Sunday, January 29, 2017

Medical Students and Nurses Can Make a Great Team

Image Credit: Flickr
Author: Scott Bland, MSIII Campbell University School of Osteopathic Medicine
AAEM/RSA Medical Student Council Southern Region Representative '16-'17

This post was peer reviewed.
Click to learn more.

In the medical realm, it is hard to go five minutes without hearing terms like “interprofessional,” “collaborative,” or “team based.” Many schools offer seminars intended to teach medical students how to interact with other professions. However, when we hit the floor for rotations, we sometimes struggle in our interactions with the largest of the health professions.[1] But nurses can be great allies in patient care and can really help a medical student transition into their clinical education. So here are a few tips on how to be a good team member with your nursing staff.

1. Treat others the way you want to be treated: If you are intentional about the quality of your work interactions, they will improve. Try to address people by their name. Be forgiving if they make a mistake. Say “please” and “thank you”.[2] If you ask a nurse to do something for your patient and they are busy, offer to help. One tip for how to phrase things is, “Mrs. Smith soiled her linens and needs them changed. If you are busy, I can go get the new linens and help you once I bring them to the room.” If the task is important, demonstrate that you are willing to get involved.

Thursday, January 26, 2017

Management of Atrial Fibrilation with Rapid Ventricular Response — Choosing Rate Control Wisely

Image Credit: Pixabay
Author: Nathan Haas, MD
University of Michigan Department of Emergency
Originally Published: Modern Resident October/November 2014

Atrial fibrillation (AF) with rapid ventricular response (RVR) is relatively commonplace in the ED, and practice patterns vary in how rate control is achieved. Presented below are different approaches to accomplishing rate control, broken down by medication class and clinical situation.


Big Picture: Calcium Channel Blocker Versus Beta Blocker
The mainstays for rate control agents include calcium channel blockers (CCBs), such as verapamil or diltiazem, or beta blockers (BBs), such as esmolol or metoprolol. Recent literature has trended towards favoring CCB from an overall standpoint, although the difference between the two classes is far from clear-cut.[1]

Sunday, January 22, 2017

Delivering Bad News

Image Credit: Pixabay
Author: Niklas Eriksson, MSIV
Loyola University Chicago Stritch School of Medicine
AAEM/RSA Social Media Committee

This post was peer reviewed.
Click to learn more.








A variety of patients present in the emergency department (ED), and every ED physician, resident, and even student will encounter patients in critical condition or life-threatening injuries. As a result, it is an essential skill for an ED clinician to be able to give bad news. One of the more helpful mnemonics I have learned and been able to apply when having to break bad news to patients or their families is SPIKES. This mnemonic is often used by oncologists, but can apply equally well in the more acute ED setting.[1,2]

S: Setting. Make sure you are in an appropriate setting to deliver the news. A private room with minimal noise interference is preferable. A recent study showed that there is a discrepancy between patient and physician perspective on the level of privacy achieved during these conversations, indicating that more emphasis could be placed on finding an appropriate setting. [2,3] Also recognize the importance of introducing yourself and your role.[3,4]

P: Perception. Ask the patient and/or their family what their understanding of the transpired events has been thus far. It may be that the patient has been suffering from a chronic disease and they have been preparing for their eventual death for a long time, or this may be a sudden and unexpected occurrence. Many times it may be better to be direct. Overall, keep in mind that every family has different experiences with their loved ones and their diseases that makes each encounter different.

Thursday, January 19, 2017

Residency Work Hour Restrictions: Is the Pendulum Swinging Back?

Author: Mike Wilk, MD
PGY-1, Brown EM
Originally Published: Common Sense January/February 2017

“I walked into the hospital on my first day of residency and didn’t walk out until 36 hours later. Those were the darkest days of my life, but I am the doctor that I am today because I went through that,” I still distinctly remember these words from one of my more senior physician mentors when our discussion turned to work hour restrictions. As I wondered how it was possible to physically stay awake for so long, there was no doubt in his mind that work hour restrictions were dampening the training experience of newly minted residents.

First instituted in 2003 and revised again in 2011, interns now “enjoy” an 80-hour work week restriction with a maximum shift length of 16 hours (PGY-2s and above are still allowed to work up to 28 consecutive hours). However, the pendulum may be swinging back on strict work hour restrictions as new research on the topic becomes available.

The event that led to work hour restrictions was the death of Libby Zion in 1984. An overworked medical intern on a 36-hour shift prescribed meperidine to the 18-year-old patient, who was on an antidepressant, the MAO inhibitor phenelzine. This drug combination is thought to have caused the serotonin syndrome, leading to Zion's death.

Sunday, January 15, 2017

Group Therapy

Author: Mary Haas, MD
AAEM/RSA President '16-'17
Originally Published: Common Sense January/February 2017

It was Monday night, and Halloween. It was the perfect storm of an ever-expanding waiting room and a revolving-door resuscitation bay occupied by sick patient after sick patient. Following an emotionally exhausting shift, I sat with some fellow residents at The Pizza House, a local late-night joint where we grab food after a shift, tell stories, and debrief in Ann Arbor. We often jokingly refer to these sessions as “group therapy.” The mood that night was more somber than usual, despite the roar of intoxicated college students at nearby tables dressed up like Pokémon trainers and Game of Thrones characters.

My co-resident shared the story of two young males who suffered cardiac arrest by drowning, after jumping into a cold lake to rescue their friends who, unknown to them, had already made it to shore after a boating accident. Another resident shared the story of a teenage boy who died after being struck by a car while crossing the street on his way to school. Another shared the story of caring for a mom who presented with pre-eclampsia, a few days after her infant was unsuccessfully resuscitated by another of our colleagues and died from SIDS. I had just cared for a man who suffered a massive intracranial bleed while going to open the door for a few trick-or-treaters. I looked his teenage son in the eye and tried not to well up with tears as I translated the findings of the CT within five minutes of meeting him. Suddenly, it made sense that we had been so eager to sit, relax, and have a beer together. We had certainly earned it, based on the events of the last week. All of us needed to talk to someone who would understand.

Thursday, January 12, 2017

Medical Education: The Confident but Incompetent

Image Credit: Flickr
Author: Michelle Mitchell MS-IV
Geisinger Commonwealth School of Medicine
Scranton, PA
Social Media Committee

This post was peer reviewed.
Click to learn more.

In 1995, a 44-year-old man named McArthur


Weeler devised the perfect plan to rob a bank. Wheeler knew (or supposedly knew) a lot about the chemical properties of lemon juice. As is taught in grade school science class, lemon juice can be used to create invisible ink. With this logic, Wheeler thought that by smearing lemon juice on his face, he would become invisible to the security cameras at the bank. He confidently walked into two banks in Pittsburgh, robbed them, and was promptly caught hours later when the security video aired on the news. When Wheeler was apprehended, he could not believe it. “But I wore the juice,” he puzzlingly mumbled.[1]

This story was the inspiration behind psychological experiments carried out by David Dunning and Justin Kruger of the Department of Psychology at Cornell University.[1] In essence, their question pondered, are the stupid too stupid to realize they are stupid? More eloquently, the article states:

“People tend to hold overly favorable views of their abilities in many social and intellectual domains. The authors suggest that this overestimation occurs, in part, because people who are unskilled in these domains suffer a dual burden: Not only do these people reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the metacognitive ability to realize it.”

Sunday, January 8, 2017

AAEM/RSA Congressional Elective: Be the Exception and Make the Rules

Author: Ashely Alker, MD, MS in Public Health
University of California, San Diego Emergency Medicine PGY2

Originally Published: Common Sense January/February 2017

Returning to Washington, D.C. at the end of my intern year, I am fortunate to be in a city filled with the familiar faces of old classmates. Sitting around the rooftop dinner table with old friends who were medical school classmates just a year ago, I realize how much has changed. What hasn't changed is how quickly time flies when we are together.

At our table of residents are an orthopedic surgeon, an OB/GYN, a pediatrician, a urologist, an anesthesiologist, and myself — an emergency physician. After attending medical school at George Washington University we pursued different specialties, but with the same goal: to serve patients.

Discussing the challenges of our intern year, we seem to have similar concerns about residency. We talk about the threat of repealing work hour restrictions, medical school debt burden, the amount of paperwork vs. resident educational time, and the lack of maternity rights for medical residents. We talk about how these policies affect us and affect patient care.

Thursday, January 5, 2017

Board Review: Traumatic Globe Rupture

Image Credit: Flickr
Author: Sophia Johnson, DO
Shane Sergent, DO
Conemaugh Memorial Medical Center
Originally Published: Modern Resident October/November 2014

A 32-year-old male presents to the ED after being struck in the right eye with a ball during a friendly tennis match. He complains of discomfort in the right eye, decreased visual acuity and nausea secondary to pain. Physical exam reveals periorbital ecchymosis, an irregularly shaped pupil and a shallow anterior chamber.

Patients may present with globe rupture after blunt or penetrating injury.[1] They may complain of pain in the eye or decreased visual acuity.[1] Maintain a high index of suspicion in patients who have any injury that may have penetrated the cornea.[1] This includes projectile objects launched while mowing the lawn, weed whacking or working with metal.[1] Blunt trauma to the eyeball or trauma with objects that impact the ocular rim and create a seal around the orbit can cause a rapid peak in intraocular pressure that ultimately leads to globe rupture.[1]