We had a great week in Grand Rounds. The first lecture included a debate about the use of rocuronium or succinylcholine in paralysis for intubation by Drs. Lang and Plash. Drs. Ryan and Moellman led a thrilling discussion through some of their most interesting and thought provoking cases of their careers. Pharmacists Nicole Harger and Paige Gaber then discussed updates in pharmacy, specifically the use of droperidol and anticoagulation reversal in the emergency department. We learned about cognitive biases and clinical decision making from Dr. Hill. The day wrapped up with Dr. Knight showcasing the NIH stroke scale with Dr. Foreman.Read More
The reality of the Emergency Department is that not everybody is sick, but every patient could be sick. The task of finding the sick patients among the non-sick is far more challenging than it may appear and the diagnostic process is far more fraught with potential sources of error than one would like.Read More
In this week's Grand Rounds, we led with our first Morbidity and Mortality conference of the year. Dr. Lagasse walked us through cognitive biases, the management of early obstetric emergencies, and the management of skin and soft tissue infections in the diabetic foot. In our leadership curriculum, Drs Hill and Stettler discussed the fundamentals of being a leader, and we got to hear from a panel of accomplished physicians within our department about their own leadership journey. Finally, in our Consultant of the Month series, Dr. Martha Ferguson discussed the management of ano-rectal conditions in the Emergency Department.Read More
“Reason itself is fallible, and this fallibility must find a place in our logic.” - Nicola Abbagnano
Decision making in Emergency Medicine is intensely complex and it also the defining characteristic of the practice of Emergency Medicine. To outside eyes we may seem to be a specialty of action: chest tubes, intubations, heroic resuscitations with massive amounts of blood products and IV infusions. In truth none of the “action” of our specialty, the big sexy things they make into TV shows and movies, occurs without rapid, precise, and accurate thinking and decision making. But the Emergency Department can be a hostile environment to the decision making process. And, I’m not just talking about the noisy environment, the multiple interruptions, the patients with a wide variety of chief complaints and acuity seen in quick succession. There’s seemingly a thousand different hurdles between the instant a patient recognizes that something might be wrong with them and the moment a clinician diagnoses the problem.Read More
This week we got an operations update with some new markers of quality and new guidelines on HIV testing. We were reminded about patient literacy and the advantages of keeping it simple. Dr. Hill also taught that every shift our biases and decision making do affect patient care, it is our duty to recognize and use them to our patients' advantage.Read More
M&M with Dr. LaFollette
Modified Sgarbossa Criteria to aid in diagnosing STEMI in the setting of LBBB
- Can be used in the setting of induced (paced) LBBB
- Unweighted scoring (any of the following indicates STEMI equivilance)
- Concordant ST elevation
- Concordant ST depression in V1,V2,V3
- Inappropriate discordance of >25% ST elevation / S wave amplitudes
- Improves your test metrics from the original criteria from sens/spec of 36%/96% to 80%/99% respectively in a new validation study
This week we had our annual Critical Care Symposium where we invited our own critical care trained faculty and a special guest to have a day chock full of critical care goodness.
Refractory septic shock with Dr. David norton
Dr. David Norton, Assistant Professor of Medicine and Director of the UCMC Medical Intensive Care Unit
Definition of Refractory Shock:
No clear definition exists, but we are generally describing a state of decreased vascular responsiveness despite high vasopressor infusion.Read More
Dr. Miller - How to Give a Lecture
Keep your presentation simple. Remember that good artists borrow and great artists steal. Find presenters that inspire you.
Know your audience and environment
P3: Prepare, Practice, PitchRead More
We are in a thinking profession.
An outsider looking in on our profession may see procedures and action as the defining characteristics of the practice of Emergency Medicine. But, reflecting on the attributes of the best EM docs I’ve worked with, their procedural excellence isn’t what stands out. Thinking back on the great physicians I have met and worked with, the ones I strive to be like every day, it is their ability to think, lead, and educate that sticks with me the most.
And, it turns out I’m not the only one who might see it like this…Read More
As critical care transport professionals we are often perceived as an action oriented specialty. We frequently pride ourselves on procedural excellence and efficiency. (a difficult intubation, or fast scene-time etc.) However, the reality is that we spend the vast majority of our patient care time engaged in cognitive behavior... in THINKING rather than acting!
Because of this, it is imperative that we make every possible effort to understand how we think while caring for others. In addition, we should be aware of some of the cognitive biases that threaten our thinking processes, decision making, and thus the patients who place their trust in us.Read More