Sunday, December 31, 2017

Wellness and Resiliency Summit

2017 Wellness and Resiliency Summit
Authors: Ashely Alker, MD, AAEM/RSA President 2017-18 and Robert Lam, MD FAAEM, AAEM Wellness Committee Chair
Originally published: Common Sense May/June 2017

Emergency medicine has historically had the highest rate of reported burnout among all specialties. In the 2017 Medscape Lifestyle Survey, 59% of emergency physicians self-identified as “burned out.” A survey conducted by the University of North Carolina-Chapel Hill showed that approximately 70% of residents met criteria for burnout. In one survey residents were asked about their quality of life, and 15% reported “life is as bad as it could be.”

In January, for the first time ever, all national emergency medicine organizations convened in Dallas for an Emergency Medicine Wellness and Resiliency Summit. In a spirit of collaboration, wellness champions and emergency medicine leaders came together to find solutions for the ongoing crisis in physician wellness and resilience. In attendance were representatives from the Council of Emergency Medicine Residency Directors (CORD), American Academy of Emergency Medicine (AAEM), Society for Academy of Emergency Medicine (SAEM), Association of Academic Chairs of Emergency Medicine (AACEM), American College of Osteopathic Emergency Physicians (ACOEP), Accreditation Council for Graduate Medical Education (ACGME), AAEM Resident Student Association (AAEM/RSA), Emergency Medicine Residents’ Association (EMRA), American College of Emergency Physicians (ACEP), American Board of Emergency Medicine (ABEM), and the American Hospital Association (AHA).

Thursday, December 28, 2017

Update on Mechanical Ventilation in the ED

Authors: Robert Brown, MD; Adeolu Ogunbodede, MD; Megan Donohue, MD; Hannah Goldberg, MD; Erica Bates, MD
Editors: Michael C. Bond, MD FAAEM; Kelly Maurelus, MD FAAEM
Originally Published: Common Sense November/December 2017

An increasing number of ED patients require critical care time and ICU admission.1 The ED length of stay for these patients has increased by 60 minutes and the median boarding time is now over five hours with nearly a third of patients waiting more than 6 hours.[1,2] Mortality of critically ill patients, including mechanically ventilated patients, in the ED correlates with increased ED length of stay.[3] Instead of just making the decision to intubate, ED physicians must now manage ventilators for critical hours. This review discusses some of the risks, best practices, and future directions of ED ventilator management.

Sunday, December 24, 2017

Young, Black & A Doctor: The Job Search

Image Credit: Common Sense
Author: Joshua A. Sherman, MD
Clinical Faculty, Department of Emergency Medicine, Advocate Christ Medical Center
Originally published: Common Sense November/December 2017

My story isn’t unique, but that in and of itself makes it worth writing. My name is Joshua Sherman; a New Orleans native, Chicago transplant and newly-minted Attending Emergency Physician in a busy Level 1 Trauma Center on Chicago’s south side. I, like most everyone reading this, spent seemingly endless years, days and hours in pursuit of this career and have yet to stop replaying in my mind the feeling that I felt as I walked across the stage on June 8th, 2017, to receive my final ‘diploma’ (aka residency completion certificate). It was the uncertainty of the months immediately before and after this date, however, that have continually been at the forefront of my thoughts and that, ultimately, contributed to my desire to write this.

Thursday, December 21, 2017

Dying to Save Lives

Image Credit: Pixabay
Author: Ashely Alker, MD MSc, PGY-3
2017-18 AAEM/RSA President
Originally Published: Common Sense November/December 2017

I remember the day I was accepted to medical school. It was one of the happiest days of my life. The first six months of medical school I fought against the imposter syndrome that plagued my incredible reality: I was going to be a doctor. To this day I feel privileged to do my job.

The only match to the privilege of being a physician is the challenge. The immense responsibility for human life, sleep deprivation, and loss of balance are challenges that plague all physicians. I have questioned my career choice and even considered quitting. And just as studies have shown that diabetes, hypertension and hyperlipidemia are risk factors for coronary artery disease, the stress, isolation, and sleep deprivation of the physician lifestyle are a perfect storm of precursors to depression.

Sunday, December 17, 2017

Updates in Geriatric Emergency Medicine

Authors: Phillip Magidson, MD MPH; David Bostick, MD MPH; Erica Bates, MD; Robert Brown, MD
Edited by: Jay Khapde, MD FAAEM and Michael C. Bond, MD FAAEM

Between the 2000 and 2010 U.S. Census, the population over age 65 increased at a higher rate that the overall U.S. population. For the purposes of this article, we will use age greater than 65 as the definition of a geriatric patient. By 2050, there will be over 83 million geriatric Americans, double the number from 2012.1 Currently, over 15% of emergency department (ED) visits, equaling 20 million total visits, are from geriatric patients.2 These numbers are certain to increase and will represent a unique challenge to the U.S. health care system, specifically to the ED. In this month’s “Resident Journal Review,” we focus on the evaluation, diagnosis, and treatment of geriatric patients presenting to the ED.

Thursday, December 14, 2017

Anaphylaxis in a Nutshell

Authors: Eli Brown, MD; Kaycie Corburn, MD; Jacqueline Shibata, MD; Lee Grodin, MD
Edited by: Jay Khadpe, MD FAAEM; Michael Bond, MD FAAEM
Originally Published: Common Sense January/February 2015

The emergency department (ED) is the most common place for treatment of anaphylaxis. While epinephrine is clearly indicated, the Emergency Medicine Practice Update Guidelines of 2011 state, “Despite a unified consensus around epinephrine as first-line treatment, patients are more likely to receive corticosteroids and antihistamines.” Prospective randomized controlled trials comparing medications for the treatment of anaphylaxis in humans are lacking, thus guidelines are based primarily on theory and anecdotal evidence. This summary examines various therapies and evaluates recommended ED observation times and dispositions.

Sunday, December 10, 2017

The Adult Learner Part 2: Where the Mark is Moving

Image Credit: Pixabay
Author: Andrew Phillips, MD
Originally Published: Common Sense September/October 2017

Last month we explored the arguments for and against adult learning theory. We began with medical educators’ attraction to the subject, evaluated the philosophical and psychological concepts behind it, and concluded that it is unlikely that there is a difference in how adults and children learn, making learning theories specific to adults unproductive for learner and educator alike. In this article we will evaluate the alternatives that are most popular and best supported in cognitive and educational psychology, and that have early support in medical education literature.

Thursday, December 7, 2017

Toxicodendron Dermatitis

This post was peer reviewed.
Click to learn more.
Image Source: Wikimedia
Authors: Taraneh Matin, DO & Daniel Leiva, DO
Larkin Community Hospital and Baystate Medical Center

Exposure to species in the genus Toxicodendron accounts for the most common cause of plant-induced allergic contact dermatitis in the United States and more plant-dermatitides than all of the other families of dermatitis-causing plants combined.[1,2] This exposure is a common complaint seen in the emergency department with an estimated 25-40 million people affected every year.[3] Of note, Rhus dermatitis is an antiquated term for these dermatitides; members of the genus Rhus do not cause dermatitis.

The significant members of the Toxicodendron genus include poison ivy, poison oak, and poison sumac.[4] While it is possible to find these in many areas of the United States, they are not found in deserts, rainforests, or at altitudes higher than 1500 meters.

Sunday, December 3, 2017

International Emergency Medicine

Image Source: Pixabay
Author: Ryan Shanahan, MD
2010-2011 AAEM/RSA President
Originally Published: Common Sense Spring 2011

I recently returned from a trip to Haiti with a group of pediatric residents from Johns Hopkins. The person who runs the trip is a pediatric emergency medicine attending, and she invites the
emergency medicine residents along. It was, in short, an eye-opening trip. It also caused me
to reflect on the fledgling field of international emergency medicine and, in doing so, I want to
highlight some of the efforts of the Academy in this regard.

To say that Haiti has a health care system is to stretch the definition of those words. To say that they have an emergency medical system would simply be false.