Thursday, May 21, 2020

The Moral Dilemma of COVID-19

Image Credit: Pexels
Author: Andy Mayer, MD FAAEM
Editor-in-Chief Common Sense
Originally published: Common Sense
May/June 2020

Certainly, there is only one issue which is dominating all thoughts, prayers, and efforts on our planet right now and it is COVID-19. Hopefully where you are, your life and practice will only be incredibly inconvenienced and that your family, your community, and your hospital will be spared the worst of this pandemic. Many areas may be relatively spared by early social distancing and the shutdown of many aspects of daily life which until last month we took for granted. This crisis has brought to the forefront many ethical and moral dilemmas which our society and world need to face with open eyes and minds. Our medical capabilities in our modern prosperous society are currently been taxed past the breaking point in the hotspots of the COVID-19 pandemic. We need as a profession and as a society to consider the correct response to the complex and difficult decisions which physicians on the frontlines are now making or may eventually be facing where conditions are worse. Even if we manage to make it through this pandemic without running out of ventilators and do not lose too many talented and selfless healthcare professionals there may be a next time.

Friday, May 8, 2020

Avalanche Resuscitation in the Emergency Department

Image Credit: Wikipedia
This post was peer reviewed.
Click to learn more.
Authors: Vivek Abraham, MS4
Medical Student
Uniformed Services University F. Edward Hebert School of Medicine

Ivan Yue, MS4
Medical Student
Uniformed Services University F. Edward Hebert School of Medicine
AAEM/RSA Publications and Social Media Committee

Alexander Li, MS4
Medical Student
Uniformed Services University F. Edward Hebert School of Medicine

Avalanches are among the most feared events to occur in mountainous areas. Although the morbidity and mortality statistics are underreported worldwide, in North America and Europe combined there are roughly 140 avalanche-related deaths per year.[1,2] The majority of victims include snowboarders, skiers, mountaineers, and snowmobilers. With more people seeking to participate in snow sports or explore the mountains as part of expeditions, preparing to treat avalanche-related injuries is essential for an emergency physician working or traveling near a mountainous area. This article details the resuscitation guidelines that physicians can implement for those who fall victim to an avalanche as well as recommendations for mitigating avalanche exposure risk.

Sunday, April 26, 2020

Considerations for Your Social Media Presence

Image Credit: Pexels
Author: David Fine 
Medical Student Council President 
Originally published: Common Sense
March/April 2020

Should you create a professional social media account? What are the benefits and risks associated with this commitment? When applying for medical school, residency, or jobs are people searching for you on the internet? How do HIPPA, professionalism, and unspoken rules factor into your social media presence? My search for information has shown that many people are asking the same questions. There are a plethora of different resources that can help you make informed decisions.

The American Medical Student Association (AMSA) has created a set of 10 social media guidelines: be professional, be responsible, maintain separation, be transparent/use disclaimers, be respectful, follow copyright laws, avoid politics, protect client/patient information, comply with all legal restrictions and obligations, and be aware of risks to privacy and security (Keating 2016). These guidelines are vague, but this speaks to the potential for problems that you might face and the importance of thoughtful posting. Even on private accounts, posts that violate HIPAA and professionalism can result in punitive actions from your home institutions. There is often this discussion about ways that these forums can be negative, but there is a massive potential benefit that is much less often explained. 

Friday, April 17, 2020

Resuscitation Guidelines Updates: What You Need to Know

Image Credit: Wikimedia
Author: Kasha Bornstein, MSc Pharm, EMT-P, MSIII
University of Miami Miller School of Medicine MD/MPH Program
AAEM/RSA Modern Resident Blog Copy Editor

In late 2019, the International Liaison Committee on Resuscitation (ILCOR) released its updated guidelines for adult and pediatric resuscitation, informing the United States-based American Heart Association (AHA)/Advanced Cardiac Life Support (ACLS) focused protocol update.[1]

Significant changes this year in ILCOR recommendations focus on:

- Vasopressor use
- Advanced airway interventions and extracorporeal cardiopulmonary resuscitation (ECPR) in adult and pediatric cardiac arrest
- Targeted temperature management (TTM) in pediatric cardiac arrest This short article will address the salient details regarding each of these updates. Vasopressor Use Epinephrine, the old standby for the all-cause pulseless patient, has undergone significant review in recent years. Multiple large-scale retrospective and placebo-controlled randomized-controlled prospective studies have probed the efficacy and safety of epinephrine in cardiac arrest.[2,3] The majority of these studies find that while epinephrine may increase return of spontaneous circulation (ROSC), the effect size is small versus placebo and no difference is seen in favorable neurologic outcome. Many aspects surrounding best practices in epinephrine use remain unknown. These include optimal timing for administration in patients with shockable rhythms, efficacious dosing, and dose/effect relationships. However, alternative interventions are limited, overall survival for patients with non-shockable rhythms (asystole, pulseless electrical activity) is low, and no other pharmacologic intervention has demonstrated improved ROSC in these cases.

Friday, April 10, 2020

Human Trafficking: Identification and Treatment Tools for the Emergency Physician

Image Credit: Pexels
Authors: Maryam Hockley, MD MPH, Erin Hartnett, BS BA, Gregory Jasani, MD
Originally published: Common Sense
March/April 2020

Human trafficking (HT) affects over 21 million people worldwide¹, with 600,000-800,000 persons being trafficked annually across international borders, approximately half of whom are younger than 18 years old.² Closer to home, roughly 18,000-20,000 trafficking victims are brought into the United States every year, and this number does not count victims already within our borders.³ Its victims are not confined to a certain age, race, gender, sexual orientation, or socioeconomic level, and it is this level of pervasiveness that makes signs of HT difficult to identify. Vulnerable populations include those in the child welfare and juvenile justice systems, runaway and homeless youth, unaccompanied children, American Indians/Alaska Natives, migrant laborers including undocumented workers and temporary workers on visas, foreign national domestic workers in diplomatic homes, those with limited English proficiency and low literacy, disabled peoples, LGBTI, and those in court-ordered substance use programs.⁴ The International Labor Office estimates that 44% of all HT victims worldwide had migrated either within or across international borders prior to being put into forced labor.¹ The nature of human trafficking often leads to both physical and emotional harm for the victims, as it relies upon the coercion of a person into such an exploited role. As a result, an article by emDocs estimates that as many as 88% of victims will seek medical care during the time that they are being trafficked, oftentimes in an emergency department. However, their studies have also shown that as few as 5% of emergency medicine providers feel comfortable identifying and treating victims of HT.⁵ This unique encounter, however, offers emergency medicine physicians an invaluable opportunity to intervene in these victims’ lives. Improving this statistic represents a crucial opportunity to increase awareness and understanding of the potential role we can play in these patients’ lives.