Tactical Medicine News Blog

Last week, we launched season 3 of the ALiEM MEdIC series and it sure took off! The Case of the FOAM Promotion brought together learners, teachers, and colleagues from across many disciplines to discuss promotion and the conversation nicely evolved to include a discussion of life goals and self-evaluation. We are now proud to present to you the Curated Community Commentary and our 2 expert opinions. Thank-you again to all our experts and participants for contributing again this week to the ALiEM MEdIC series.

I was recently invited by Rick Body and Natalie May to speak at the Royal College of Emergency Medicine (RCEM) Meeting in Manchester, England, September 2015.  The topic was “The Essence of Emergency Medicine.”  I was allotted 20 minutes to give this talk and in my mind I immediately thought about two questions: How am I supposed to talk about the essence of EM in 20 minutes? What is it that we really do in the emergency department on a day to day basis? So instead what I did, was make an executive decision to change the lecture to something slightly different.  I figured we could talk about the modern day superhero.  When you think about it, some of the things we are asked to do in the first 20 minutes of a patients care, truly are superhuman. Now when we were kids, many of us wanted to be superheroes.  How many of us tied a table cloth or towel around our necks like a cape?  Well, to me emergency medicine is one of the closest things to a  modern day superhero.  So instead of the essence of emergency medicine, I gave a talk on the five powers of the modern day superhero.  To me, these are the things that encompass the essence of EM and our initial care of patients.

“Can you help me? I have a patient who is what I like to call, a kid at heart,” asked one of our ED adult nurses. As we walked to the adult side of the ED the nurse let me know that this patient had intellectual and developmental disabilities (IDD). The adult patient required IV access and had already been poked a few times. Although I do not often work with adults, I knew that remembering a few key Child Life principles could help us care for the patient.

Most of us in North America live in cultures that almost never talk about death and dying. And medical progress has led the way to a shift in the culture of dying, in which death has been medicalized. While most people wish to die at home, every decade has seen an increase in the proportion of deaths that occur in hospital. Death is often seen as a failure to keep people alive rather than a natural dignified end to life. This is at odds with what a lot of people actually want at the end of their lives: 70% of hospitalized Canadian elderly say they prefer comfort measures as apposed to life-prolonging treatment, yet as many as ⅔ of these patients are admitted to ICUs. Quality End of Life Care in Emergency Medicine is not widely taught. Most of us are not well prepared for death in our EDs – and we should be. There’s no second chance when it comes to a bad death like there is if you screw up a central line placement, so you need the skills to do it right the first time. To recognize when comfort measures and compassion are what will be best for our patients, is just as important as knowing when to intervene and treat aggressively in a resuscitation. Emergency physicians should be able to recognize not only the symptoms and patterns that are common in the last hours to days of life, but also understand the various trajectories over months or years toward death, if they’re going to provide the high quality end of life care that patients deserve. So, with the help of Dr. Howard Ovens, a veteran emergency physician with over 25 years of experience who speaks at national conferences on End of Life Care in Emergency Medicine, Dr. Paul Miller, an emergency physician who also runs a palliative care unit at McMaster University and Dr. Shona MacLachlan who led the palliative care stream at the CAEP conference in Edmonton this past June, we'll help you learn the skills you need to assess dying patients appropriately, communicate with their families effectively, manage end of life symptoms with confidence and much more... The post Episode 70 End of Life Care in Emergency Medicine appeared first on Emergency Medicine Cases.

Most of us in North America live in cultures that almost never talk about death and dying. And medical progress has led the way to a shift in the culture of dying, in which death has been medicalized. While most people wish to die at home, every decade has seen an increase in the proportion of deaths that occur in hospital. Death is often seen as a failure to keep people alive rather than a natural dignified end to life. This is at odds with what a lot of people actually want at the end of their lives: 70% of hospitalized Canadian elderly say they prefer comfort measures as apposed to life-prolonging treatment, yet as many as ⅔ of these patients are admitted to ICUs. Quality End of Life Care in Emergency Medicine is not widely taught. Most of us are not well prepared for death in our EDs – and we should be. There’s no second chance when it comes to a bad death like there is if you screw up a central line placement, so you need the skills to do it right the first time. To recognize when comfort measures and compassion are what will be best for our patients, is just as important as knowing when to intervene and treat aggressively in a resuscitation. Emergency physicians should be able to recognize not only the symptoms and patterns that are common in the last hours to days of life, but also understand the various trajectories over months or years toward death, if they’re going to provide the high quality end of life care that patients deserve. So, with the help of Dr. Howard Ovens, a veteran emergency physician with over 25 years of experience who speaks at national conferences on End of Life Care in Emergency Medicine, Dr. Paul Miller, an emergency physician who also runs a palliative care unit at McMaster University and Dr. Shona MacLachlan who led the palliative care stream at the CAEP conference in Edmonton this past June, we'll help you learn the skills you need to assess dying patients appropriately, communicate with their families effectively, manage end of life symptoms with confidence and much more... The post Episode 70 End of Life Care in Emergency Medicine appeared first on Emergency Medicine Cases.