This past Wednesday, I had the pleasure of giving a lecture on FOAM to the UC Emergency Medicine Residency. Well, it wouldn't quite be a lecture on FOAM if I didn't make it freely available to all after I finished it all up. You can check out the lecture slides on slideshare embedded at the bottom of the post. I also recorded the lecture and broke it down into a series of 5-ish minute long videos which you can look at based on your area of interest.
Read More"We are in the business of delivering health care to a very unique population, in a very unique environment, in a very unique way" - Dr. Edward Racht
EMS formally became a subspecialty of EM in 2006. The first board certified EMS physicians passed their exams last year (we have 3 in our EMS division).
EMS physicians train in clinical aspects of EMS medicine, medical oversight of EMS, quality management, and special operations.
Read MoreIn 2012 in the Annals of Emergency Medicine, Weingart and Levitan published a review of preoxygenation and peri-intubation oxygenation techniques in the emergency airway management of adult patients. Topics reviewed included the evidentiary support for preoxygenation and denitrogenation, appropriate positioning and patient selection, the utility of positive pressure in select circumstances, apneic oxygenation, as well as a proposed risk stratification approach based on pulse oximetry levels and peri-intubation risk.
A great discussion was had with many excellent learning points, upon which some were elaborated in great detail in the article and some only briefly mentioned. What follows is a brief summary of learning points from the article as well as from the discussion.
Read MoreBotulism
Utility of the imaging modality aside, abdominal radiographs can be a bit of a challenge to interpret. With a number of possible techniques (cross table laterals, left lateral decubitus, AP, upright, or supine) and a lot of structures to evaluate (is that small bowel or large bowel?, is that a kidney stone or an infamous phlebolith?), it's pretty easy to stare at a film and zone out as you eye moves from one shade of gray to another.
In the embedded video below, PGY-1 resident, Dr. Julie Teuber goes through a standardized approach to reading the abdominal x-ray that hopefully help keep your eyes from going cross-eyed next time you need to interpret an acute abdominal series.
Read MoreThe phenotype of acute presentation of heart failure can be dramatically different. Consider the difference between the hypotensive patient who has very poor cardiac output now in cardiogenic shock requiring pressors (these have a very poor outcome), the normotensive patient who has slowly become retained fluid, and the acutely hypertensive patient who presents in extremis (who actually does quite well even though they are so sick on arrival).
Read MoreR4 Simulation Series: Genitourinary Emergencies with Dr. Moschella and Dr. Verzwyvelt
Some of the challenges to think about when performing these procedures in the aircraft include:
M&M Learning Points with Dr. Stull:
I recently had the pleasure of sitting down with my co-EMS fellow, Dr. Ryan Gerecht, to discuss his experience with the implementation of a new blood product on our HEMS service: Liquid Plasma. Ryan was responsible for this implementation while serving as a Resident Assistant Medical Director during his last year of EM training at UC (2013-2014).
Here is what Ryan has to say…
In the Emergency Department, ICU, or operating room what do you resuscitate the hemodynamically unstable, bleeding trauma patient with? What about the patient with a massive GI bleed or ruptured AAA? How do you manage the patient with an intracerebral hemorrhage on Coumadin? (assuming you don’t have PCC’s readily available)
Read Moren general, the best way to learn is to challenge yourself. Teaching styles should take into account different learner types and levels
Learner levels:
Not much gets me as fired-up anymore as trying to optimize them. While I like to think that it’s because they are integral to our mission and are the ultimate weapon in our quest to go from “good to best”, it’s really just my borderline OCPD (just kidding…sort of).
Long story short, I spend a lot of time thinking about clinical and operational logistics in HEMS – it’s become my thing. My goal with this post is to share some of that thinking with others who might want to build off of our ideas in hopes that those colleagues (i.e. you) will share their ideas that they are really excited about with us at some point.
Read MoreThe pt is a 70 yo M who presents with AMS, weakness and nausea for 1-2 days. He complains of diffuse weakness and feeling "sick". His hx is significant for HTN, HLD, CHF and he takes digoxin. Vital signs on arrival are BP 90/60 with HR 47. There is concern for digoxin toxicity, so dig level is obtained and is 2.4
(normal is less than 1.2).
His K is 6 and Cr is 1.9. EKG shows LBBB.
Read MoreWhy Should You Care?
SRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
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