committee Chair
Michigan State University - ‎Sparrow Health System

Alex Gregory, MS3
Copy Editor
Saint Louis University School of Medicine

Elaine H. Brown, MD
RSA Board Liaison to the Social Media Committee
Thomas Jefferson University Hospital

Janet Wilson, CAE
Executive Director, AAEM/RSA

Laura Burns, MA

Senior Communications Manager, AAEM

Cassidy Davis
Communication Manager, AAEM

Madeleine Hanan, MSM
Administrative Manager, AAEM/RSA

Publications Mentors:

Attending physicians or fellows who have agreed to help authors and reviewers learn about and navigate the publications process. Interested attendings/fellows can contact

Michael Epter, MD
Laleh Gharahbaghian, MD
Nikita Joshi, MD
Arayel Osborne, MD
Andrew Phillips, MD MEd
Loice Swisher, MD

Peer Reviewers:

Elaine H. Brown, MD
Bill Christian
Ashley Grigsby, MD
Caleb Larsen
Jennifer Reink, MD
Jake Toy
Aaron C. Tyagi, MD

Sunday, May 28, 2017

TXA Literature Review

Author: Alexandra Murray
Mercy St. Vincent Medical Center Emergency Medicine
Originally Published: Modern Resident December/January 2016

What is tranexamic acid (TXA)?
When the body experiences vascular injury, the hemostatic system tries to maintain circulation by balancing the formation and degradation of blood clots. In response to severe blood loss, this balance is challenged and hyper-fibrinolysis can occur. The conversion of plasminogen to plasmin plays a large role in fibrin binding and degradation. Tranexamic acid is a synthetic derivative of lysine that reversibly blocks binding sites on plasminogen and inhibits fibrinolysis.[1] TXA has been approved by the FDA since 1986 as an antifibrinolytic and has been marketed for menorrhagia (Lysteda) and dental hemorrhage in hemophiliacs (Cyklokapron).[2,3] More recently, TXA has been investigated as a treatment for posttraumatic hemorrhage, postpartum hemorrhage and prevention of surgical blood loss.

Thursday, May 25, 2017

Interstitial versus Cornual Pregnancies: There is a Difference

Image Credit: Pixabay
Author: Megan Litzau, MD
Indiana University
Originally Published: Modern Resident April/May 2016

Commonly the terms interstitial and cornual pregnancies are used interchangeably. However, these are two distinct entities, and are managed differently.[1] An interstitial pregnancy occurs when there is implantation in the proximal intramural portion of the fallopian tube. A cornual pregnancy is when there is implantation in the lateral portion of the uterus.

Thursday, May 18, 2017

Case Report: Hypopharyngeal Burns Secondary to Hot Potato Ingestion

Image Credit: Pixabay
This post was peer reviewed.
Click to learn more.
Author: Alexandria Gregory, MS-2
Saint Louis University School of Medicine AAEM/RSA Social Media Committee

Eric Goedecke, DO
Milford Regional Medical Center


A 59-year-old male presented to the emergency department (ED) with a food bolus sensation several hours after eating hot potatoes for breakfast. Since then, he had been able to tolerate coffee, scrambled eggs and handle his secretions without difficulty. He was feeling well otherwise and denied any recent illness.

On exam, the patient was well-appearing and in no respiratory distress. There was no wheezing or stridor. Oropharyngeal exam showed no edema, lesions, burns, or visible foreign body. The remainder of the physical exam was unremarkable.

Sunday, May 14, 2017

Button Batteries

Image Credit: Flickr
Author: Phillip Fry, MSIV
Midwestern University - Arizona College of Osteopathic Medicine
Originally Published: Modern Resident February/March 2017

Patients presenting to the emergency department after ingesting a button or cylindrical battery typically warrant prompt foreign body removal. The majority of battery ingestion cases involves button batteries and occurs in children younger than six years of age.[1] However, there is also a growing number of ingestions in the elderly with hearing aid batteries being mistaken for pills.

Thursday, May 11, 2017

Eyelid Lacerations

Image Source: Flickr
Author: Kaitlin Fries, DO
Doctors Hospital
Originally Published: Modern Resident February/March 2016

Eyelids are often one of the more complex locations for providers to perform laceration repairs. The eye has many important neighboring structures that can often be damaged by even minor trauma to the eye. As with any wound, it is important to start by doing a thorough exam of the tissue involved, being sure to assess for the possibility of a retained foreign body. Once the area has been evaluated it is time to ensure that a few critical nearby anatomical structures are still intact.

Sunday, May 7, 2017

Chilaiditi’s Syndrome

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

Author: Megan Litzau, MD
Indiana University Emergency Medicine Residency

A previously healthy 29-year-old male arrived with right upper quadrant pain for approximately six hours prior to arrival. On examination, the patient appeared uncomfortable. Vital signs were remarkable for mild tachycardia with an afebrile patient. Labs were obtained including a complete metabolic panel, complete blood count, lipase and urinary analysis. All of the lab values returned within normal limits. Given the patient’s persistent abdominal discomfort, computed tomography (CT) imaging of the abdomen was also obtained. On CT imaging, a segment of his transverse colon was located in an abnormal position between his liver and his diaphragm, which was in the correct location for the patient’s discomfort.

Thursday, May 4, 2017

Did You Know? Broselow Pediatric Emergency Tape

Image Credit: Wikimedia Commons
Author: Jenna Erickson, MD
Phoenix Children's Hospital/Maricopa Medical Center
Originally Published: Modern Resident August/September 2015

In a pediatric trauma, one of the initial treatment steps is determination of a child’s “color.” This is referencing the Broselow Pediatric Emergency Tape, an old but widely accepted method of estimating a child’s weight based on length. Pediatric drug dosing is based on weight, therefore a fast, efficient way to calculate dosing is essential to reduce medical error and optimize patient outcomes. The Broselow Tape is a color-coded tape measurer consisting of nine color zones that group together pediatric medication doses and equipment sizes. When a child first arrives in a trauma bay he is measured with the tape from crown to heel. The color that is reached by the child’s heel indicates a weight estimate; this color is then used for a quick reference sheet of pre-calculated medication doses, voltages and equipment sizes. Resuscitation carts with color-coded drawers further simplify the process of selecting the correct supplies for pediatric patients, thus expediting treatment and minimizing error.

Sunday, April 30, 2017

The Difficult Situation

This post was peer reviewed.
Click to learn more.

Image Credit: Flickr

     Author: Thomas Hull, MSIV
     Loyola University Chicago SSOM

I remember trying to take my first history and physical as a first-year medical student when a middle-aged man came into the emergency department (ED) with transient ischemic attack-like symptoms. With the encouragement of my preceptor, who was the attending emergency physician, I went to do a full interview history and physical. After spending almost 45 minutes learning about this man and his life in friendly conversation, I exited the room to see my preceptor with a somber face. The patient’s head computed tomography revealed numerous scattered round tumors at the gray-white junction, likely metastases from melanoma, which I’d just heard had been treated years ago and he considered “past” medical history. My preceptor apologized for such a first encounter, though confessed she was relieved to have a partner in delivering the news. I welcomed the role, willing to employ whatever emotional capital I’d just established, and confidently planted myself at his bedside as she began to tell him. But when he started crying, I knew that there was no good response – I stood there speechless.

Sunday, April 23, 2017

Pediatric Breath Holding Spells

This post was peer reviewed.
Click to learn more.

Author: Christine Au
Western University of Health Sciences, College of Osteopathic Medicine of the Pacific

In the world of emergency medicine, it is prudent to be trained and adept at handling the worse case scenario. Breath holding spells are a pediatric phenomenon that affects 5% of children from six months to four years where an involuntary pause in breathing occurs. This may lead to a patient becoming unconscious; however, these routine episodes are far from life-threatening.[1] Breath holding spells can be a result of various situations, such as a frightening or painful event, or can be linked to excessive anger in a child. Goldman defined this as a “benign paroxysmal non-epileptic disorder occurring in healthy children 6 to 48 months of age”.[2] There are two main types of spells: cyanotic and pallid. Cyanotic is much more common compared to the pallid type. These spells are a result of a decrease in heart rate, low oxygen, and high carbon dioxide in the system that may precipitate a loss of consciousness.

Thursday, April 20, 2017

Scapulothoracic Disassociation: A Rare and Devastating Injury

This post was peer reviewed.
Click to learn more.

Image Credit: Emergency Medicine: Open Access

The Case
Trauma Activation: A 25-year-old motorcyclist traveling approximately 75 miles per hour lost control and the motorcycle slid from underneath him. His entire right side made primary contact with the road. Upon arrival, he was awake and able to participate in his examination. His left upper extremity was pulseless with a complete loss of motor function and sensation. 

Left Scapulothoracic Dissociation - a traumatic disruption of the scapulothoracic articulation often associated with:
  • other orthopedic injuries including those to the acromioclavicular joint, clavicle, scapula, and sternoclavicular joint,
  • vascular injuries particular to the subclavian and axillary arteries,
  • neurologic injuries especially to the ipsilateral brachial plexus.[1,2] 

Sunday, April 16, 2017

An Electronic Resource Guide to the EM Clerkship

Image Credit: Pixabay
Author: Stephanie Cihlar
AAEM/RSA Medical Student Council President (2016-2017)

Smartphones and tablets have changed the way we practice medicine. They help us make informed medical decisions and offer a practical way to keep us up to date on the latest research. Apps and podcasts are increasingly popular tools used to help us achieve these goals, both inside and outside of the ED. For students striving to do well in EM clerkships, the ability to stay organized and access to the right resources is critical for success. However, in this rapidly changing world of medical apps, podcasts, and seemingly endless amounts of available information, it can be difficult to know where to begin. After evaluating some popular EM resources, I developed this guide of apps and podcasts to help students ensure success in their EM clerkships.

Thursday, April 13, 2017

Personal Learning Networks

Image Credit: Pixabay
Author: Mary Haas, MD (PGY-3)
University of Michigan

Over the past year I have come to appreciate the importance of concepts from sociology, psychology, and education theory on my development as a physician and educator. I recently had the pleasure of working with Drs. Felix Ankel, Anand Swaminathan, and Sally Santen on a lecture for the CORD Academic Assembly in Nashville, called Personal Learning Networks. This launched me on a study of personal learning networks and their impact on my own development so far.

A personal learning network refers to a dynamic group of connections that allow individuals to both teach and learn, share ideas and collaborate. Each individual or organization within a network is referred to as a “node.” These networks reflect our values, goals and interests. They include a mixed level of expertise: peers, novices, and experts can all serve as nodes. The most effective personal learning networks include connections outside one’s immediate institution and area of expertise, called “weak ties.”

Sunday, April 9, 2017

Point-of-Care Ultrasound

Image Credit: Flickr
Author: Aaron C. Tyagi, MD
Vice-Chair, RSA Social Media Committee
Originally Published: Common Sense March/April 2017

It is the start of your shift. You are just starting to get settled in after taking sign-out, when one of the nurses comes over and says he needs a physician in room 22 immediately!

You enter the room to find a patient in obvious distress, diaphoretic, tachypnic, sitting straight up in the bed. You immediately assess his ABCs. He exhibits severe dyspnea but his airway is intact. He has a generous amount of soft-tissue for a neck, so it is difficult to assess his trachea. You move on to his breath sounds. They are somewhat decreased on the right compared to the left, but there are some audible breath sounds on the right — though they may be transmitted sounds. No adventitious sounds. Peripheral pulses are palpable and fast. Vital signs show a heart rate of 112, a respiratory rate of 29, blood pressure in the 140s/90s, and a SpO2 of 94% on room air.

Thursday, April 6, 2017

Lessons from My First Lobbying Experience

L-R: Matt Hoekstra, Williams & Jensen;
Mary Haas, MD;
Brian Potts, MD MBA FAAEM;
Kevin Rodgers, MD FAAEM
Author: Mary Haas, MD, AAEM/RSA President
University of Michigan
Originally Published: Common Sense March/April 2017

In December I traveled to D.C. with the AAEM Board of Directors, for my first Advocacy Day. I admit I did not know what to expect, and although I looked forward to actively advocating for our specialty, the idea of lobbying intimidated me. Would I know how to “speak the language?” How would I make Congressional staffers understand the importance of our cause, let alone care about it? I was both excited and nervous for this new and very important experience.

It was eye-opening and incredibly educational. On the morning of our visit to Capitol Hill we reviewed our big issue, due process, one of critical importance for emergency physicians. “Due process” refers to a fair hearing in front of peers on the hospital medical staff, prior to the termination of a physician's privilege to practice there.

Sunday, April 2, 2017

AAEM/RSA 2017 Award Winners

RSA Secretary-Treasurer, Philip Dixon, MD (left) with AAEM/RSA Program Director of the Year Award recipient,
Jonathan S. Jones, MD FAAEM (center), and AAEM/RSA Resident of the Year Award recipient,
Mary Haas, MD (right)
Author: Michael Wilk, MD

Congratulations to our AAEM/RSA award and scholarship winners from this past year! All of them have made outstanding contributions to their programs and/or RSA over the past year and we are pleased to recognize them.

AAEM/RSA Program Director of the Year Award
Jonathan S. Jones, MD FAAEM, Mississippi University

To nominate your program director next year:

AAEM/RSA Program Coordinator of the Year Award
Krista Fukumoto, Stanford University

AAEM/RSA Resident of the Year Award
Mary Haas, MD, AAEM/RSA President, PGY3, University of Michigan

AAEM/RSA Committee Member of the Year AwardJake Toy, MS3, Copy Editor, Social Media Committee.

AAEM/RSA Medical Student “Why EM?” Essay Scholarship Winners:

For information for medical students to apply next year visit: (

Thursday, March 30, 2017

Palliative Care Myth Busters

This post was peer reviewed.
Click to learn more.

Image Credit: Wikipedia

Author: Michelle Mitchell, MS-IV
Geisinger Commonwealth School of Medicine

Palliative care concepts have increasingly become integrated into care in the emergency department (ED). As the health of patients with advanced and end-stage disease continues to decline, they often present to the ED for symptom management and pain relief. Therefore, emergency medicine physicians should be knowledgeable about basic palliative care treatments, as well as some common myths surrounding palliative care.

Sunday, March 26, 2017

Needle Thoracostomy: Is it Time to Switch to a Longer Needle?

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

Author: Jake Toy, MSIII
Western University of Health Sciences

Needle thoracostomy (NT) is a lifesaving procedure often utilized in pre-hospital settings and emergency departments (ED), and is indicated in cases of tension pneumothorax. Placement of a needle catheter into the pleural space allows for emergent decompression, resulting in restored and/or increased venous return to the right atrium.[1] Placement of a chest tube is the definitive management of a tension pneumothorax following both a successful or failed needle placement. Advance Trauma Life Support (ALTS) guidelines recommend the use of a 14-gauge 5 cm (approx. 2 in) angiocatheter placed in the 2nd intercostal space, midclavicular line (ICS-MCL), inserted at a perpendicular angle to the skin.[2]

Thursday, March 23, 2017

No But Really…How Much Weed Do You Smoke?

This post was peer reviewed.
Click to learn more.

Image Credit: Flickr

Author: Ashley Grigsby, DO, PGY-3
Indiana University, Emergency Medicine/Pediatrics

A 21-year-old female presented with epigastric abdominal pain and severe vomiting for the last three days. She has had similar vomiting episodes before and has had a large workup that was unremarkable for the etiology. She was unable to stay hydrated during this latest episode so she presented to the emergency department (ED). She stated that the only thing that helped her vomiting has been a hot shower. Her vitals were normal except for a heart rate of 112 beats per minute; her exam was unremarkable except for mild epigastric tenderness to palpation. The patient was questioned multiple times alone in the room and denied, multiple times, any marijuana use or other drug use. She was treated symptomatically and improved. On discharge, she was again questioned about drug use and admitted to twice daily marijuana use for the past several years. She was diagnosed with cannabinoid hyperemesis syndrome, counseled on the importance of marijuana cessation, and discharged home in good condition.

Sunday, March 19, 2017

The Waiting Game

Image Credit: Pixabay
Author: Victoria Weston, MD
Originally Published: Common Sense November/December 2015

I could feel her eyes on me, burning with anger. It was a hot July day and she had been waiting for hours in our crowded waiting room, and then waited even longer in our ENT room in an upright, unforgiving chair as our team cared for multiple unstable patients who had been roomed shortly after sign-out. The ED was packed with patients, new interns, and other new learners — and everything seemed to be moving so much more slowly than just a few weeks before.

When I walked into her room, I entered with a smile, made eye contact, introduced myself, and made my apologies: I am so sorry for the wait. I am glad that you came in today and appreciate your patience. I know that it has been a long wait, but I am here now and am totally focused on you. How can I help you today?

Thursday, March 16, 2017

All I Really Need to Know — Still — I Learned in Kindergarten

Image Credit: Pixabay
Author: Andrew W Phillips, MD Med
Originally Published: Common Sense July/August 2015

While still being far from hitting my full stride as a “real” emergency physician, I feel that I’ve come a long way now that I’m finally finishing residency. And while I’m cautious of being overly nostalgic or simplistic at this point, I find myself reflecting that life’s core lessons change very little. The medicine changes every five to 10 years, but certain constants never change, and they all have to do with playing together well in the sandbox.

Sunday, March 12, 2017

Reflections of a Third-Year Resident

Author: Meaghan Mercer, DO
Originally Published: Common Sense March/April 2015

Writing this around New Year's Day makes me nostalgic. There is a contagious sense of hope and excitement this time of year. Fourth-year medical students are thrilled that interviews have come to a close, rank lists are in, and Match Day looms around the corner. Interns are feeling comfortable in their shoes, seasoned residents are in the groove, graduating residents are applying for licensure, and nervous excitement accompanies the end of residency. Each New Year's Day I write a letter to myself that includes what I expect from the year and what I hope to achieve. I then seal it, and one year later open it and read it. As I reflect back on the last seven years, I want to leave you my experience and advice.

Thursday, March 9, 2017

Clinical Pearl: A Parent’s Kiss for Nasal Foreign Body Removal

Image Credit:flickr
Author: Ashley Grigsby, DO PGY-1
Indiana University Emergency Medicine/Pediatrics
Originally published: Modern Resident April/May 2015

Every little boy knows the best place for anything is up your nose. That is, until they show up in your emergency department (ED).

The Case:
Three-year-old previously healthy male presents after he put his older sister’s jewelry bead up his right nostril two hours ago. Vitals are normal. As you walk in the room, he is breathing comfortably and appears well, but his big brown eyes see you coming and immediately start welling up with tears. He’s sitting in his mom’s lap; he’s anxious and wants no part of you coming near him.

Sunday, March 5, 2017

Lean, Mean, ED Resident Machine: Resident Application of Lean Tools

Image Credit: Pixabay
Author: Thomas Damiano, MD
Christiana Care Health System
Originally Published: Modern Resident February/March 2013

One of the first responses when asked what field of medicine I practice following "that must be interesting work," undoubtedly becomes "the waits are awfully long." The demand for emergency services has far outpaced supply over the last two decades. Administrators across the country are looking to the Lean philosophy to help deal with ED operational improvement. From a Lean perspective, resident involvement in advancing ED operations is essential.

If one were to search "Lean," results mentioning Toyota, various courses offering black belts and attempts at definitions may quickly confuse the inquirer. Lean has nothing to do with sticking accelerator pedals (too soon?). Courses are not taught by Chuck Norris (although I would be the first to sign up). Rather, Lean is a term for a production philosophy with the central concept that the expenditure of resources for any goal other than adding value for the customer is wasteful and should be minimized. Lean involves various tools for operational improvement and seeks to foster "a community of scientists" to employ these tools.

Thursday, March 2, 2017

Family Presence During Cardiopulmonary Resuscitation – What’s the Policy at Your Hospital?

Image Credit: Wikipedia
This post was peer reviewed.
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Author: Jake Toy MSIII
Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, CA

The upper gastrointestinal bleed patient that I had been following since admission was in cardiac arrest in the intensive care unit. The resuscitation effort was routine; however, the presence of his family at bedside was new to me.

One initial concern lay with the patient’s observing family members in regards to the possibility of psychological trauma due to a limited capacity to understand or comprehend the resuscitation events. These concerns have been documented among the medical community and further include the potential for family member disruption and delay of resuscitation efforts, which may directly or indirectly influence treatment outcomes, and the notion of an increased frequency of litigation following family presence during resuscitation (FDPR).[1-3] However, little evidence substantiates these concerns.[1] Current literature suggests FDPR during both out-of-hospital and in-hospital cardiac arrest confers psychological benefits for family members regardless of treatment outcome.[4, 5] What’s more, multiple cohorts of surveyed patients wished their family member(s) to be at bedside should they need to be resuscitated.[6, 7]

Sunday, February 26, 2017

Cancer in the ED

This post was peer reviewed.
Click to learn more.
Author: Nicholas Pettit, DO, PhD
Indiana University

Next up on the board, a 55-year-old male with a temperature of 102.3, heart rate of 119, and blood pressure of 89/50. Sick versus not sick? Clearly sick.

After that, 45-year-old male, with a temperature of 100.1, heart rate of 110, and blood pressure of 120/80, and who is also a cancer patient. Sick versus not sick? Hard to tell, right?

Cancer is a frequent comorbid condition that presents to the emergency department (ED), and researchers are just now starting to demonstrate the association between emergency medicine and the outcomes for cancer patients. The most common symptoms that are brought through our doors are shortness of breath (23%), pain (18%), fever (14%), and nausea/vomiting (14%).[1] From the same study, the investigators found out that approximately 60% of the patients were admitted, 47% of patients subsequently died after admission to the ED, and the 1-year overall survival of all patients seen in the ED was 7.3 months.