Chronic Pain and Addiction Patients Need Us Now More Than Ever

Image credit: Pexels

Author: Shane A. Sobrio, MD
Originally published: Common Sense
March/April 2021

Flashback to 2019. Hong Kong protests were raging on, the U.S. Women’s National Team won the world cup, Donald Trump was being impeached, and the health care battle continued to revolve around the opioid epidemic. It wasn’t necessarily easy, but it was familiar. Practices were being implemented to help prevent reckless opioid prescribing and increase availability of naloxone which, to an extent, were working. Flash forward to 2020, the year of the COVID-19 pandemic. Millions of people worldwide now dead from a novel respiratory virus and opioids are a distant memory, no longer causing the problems they used to, right? Unfortunately, not right at all.

The Brink of Burnout

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Author: Ryan P. Gibney, MD

Originally published: Common Sense
March/April 2021

It definitely felt different this new year. The normal buzz around town, packed stores, twinkling lights, and family gatherings uncharacteristically muted as compared to years past. I noticed a profound change in the hospital starting in mid-November: the winter chill was ever present in the air, while families prepped for the upcoming holidays in uncertainty. It started as a trickle three or four critically ill patient’s per day—COVID and others—but quickly became evident that the levee holding back the flood of patients was about to break. Over the course of two weeks, I saw the volume expand from a few sick COVID patients to every other patient coming in at the brink of complete respiratory failure, clinging to each breath, struggling to speak any words. Time and time again, I would ask a single family member to say their goodbyes while I prepared airway equipment and counseled families and patients that I was concerned and this may be the last time they speak to their loved ones. Tears and fear filling the eyes of patients and their family, quivering lips hidden behind flimsy masks, screaming, and hand holding had become the pre-intubation ritual I was now performing countless times per day. It is incredibly difficult. 

Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

Authors: Taylor M. Douglas, MD; Taylor Conrad, MD MS; Wesley Chan, MD; and Christianna Sim, MD MPH
Editor: Kelly Maurelus, MD FAAEM and Kami Hu, MD FAAEM

Most, if not all, emergency medicine clinicians are familiar with massive transfusion protocols (MTP), which were developed to create a systematic method for the administration of large volume resuscitation for hemorrhagic shock. The evidence behind these protocols and how they were developed, however, are less well known. First seen in military trauma settings, MTPs have been translated to civilian patients with the supporting evidence to do so following behind their application.1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 Here we examine some of the evidence behind the various components of MTPs, specifically calcium and factor VIIa, and the ratios in which the main products of red blood cells, plasma, and platelets should be administered.