Total Em - Tools Of The Trade And Academic Learning In Emergency Medicine

​Recently, the Surviving Sepsis Campaign (SSC) launched their 2018 update.  Although sepsis bundles have been brought up in the past, they are now pushing the limits by introducing a revised “hour-1 bundle” with the initiating time starting in triage.  Initially, this may not seem like a big deal, but there are significant implications.

Patients die.  It is a reality we all must face.  But what happens after you call the code?  This is when you may meet a death investigator such as Darren Dake.  He hosts the popular Coroner Talk website which has a weekly podcast.  After being invited to come onto his show, we wanted to share the conversation on our site to both help promote his work and to discuss some of the key points we can do to help facilitate a death investigation.

Fritz Fuller has been gone for a while but joins us for a discussion of lung ultrasound with its application specifically for pneumothorax.  This is probably something you have learned or at least heard of before, but rarely does an introductory course get into the details we are going to discuss in this post.

Our friendly evidence based medicine (EBM) PA guru, Adrian Banning, joins us again to talk about being a lifelong learner.  It is a "hot topic" for PAs and other medical providers, but what does it actually mean and how do we become a lifelong learner?  To help us with these questions and more, Adrian joins us for a detailed discussion.

Did you know that many of the aircraft that are being used in helicopter emergency medical services (HEMS) in the United States are not using advanced safety features that could help save the lives of crews and patients in an accident?  We are joined today by Karen Mahany who has taken it upon herself to make a real change when it comes to safety in HEMS.

​It is so tempting to want to share stories of the things we see, especially in emergency medicine.  Maybe we just want to tell the world about something strange, or maybe we are being more innocent and want feedback or to answer questions.  However, patient confidentiality is a major issue and in the United States specifically we run into the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Our guest, Eric Steffel, is a paramedic that reached out wanting to discuss active exhalation.  It goes by many other names including "external chest compressions" or "lateral chest compressions" as some sources have indicated.  We decided not to use the term "compression" though because this can quickly lead to someone thinking this is a chest compression similar to what is performed in cardiopulmonary resuscitation (CPR).  Eric prefers "active exhalation" and (understanding its potential limitations) is what we use for this podcast to define this procedure.

​There is also some source of news out there that is contributing to misinformation.  As we have talked about before, misinformation is a daily presence but usually we can quickly fact check a source.  Most of these are from sources where the credibility is already questionable.  However, what happens when a major media source misrepresents information in a way that is potentially damaging to medicine and the patients we care for?

We have Tyler Christifulli from FOAMfrat back on to discuss two acronyms (we each developed one) for post-intubation agitation and sedation.  We also talk about the utility of acronyms in general.  As a fair warning, there is some explicit language in the podcast itself.  However, this is not only a great post but is entertaining and sure to help you better understand the topic.

Building off of our last post with Harrison Reed talking about communication, we are moving to a very similar and related topic this time talking about cognitive stop points with paramedic Tyler Christifulli.  He also has his own blog and podcast called FOAMfrat and one we have actually featured on our website.  Our next post will also have Tyler back discussing acronyms and how they tie in with these cognitive stop points so make sure to check that, as well.

Critical care PA Harrison Reed joins us to discuss communication in critical care resuscitation by breaking it down into phases along with talking about the pearls and pitfalls when it comes to these challenging situations.

​Fever can be scary.  It brings in many parents and even adults no matter the time of day.  However, there is a lot of misinformation regarding fevers which brings about this important discussion.  Using available evidence, we are going to talk about fevers and some of the main myths versus the actual evidence.  As always, with topics like these, it is worth remembering that this does not replace clinical judgment and is meant to be informational.  Any time there is concern, it should be appropriately evaluated and managed.

​Every time we transfer the care of a patient, we are performing in many ways a high risk maneuver.  It is so second nature to many that we do not think about the risks.  However, according to the Joint Commission up to 80% of serious preventable medical errors are attributed to poorly communicated handoffs.  It begs the question, how do we better transition the care of patients within the emergency department (ED).

We are medical professionals and we want to help our family and friends as much as we help our patients.  However, there is a real challenge to balance how you help a family member or friend when they have medical questions or concerns.  After all, most likely you are not their primary care provider (PCP).

​Most of us are having issues with using opiates in general given problems with misuse and abuse.  However, more recently we are experiencing significant shortages.  We discuss some key articles in recent literature (almost exclusively 2017) to help discuss alternatives to using opiates in pain control.

​We are no stranger to controversial subjects here at TOTAL EM, but one that already has a significant division in emergency medicine is the use of pelvic exams.  Most people fall into one of two camps: to do one, or not to do one in the event of vaginal bleeding.  The big factor in more recent medical history has been with the availability of ultrasound to supplement or fully replace the pelvic exam.  Michelle Perkins, who has co-authored some of our most well visited posts, joins us in this discussion.

​​Night shift can be rewarding and some of us choose to do it all the time.  There is little to no administration, the crew tends to be more relaxed (but obviously place variant), the cases can be a bit more interesting, the patients are very different from the daytime (both good and bad), and it can there are the small things that is hard to list but you can truly appreciate with time (watching meteor showers and shopping while the rest of the world is asleep) are only a few of the bonuses.  However, it also has its challenges and it is hard to get into the routine.  We discuss some tips from friends, other media, and research in this review.

​What do you do when the dead are awake?  It is confusing terminology, but patients may develop consciousness and be alert during cardiac arrest while receiving chest compressions.  In the literature, this is often reported as cardiopulmonary resuscitation induced consciousness (CPR-IC)  The phenomenon is overall rare but reports are increasing with time.  In this blog and podcast we talk about how to manage such patients.

Most of us working any length of time in emergency medicine are either familiar with or perform the (extended) Focused Assessment of Sonography in Trauma (eFAST).  Some keep with the original FAST exam which does not include the lungs, and we will talk more about why you want to include the lungs in a separate podcast.  However, after having just returned from 2018 AASPA Conference where we taught participants about many clinically important exams, there were some details of the eFAST that simply could not be covered simply due to time.  This podcast is devoted to providing some quick tips to improve your exam no matter your practice level.

Back in April 2017 we went to SEMPA 360 and we have been saving some pearls just for a reminder of what SEMPA can offer when it comes to a conference.  The long wait is over and to help support our SEMPA friends we have an interview of some quick pearls from expert Robert Dachs.