Velocity Time Integral (VTI) and the Passive Leg Raise: Taking Volume Assessment to the Next Level

Velocity Time Integral (VTI) and the Passive Leg Raise: Taking Volume Assessment to the Next Level

Hypotensive patients requiring volume resuscitation are a regular occurrence for emergency physicians. Clinicians are often faced with determining whether patients will respond favorably to IV fluids both before and during vasopressor administration. The ability for point of care ultrasound (including assessment for B lines and IVC collapsibility) to predict volume status and fluid responsiveness has mixed evidence. Here we explore the velocity time integral (VTI), a measurement that can be coupled with a passive leg raise to more accurately assess for true fluid responsiveness.

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Coding in the Community

Coding in the Community

Coding patients in the community setting is difficult given constraints of man power, specialists, equipment, and other resources. Knowing how to code a patient well in the community is a skill all EM practitioners should master. In this post we review the priorities and pitfalls of coding in the community, with our guest Salim Rezaie.

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Beyond Burnout: Physician Depression and Suicide

Beyond Burnout: Physician Depression and Suicide

The statistics on physician suicide are frightening. Each year approximately 400 physicians commit suicide. That is more than one per day and roughly the equivalent of two entire classes of graduating medical students. Suicide accounts for 26% of deaths among physicians aged 25-39 - more than twice (11%) that of same age group in the general public. When screened, approximately 10% of medical students and physicians report current suicidal thoughts. Why are these numbers so high in the medical profession? Dr. Casey MacVane helps shed some light on this neglected crisis and what we can do to help our suffering colleagues.

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Journal Club March 2018 - Risk Stratification and Work Up of Non-accidental Trauma

Journal Club March 2018 - Risk Stratification and Work Up of Non-accidental Trauma

The evaluation of a child for non-accidental trauma (NAT) is an infrequent, yet high risk endeavor for emergency physicians.  Abusive head injury is the most common cause of death in cases of non-accidental trauma and up to 30% of cases of child maltreatment are misdiagnosed at first health care contact.  There is a growing body of literature that helps to frame the workup and risk stratification of children at risk for NAT.  This month’s journal club focused on 3 articles centered on risk factors and diagnosis of abusive injuries. 

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Feature Film(s) - Pediatric Point of Care Ultrasound in the Emergency Department

Feature Film(s) - Pediatric Point of Care Ultrasound in the Emergency Department

Dr. Rachel Rempell is a pediatric emergency medicine physician in Boston, Massachusetts and is affiliated with Boston Children's Hospital. She is board certified in pediatrics, pediatric emergency medicine and completed an ultrasound fellowship with a focus on pediatrics.  We were fortunate to have her as a guest speaker for our grand rounds where she gave us a tour of the current landscape of pediatric point of care ultrasound in emergency medicine. 

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Journal Club February 2018 - Contrast-Associated Nephropathy. The Risk is …. Well, Maybe not as High as We Thought

Journal Club February 2018 - Contrast-Associated Nephropathy.  The Risk is …. Well, Maybe not as High as We Thought

Computed tomography (CT) is a commonly used imaging modality in the US. In 2013, greater than 74 million CT scans were ordered.  Although recently there has been a decrease in the need for contrast for certain diagnostic needs, contrast remains very important in the diagnosis of pulmonary embolus, aortic pathology, infectious processes, and other soft-tissue pathology. Acute kidney injury (AKI) has been a concern for many years and the teaching has been that contrast can increase the risk of acute kidney injury.  Recent literature has addressed this issue and this month’s journal club offers a synopsis of these articles.  

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Difficult Discussions - Death notification and End of Life Care

Difficult Discussions - Death notification and End of Life Care

Professionalism and related personal attributes such as ethics, humanism, and communication have played a central role in the major critiques and calls for reform in medical education over the past century.  The Association of American Medical Colleges currently recommends professionalism and interpersonal skills (including communication) as core competencies to be included in the curricula of medical schools.  In part 2 of "difficult discussions", we share our approach for two difficult patient discussions - death notification and end of life care. This was recorded at the 2017 Tufts University School of Medicine Capstone Course.

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Difficult Discussions - Medical Error Disclosure and Refusal of Medical Care

Difficult Discussions - Medical Error Disclosure and Refusal of Medical Care

Professionalism and related personal attributes such as ethics, humanism, and communication have played a central role in the major critiques and calls for reform in medical education over the past century.  The Association of American Medical Colleges currently recommends professionalism and interpersonal skills (including communication) as core competencies to be included in the curricula of medical schools.  In part 1 of "difficult discussions," we share our approach for two difficult patient discussions - medical error and refusal of medical care. This was recorded at the 2017 Tufts University School of Medicine Capstone Course.

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