A Crash Course in Sports-Related Concussions

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Author: Jennifer Reink, MSIV
Ohio University Heritage College of Osteopathic Medicine
AAEM/RSA Social Media Committee '16-'17

This post was peer reviewed.
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With school back in session and autumn just around the corner, the fall sports season is upon us, and where there are athletic competitions, there are bound to be concussions. Nearly half of all emergency department (ED) visits for concussions are sports related, with 4 in 1000 children ages 8 to 13 and 6 in 1000 children ages 14 to 19 presenting to the ED each year for a concussion sustained during an organized team sport.[1] Furthermore, sports are second only to motor vehicle accidents as the leading cause of traumatic brain injury among people ages 15 to 24.[2] From football and cheerleading, to swimming and basketball, each sport has its own risk for head injury. For those of us who find ourselves caring for these young beaten warriors, here is what you need to know about what makes sports-related concussions such a challenging diagnosis.

1) Clinical symptoms are often subtle and may manifest with immediate or delayed onset.

A concussion is defined as a disturbance in brain function caused by a direct or indirect force to the brain resulting in a disruption of neural membranes.[1,3] This leads to a variety of non-specific signs and symptoms. Although symptoms typically present immediately after injury, some may not appear until several hours following impact. There are even patients who present days later with delayed or worsening symptoms. Common manifestations of concussions include:[2,3]

Patient Satisfaction

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Author: Victoria Weston, MD
AAEM/RSA President '15-'16
Originally Published: Common Sense March/April 2016

Patient satisfaction. It feels like sometimes the concept is overemphasized, yet another addition to the countless expectations and constraints placed on doctors. I have felt this way at times, but recently my thinking has shifted. Instead of trying to meet arbitrary Press Ganey requirements, I have focused on trying to understand patients' wants and needs in order to better connect with them.

I recently had a shift with what seemed an unusually high number of patients with difficult personalities and “supratentorial pathology.”At times it was exceptionally frustrating, and although I started the shift feeling positive, by midway through the morning I could feel my spirits sinking. People had psychosomatic complaints. Some were drug-seeking and negotiating for narcotics. Some were demanding inappropriate care or tests. Some acted entitled and were rude to staff. I took this as a challenge, and tried to reframe my mind to see it as a learning experience in how to deal with difficult patients.

Bronchiolitis: Updated Guidelines

Image Credit: Wikipedia

Author: Ashley Grigsby, DO
Indiana University
Emergency Medicine/Pediatrics Residency

Originally Published: Modern Resident December 2014/January 2015

It’s that time of year again. Snow is starting to fall, holiday lights are going up and little babies are showing up wheezing in your emergency department. While babies sometimes make emergency physicians nervous, the treatment for bronchiolitis just got a little easier. The American Academy of Pediatrics recently updated their clinical practice guidelines; the last update prior to this was in 2006. These guidelines were updated to provide clinicians with the most recent evidence based management strategies.

Bronchiolitis is a viral illness caused by multiple viruses and occurs in 90% of children before the age of two. Bronchiolitis is a clinical diagnosis and as such, it does not require any testing to confirm diagnosis. Illness usually starts with rhinitis and cough, but can progress to respiratory distress.1 Exam frequently reveals tachypnea, mild retractions and expiratory wheezing.[2] Patients with more severe disease can have grunting, nasal flaring or severe retractions.[1] Assessment of these patients should include evaluation of hydration status, respiratory status, history of apnea, behavior changes and history of cyanosis.[2]

Standardized Residency Video Interviews: Benefit or Burden?

Author: Mike Wilk, MD
PGY-1, Brown EM

Forward: Please note that after submission of this article, the Standardized Video Interview Project was put on hold this year for further review by the AAMC. However, its implementation remains expected at a later date.

We are trained as emergency physicians to start evaluating patients from the moment we lay eyes on them. Sometimes referred as the “door test,” we assess, determine workups and consider possible dispositions from the moment we step through the door to lay eyes on our patient. Much like assessing patients, EM residency programs are looking for more efficient ways to rapidly evaluate future residents even before they are invited for an in-person interview. This year, medical students bound for an EM residency will have a new option to complete on their residency applications: the AAMC Standardized Video Interview.

What exactly will this video interview involve? When I first heard of the concept, I initially envisioned it to be a “personal branding” video where each student would have a minute or two to sell themselves. While this idea is exciting, I also envisioned medical students spending many hours perfecting this video, and even more burdensome, spending hundreds of dollars for professional videography. Basically, I imagined something similar to YouTube high school football recruiting videos, complete with pump-up music and special effects.

When Pneumothoraces Become Cyclic

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Author: Kaila Pomeranz, OMSIV
Midwestern University, Arizona College of Osteopathic Medicine

This post was peer reviewed.
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A 34-year-old Caucasian female presents to the emergency department with acute onset breathing difficulty and right-sided, stabbing chest pain. Physical exam reveals decreased breath sounds over the right hemithorax and chest x-ray confirms a right pneumothorax. This is her third occurrence of right-sided pneumothoraces.

What can be considered a cause of recurrent pneumothoraces?
Upon further questioning, the patient’s past medical history consists of clinically diagnosed endometriosis treated with NSAIDs. She has no history of asthma, COPD, chest injury, or history of smoking. The patient has no history of Marfan’s syndrome, which may increase the risk of pneumothoraces due to apical blebs or bullae.