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.

Friday, April 3, 2020

Resident Journal Review: Assessing Fluid Responsiveness in the Emergency Department Part II

Authors: Taylor Conrad, MD MS, Taylor M. Douglas MD, Ted Segarra, MD, Rithvik Balakrishnan MD, Christianna Sim, MD MPH Editor: Kelly Maurelus MD FAAEM, Kami Hu MD FAAEM
Originally published: Common Sense
March/April 2020

Clinical Question
What methods are most effective at determining if a patient will be fluid responsive?
The most recent Common Sense Resident Journal Review article looked at the utility of ultrasound to accurately assess fluid responsiveness in the Emergency Department (ED). In this article, we attempt to look at other modalities that ED physicians may use to quickly determine how patients with various etiologies of hypotension and shock respond to fluid. Initial intervention often involves a fluid bolus of varying amounts to determine if increasing preload can improve the patient’s hemodynamic status along the Frank-Starling curve1,2. Other factors affect the patient's hemodynamics, however, including systemic vascular resistance and the contractility of the myocardium. Vital signs and the rest of the physical exam are inadequate in determining response to fluid and persistent hypotension may represent alterations in these other factors3. Invasive measurements of a patient's hemodynamic status can be performed with insertion of Swan-Ganz catheter but its lack of proven benefit in the ED and associated potential complications has led to a decline in its use5. As such, patients often receive varying amounts of fluid by ED providers, which often comprises a large amount of the initial resuscitation volume. As it has also been established that a positive fluid balance is associated with a variety of negative effects and worsened patient outcomes, identifying means to help avoid unnecessary fluid administration is crucial.2,6