SBO: Seize Back Onus – Focus on POCUS.

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Authors: Ahmed Mamdouh Taha Mostafa, MD; Kevin C. Welch, DO; and Max Cooper, MD RDMS

Originally published: Common Sense
January/February 2021

Case
A 76-year-old female with a past medical history of hypertension, obstructive sleep apnea, diverticulitis, fibromyalgia, osteoarthritis, depression, and renal cell carcinoma status post remote nephrectomy who presented to our ED with four days of intermittent, diffuse, crampy abdominal pain associated with nausea and non-bloody, non-bilious emesis, hiccoughs, and inability to tolerate PO.

On examination, vital signs were temperature of 98.3º F, pulse of 108 bpm, respiratory rate of 15, blood pressure 146/91 and oxygen saturation of 97% on room air. Significant findings on examination were mild, diffuse tenderness over the abdomen on palpation, which was soft, positive for bowel sounds on auscultation. Bedside ultrasound performed showed keyboard sign - plicae circularis on the interior aspect of the jejunal wall, “to-and-fro” motion, and dilated bowel loops raising suspicion for small bowel obstruction (SBO), which was confirmed by CT.

How to Be a Great Senior Resident

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Author: Alexandria Gregory, MD – AAEM/RSA Editor, Common Sense

Originally published: Common Sense
January/February 2021

Four months after the beginning of second year, I still feel weird being called a “senior resident.” It feels like just yesterday I was the intern, lowest on the totem pole, learning to navigate the flow of patient care and the ED. I didn’t expect July 1st to feel any different than the days prior when I walked into my shift, but I was wrong. Suddenly, it felt as if my attendings trusted me more, and now there were more junior doctors seeking my advice regularly. I am lucky to be at an institution that encourages independence and leadership early on, so even at the beginning of PGY-2, we are working senior shifts and running critical care pod shifts, helping to supervise interns and medical students while in those roles. Even in just a few months, I have learned a lot about what makes for a great senior resident and the qualities I hope to emulate. A great senior resident:

Resident Journal Review: End-Tidal Carbon Dioxide Monitoring in Cardiopulmonary Resuscitation

Authors: Christianna Sim, MD MPH; Taylor Conrad, MD MS; Taylor M. Douglas, MD; Wesley Chan, MD

Editors: Kelly Maurelus, MD FAAEM and Kami Hu, MD FAAEM

Originally published: Common Sense
November/December 2020

Question: How can end-tidal carbon dioxide (ETCO2) monitoring guide our management of cardiac arrest?

In 2010, the American Heart Association (AHA) revised the Advanced Cardiac Life Support (ACLS) guidelines to include the recommendation of using capnography to monitor end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR),¹ and has continued this recommendation to date. Measured ETCO2 during cardiac arrest is a measure of the cardiac output generated by chest compressions but is affected by various other factors including endotracheal tube complications, ventilation, and medications administered. These issues notwithstanding, studies supporting ETCO2 as a surrogate marker of cardiac output outside of cardiac arrest^2,3 indicate that ETCO2 could be a non-invasive, more readily available means of providing feedback in real time during resuscitation efforts. Previous studies have shown that low (<10 mmHg) ETCO2 values during resuscitation are predictive of mortality^4,5,6 and that initial, average, and final ETCO2 are higher in successfully resuscitated patients^7,8 and there is an emerging possibility that ETCO2 could possibly even predict survival to discharge.^7,9 Here we review some of the more recent literature regarding the use of ETCO2 during CPR and evidence on how it can guide resuscitation efforts. 

Virtual Insanity: Adapting Curriculum to the Virtual Environment

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Author: Ryan Gibney, MD
AEM/RSA Editor
Originally published: Common Sense
November/December 2020

The sun peaks over the bay, as the crispness evaporates from the morning air to greet, what — in any other normal time — would be the start of a new school year. The traditional morning routine of packing lunch, gathering supplies, and a haphazard scurry to the front door to make it to class on time, has all but disappeared. The start of a new school year as a parent has brought a new face to education across the board. In my home, we have set up a dedicated learning space for both my daughter and I, complete with paper, pens, computers, reference books, and any other tool that may be needed. As I watch my daughter dive into the realm digital learning, I wonder how this generation is going to adapt. How are they going to apply their knowledge? Is this the new norm for education (please, God I hope not)? More importantly, how will the lack of social interaction shape her future? It has been shown that peer education with regards to emotional resiliency, empathy, and problem solving, are attained through social interactions. I believe that the same is true in medical education.

Top 10 Most Read Posts of 2020

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As 2020 comes to an end, we look forward to recognizing the year’s top 10 articles! Join me in congratulating this amazing group of authors at all levels of training and from across the United States!

Additionally, I would like to thank each of the AAEM/RSA Modern Resident Blog authors, reviewers, mentors, and editorial staff members for their tireless contributions to the blog. Without all of them, the blog would not be what it is today. Thanks for a successful 2020!

We are currently accepting articles for 2021 and are always looking for additional faculty mentors as well. Feel free to contact us at info@aaemrsa.org with questions.

Sincerely,

Alex Gregory, MD
Editor-in-Chief
AAEM/RSA Modern Resident Blog