Carotid Doppler Ultrasound and Passive Leg Raise to Predict Fluid Responsiveness

Image Credit: Wikimedia

 

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Author: Jake Toy, DO
PGY1 Emergency Medicine, Harbor UCLA Medical Center
Modern Resident Blog Editor-in-Chief

Background
The management of intravascular volume in critically ill patients is a challenge we face daily in the emergency department (ED). Since the beginning of our training, hypotension and shock have often been synonymous with rapid fluid resuscitation. Yet at present, fluid resuscitation remains largely empiric in nature.

Be Aware of the Stoic Man

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Author: Taylor Brittan, MSIV
University of Queensland-Ochsner Clinic
AAEM/RSA Education Committee

Introduction
There are several patient populations to which we are attentive so as not to miss a diagnosis in the context of an atypical presentation. Typical cases include the elderly, female, diabetics, or those with HIV.[1,2,3] I contend that there is another group which we should assess with even more caution—the stoic man.

Burning Both Ends of the Candle

Image Credit: Common Sense

Author: Faith Quenzer, DO
AAEM/RSA At-Large Board Member
Originally Published: Common Sense July/August 2018

I wasn’t out of the woods yet. After the birth of my first child, my son would keep me up every two to three hours a night. This was not what I imagined life to be as a mother. Additionally, I was out of the department for several months taking time off and doing outside rotations. However, I was struggling to keep things together at home and in the emergency department during shifts. Balancing life inside and outside the home was difficult until my working husband and I got extra help. My mom helped watched my son until he was 10 months old. My husband worked from home two days of the week, but his work was based primarily in San Diego. This still was too much for everyone. So we decided to use my residency income to pay for daycare five days per week. “Finally, a break.” I thought to myself.

Fast forward a year, my father goes to see a cardiologist for his persistent dyspnea he has had for several months. I had bugged him about it for a while and he agreed to see someone at the hospital where I work. Finally, we figure it out; his heart has an ejection fracture of 15%. My hopes could not sink any further than the depths of the sea. The cardiologist decided to take him to cardiac cath lab and I, as the both daughter and the doctor in the family, took a deep breath and braced myself. I noticed the cold temperature of the cardiac cath suite as the cardiologist prepped and draped. Dad is out with a touch of Versed and the dye squirted in and very slowly trickled through the brittle appearing arteries.

Find Your Power Ballad

Image credit: Pixabay

Author: Aaron C. Tyagi, MD
Originally Published: Common Sense July/August 2018

The ED is a naturally stressful environment, where sensory overload is the norm. At any given moment, you can simultaneously be handed two stat EKGs while receiving an EMS refusal and have a consultant return a page. As a senior resident, I have taken to reflecting on this and how I will approach this in my own independent practice going forward. In doing so, I have found that I have already subconsciously been finding my own ways of mitigating my own stress. One of my favorite methods of doing this on-shift is music.