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.

Read More

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.

Read More

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.

Read More

So You Diagnosed Your Pediatric Patient With A Concussion… What Do You Tell The Parents Now?

/
So You Diagnosed Your Pediatric Patient With A Concussion… What Do You Tell The Parents Now?

In the United States an estimated 300,000 sports-related concussions occur annually. Many of these are young athletes who are referred to the emergency department for evaluation. While there are robust clinical decision aids to clarify the need for a CT brain, the literature around concussions is a bit murkier. Recently, athletes who sustained a concussion were recommended to avoid exercise and vigorous cognitive activity until their symptoms resolved entirely. Several studies over the last several years have challenged these recommendations. Dr. William Meehan is the director for the Micheli Center for Sports Injury Prevention. We were fortunate to “pick his brain” regarding questions we are often asked by the parents of the young athlete . . . when can their child return to play? When can they return to their full course work at school?

Read More

Enhancing Human Performance and Flow in Resuscitation

/
Enhancing Human Performance and Flow in Resuscitation

Mike Lauria was a pararescueman, providing medical/rescue support for special operations throughout the world.  Through this experience, he learned how to use psychological skills to perform under acute stress.  We were fortunate to have him join our winter symposium this year, discussing the cognitive science behind stress and performance, as well as how to use performance enhancing psychological skills for acutely stressful conditions. 

Read More

To the Cath Lab or Not? You Make the Call! - Part 2

/
To the Cath Lab or Not? You Make the Call! - Part 2

Making big decisions on little information is the very nature of emergency medicine.  Nothing epitomizes this more than the decision to activate your cardiac catheterization lab for a patient with a potential ST elevation MI.  Grand Master of the squiggly lines, Dr. Sara Nelson, recently took us through a tour of several challenging chest pain patients and their respective ECG's.  Here is part two of our two part series (click here for part one).  Take a look at these cases and ask yourself, what is your initial management? What is your interpretation of the ECG  . . . do you activate the cath lab or not?.... you make the call!!

Read More

To the Cath Lab or Not? You Make the Call! - Part 1

/
To the Cath Lab or Not? You Make the Call! - Part 1

Making big decisions on little information is the very nature of emergency medicine.  Nothing epitomizes this more than the decision to activate your cardiac catheterization lab for a patient with a potential ST elevation MI.  Grand Master of the squiggly lines, Dr. Sara Nelson, recently took us through a tour of several challenging chest pain patients and their respective ECG's.  Take a look at these cases and ask yourself, what is your initial management? What is your interpretation of the ECG  . . . do you activate the cath lab or not?.... you make the call!!

Read More

Resus of the Hypotensive Patient Part 2 - Why You Should be Using Peripheral Pressors (and not feeling guilty about it)

/
Resus of the Hypotensive Patient Part 2 - Why You Should be Using Peripheral Pressors (and not feeling guilty about it)

For the patients we see that are potential recipients of large volume resuscitation, excessive IV fluids can harm.  In part one of this two part series, Dr. Mackenzie discussed how IV fluids can lead to increased renal injury, pulmonary edema, and extra-vascular lung water.  So how do we avoid the harms of excessive IV fluids?  Plan to start peripheral pressors.  

Read More

Resus of the hypotensive patient Part 1 - When IV Fluids Kill

/
Resus of the hypotensive patient Part 1 - When IV Fluids Kill

There is probably no other drug emergency providers administer more often than IV fluids.  We give them to patients with mild heat exhaustion, gastroenteritis and orthostatic dizziness to name a few.  These patients tend to feel better, go home and no harm comes to them.  However, for the subset of patients with shock and potential recipients of large volume resuscitation, excessive IV fluids can harm.  In part one of this two part series, Dr. Mackenzie discussed how IV fluids can lead to increased renal injury, pulmonary edema, and extra-vascular lung water.    

Read More

What the Heck is Going on with this Pacemaker?!

/
What the Heck is Going on with this Pacemaker?!

Pacemakers and implantable cardioverter/defibrillators (ICDs) are fascinating little machines.  They were first placed in survivors of sudden cardiac death in 1980, and over the past several decades have become more complex with increasing abilities to sense, pace and defibrillate.  As the population ages and the prevalence of cardiovascular disease increases, patients with pacemakers and ICDs will present more commonly to the emergency department.  It is imperative that the emergency provider have a framework for troubleshooting these devices.  This post will briefly review the use of the "donut" with an implantable pacemaker, as well as three pacemaker malfunctions the emergency provider may encounter.

Read More