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

Dental pain is a common complaint in emergency medicine.  Often, it is seen as a non-emergent complaint and there is truth to that issue.  However, dental pain can be life threatening and has some key points we will discuss in this podcast.  The first step is to remember 3-2-1.

​2017 has been an intriguing year.  For the blog and podcast specifically, there have been many accomplishments.  Goals have been obtained faster than planned and we still are striving for even more success.  Today, we are talking about something that is not in medicine much but we see it elsewhere such as the military and firefighting: the after action review (AAR).  However, a traditional AAR can sometimes be difficult to perform at it takes a long time.  In critical events there is an abbreviated version known as the "hot offload" which is being promoted by some such as Ashley Liebig.  However, it is worth noting there are some key differences.

Working in emergency medicine is always a challenge, but when you work solo it can make you feel like a lone wolf.  In reality, there is always help somewhere.  New grad and EMPA Aaron Inouye is in a relatively unique scenario.  Not only does he work in the challenging environment of a single-coverage EM provider, he does so as a new graduate.  Listen to this interview no matter your career as you may find some fascinating pearls you were not expecting.

We are joined by a specialist in child abuse and neglect, Tom Balga, who is a fellow EMPA.  Child abuse and neglect is not a fun subject, but it is very important as we can truly change lives.  In this blog and podcast we cover some of the essentials that can be easily carried over to your next shift.

We hear plenty on the news about the opioid crisis, but we are hearing more and more about exposure to these opiates potentially harming first responders and even those in the emergency department.  It begs the question, how much is enough in regards to personal protective equipment (PPE)?

Risk management expert Kevin Klauer joins us today with some rapid fire documentation pearls.  We had a similar discussion focused on the MDM when we had Mike Weinstock on back in September.  Hopefully, we will have both experts (and others) back again in the future but this was a great talk focusing on some key pearls that we can all bring on the next shift.

​Practice makes permanent and only perfect practice makes perfect.  There have been recent conversations on "deliberate practice" which has hit FOAMed with Scott Weingart's interview of Anders Ericsson and subsequent posts.  This post is not going to delve in that topic, but rather how we should be teaching and training when it comes to procedures.

​There have been recent requests for further discussion of the neurological exam.  Specifically, how to do a brief neurological exam in the emergency department, how to perform a HINTS exam, and documenting the exams performed. 

We need to talk about something: misinformation.  Unfortunately, the world is full of it and we cannot seem to stop ourselves. The Internet was one of the greatest inventions brought forth to the modern world to allow for the rapid sharing of scientific information. We have bastardized it in time to now spread hate and grossly incorrect information. What was once a way to spread knowledge is now attacking science and what we have learned.

When we started last month's celebration of PAs for October, we discussed breaking bad news.  We were then going to expand on that discussion with reference to end of life discussions.  However, through some very unfortunate audio issues, we lost the original content in a way that made it so we could not present the original conversation.  However, Melodie Kolmetz was gracious enough to record it again on her own and we are presenting this for our newest post.

Technically, this is the last post for PA Month here on the podcast.  Fear not!  There will be more PAs on podcasts coming up.  However, we wanted to finish our discussion with Fred Wu since people may find this portion on contracts helpful in the immediate future.

Emergency Medicine PA Fred Wu is joining us to talk about starting and advancing a career in emergency medicine.  In this two-part series, Fred is reviewing the many aspects of emergency medicine careers from finding a position that will work well for you to signing a contract.

​We continue our month of celebrating PAs with a new podcast on a topic not well covered: triaging and assessment of the total joint arthroplasty (replacement) patient.  To help us, we have a special guest who is an orthopedic surgery PA named Amy Jean.

Our guest today (the first for PA month here on TOTAL EM) is Adrian Banning.  She is an Evidence Based Medicine (EBM) guru and is also on the JAAPA Podcast with a previous guest, Kris Maday.  Today though she is here to talk to us about breaking bad news.  Something most of us are experienced with but one thing few of us do well.  We combine EBM and "soft skills" to better care for our patients and families in this very difficult time.

PA Week is October 6-12 this year.  As PAs, we have a lot to be proud of in the 50 years of our existence but with our many advances, there still more we can do.  This month, we are hosting PAs for our podcasts.  However, to kick off the month, we are going to talk about the challenges that lay ahead.  It is worth noting though that much of it is now possible thanks to those who came before us.

Some of us do it well, some of us do not do it at all, but we all could use improvement.  The medical decision making (MDM) portion of the chart is one area we all can work on.  It is quite possibly the single most important portion of the chart for multiple reasons including acting as a "hard stop" in decision making, explaining course of care and management, reviewing highlights of the visit, and even potentially helping in a legal situation.  Today, we have Mike Weinstock joining us on this very important podcast.

We need to get better taking care of out patients.  One of the easiest ways to get better is to work both sides of the emergency medicine realm.  The main divide rests in the prehospital environment versus the emergency department.  We can still see this in the rural versus urban environment.  Our experiences in different realms can make us much better providers.

Today is a brief podcast about leaving the ivory tower.  As a PA or physician, we have to train at such a place but with time we will leave.  Not all nurses, paramedics, or others in such settings will ever see the "ivory tower" and may have their education only in rural environments or at least not at a tertiary care center.  The challenge for us becomes not only getting the medical knowledge, but also how to spread it.

​Today’s podcast is a little brief but covers and important topic: blood draws and patient’s rights.  This comes up due to a recent incident in Salt Lake City at University Hospital when a detective of the Salt Lake City Police Department arrested Alex Wubbels, a nurse there, when the officer attempted to collect blood for testing from an unconscious patient.

“Everyone has a plan until they get punched in the mouth.” – Mike Tyson Mental preparedness is not taught to us in emergency medicine or in healthcare generally, but it is something we are all doing to a degree.  However, we need to improve our abilities and expand on them to do our jobs better.  There are many approaches and everyone has their own style, but we will go over some approaches today to help improve your shifts and hopefully lead to you being a better clinician.​