The Difficult Situation

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     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.

Pediatric Breath Holding Spells

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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.

Scapulothoracic Disassociation: A Rare and Devastating Injury

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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. 

Diagnosis
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] 

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.

Personal Learning Networks

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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.”

Point-of-Care Ultrasound

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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.

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.

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: http://www.aaemrsa.org/get-involved/residents/program-director-of-the-year-award

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:

• Hannah Wolsiefer-Leak, MSIV, Indiana University
  http://aaemrsa.blogspot.com/2017/02/aaemrsa-medical-student-scholarship_16.html
• Yasmeen Elmelige, MSIV, Morehouse School of Medicine:
  http://aaemrsa.blogspot.com/2017/02/aaemrsa-medical-student-scholarship.html

For information for medical students to apply next year visit: (http://www.aaemrsa.org/get-involved/students/medical-student-scholarship)