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
Dr. Ventura discusses the value of head CT and risk factors of CNS complications in HIV. Dr. Goel discussing the cognitive biases that drive decision making in EM. Dr. Stettler taught us that framing feedback can be as important as giving it and finally our CCHMC colleagues run through some difficult tox and airway cases. Plenty of learning to go around this week!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 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
We were fortunate, a couple weeks back, to have Dr. Brian Burns of Sydney HEMS come and speak to us. In his lecture, “When the 1% Makes All the Difference” which you can find here, Dr. Burns hit on a number of excellent points. We sat down and talked with Dr. Burns a bit more extensively over a couple of the themes of his lecture.
In this podcast, we cover some of the plus/minuses of checklists, the importance of high fidelity continuous training practices (simulation, routine case debriefing, intensive induction training), and the role of cognitive factors in running resuscitations.
Should resuscitations run like a jazz quartet or a Formula 1 pit crew? Are checklists simply in the way or do they cognitively unload the team members to improve performance? How do you train cognitive factors in resuscitation?Read More