Tactical Medicine News Blog

Recently, I just finished reading a book called Presentation Zen by Garr Reynolds.  This book is a game changer in the presentation world in my humble opinion.  If you are giving presentations at any level, this is a must read book.  Now I know that REBEL EM has traditionally been a clinical blog, but every once in a while we come across something that is just too good to not share. What I am going to try and do in this blog post is summarize some of the key messages of this book.  In the book the author basically breaks presentations down into 3 parts and applies principles from the art of Zen: Restraint in Preparation Simplicity in Design Naturalness in Delivery

Today we have the privilege of hearing from Dr. Azita G. Hamedani MD, MPH, MBA, founding chair of the Department of Emergency Medicine at the University of Wisconsin School of Medicine and Public Health (UWSMPH). Under her leadership, the department has grown exponentially, growing from 6 to 36 residents, from 14 to 45 faculty while experiencing a 100% increase in patient volume. For showing exemplary skills in leadership, clinical quality, operations and healthcare finance she has been awarded – amongst other awards – both ACEP’s Outstanding ED Medical Director of the Year Award and the Association of Women in Academic Emergency Medicine Early Career Award. But beyond numbers and awards Dr. Hamedani is known for fostering the academic spirit at UWSMPH, elevating the department renowned to a national level. Below, she shares her tips on efficiency and getting things done.

Dr. Kathryn Dong (@kathryndong) is no stranger when it comes to keeping well! Currently, she is the Director of the Inner City Health and Wellness Program and the Addiction Recovery Community Health (ARCH) Team. She also keeps busy with her 3 boys, who keep her active and on her toes! Dr. Dong’s inspiring work with inner city populations, has given her a welcoming perspective on the value of community. Here, she shares her thoughts on how to maintain mental wellness and keep mentally in check. Take a look at how she stays healthy in emergency medicine!

As we have discussed in previous posts, the care of patients with cardiac arrest is a key skill for Emergency Providers. ACLS provides a foundation for care but is rife with shortcomings including, but not limited to, reliance on outdated data and inability to adapt in the face of improved understanding of cardiac arrest pathophysiology. The incorporation of technological advances and skills is another massive limitation of ACLS. One of these technologies is point of care ultrasound (POCUS). Over the last two decades, POCUS has become a integral part of Emergency Medicine training and practice. POCUS allows for rapid, bedside diagnosis of a number of conditions including cholecystitis, urinary retention and ectopic pregnancy. Additionally, it is becoming a greater component in the management of the critical patient where it can be used to assess cardiac contractility, wall motion abnormalities, intraperitoneal free fluid and more. Application of POCUS in all patients with cardiac arrest is simply the next step. This diagnostic modality is not highlighted in the current iteration of ACLS but is a practice changer. The bottom line is that application of POCUS in cardiac arrest allows the emergency provider to guide resuscitation with a direct look into the body – we are no longer blind. For this post, I want to discuss two ways that we can use ultrasound in cardiac arrest patients, specifically in pulseless electrical activity (PEA), in the Emergency Department: Assessment for the presence or absence of cardiac output and As an alternate framework to the Hs and Ts. A quick disclaimer – I am not an ultrasound expert, I did not do a fellowship but I am passionate about it’s application in our sickest patients.

A recent needs assessment completed in Toronto found that Emergency providers are undereducated when it comes to the Emergency Management of Sickle Cell Disease. This became brutally apparent to me personally, while I was researching this topic. It turns out that we’re not so great at managing these patients. Why does this matter? These are high risk patients. In fact, Sickle Cell patients are at increased risk for a whole slew of life threatening problems. One of the many reasons they are vulnerable is because people with Sickle Cell disease are functionally asplenic, so they’re more likely to suffer from serious bacterial infections like meningitis, osteomyelitis and septic arthritis. For a variety of reasons they’re also more likely than the general population to suffer from cholycystitis, priapism, leg ulcers, avascular necrosis of the hip, stroke, acute coronary syndromes, pulmonary embolism, acute renal failure, retinopathy, and even sudden exertional death. And often the presentations of some of these conditions are less typical than usual. Those of you who have been practicing long enough, know that patients with Sickle Cell Disease can sometimes present a challenge when it comes to pain management, as it’s often difficult to discern whether they’re malingering or not. It turns out that we’ve probably been under-treating Sickle Cell pain crisis pain and over-diagnosing patients as malingerers. Then there are the sometimes elusive Sickle Cell specific catastrophes that we need to be able to pick up in the ED to prevent morbidity, like Aplastic Crisis for example, where prompt recognition and swift treatment are paramount. A benign looking trivial traumatic eye injury can lead to vision threatening hyphema in Sickle Cell patients and can be easy to miss. In this episode, with the help of Dr. Richard Ward, Toronto hematologist and Sickle Cell expert, and Dr. John Foote, the Residency Program Director for the CCFP(EM) program at the University of Toronto, we’ll deliver the key concepts, pearls and pitfalls in recognizing some important sickle cell emergencies, managing pain crises, the best fluid management, appropriate use of supplemental oxygen therapy, rational use of transfusions and more... The post Episode 68 Emergency Management of Sickle Cell Disease appeared first on Emergency Medicine Cases.