Doing well on your Emergency Medicine rotation, whether you are a medical student or resident, will depend in large part on your ability to deliver a coherently concise presentation to the senior resident or attending physician. It's about telling a story that fits into the construct of how the expert physician thinks.
If you ask 20 attendings physicians what the perfect presentation is like, you'll get 40 different answers. I know, frustrating. Rahul's video describes a reasonable approach and thought process.
That was me as a medical student, when I first encountered an undifferentiated patient in moderate distress. The trick is to have a standardized primary and secondary survey approach. Sometimes it takes just a little kick-start to get you thinking and doing.
This is the last installment of Dr. Rahul Patwari's digital whiteboard video talks on ACLS, specifically focusing on post-resuscitation care and therapeutic hypothermia.
What is the definition of bradycardia and tachycardia in the 2010 ACLS guidelines, for the purposes of resuscitation algorithms?
Bradycardia: heart rate < 50 bpm
Tachycardia: heart rate > 150 bpm
Below are the next 3 video installments of Dr. Rahul Patwari's digital whiteboard talks on ACLS. These videos cover both bradycardias and tachycardias.
Below are the next 3 video installments of Dr. Rahul Patwari's digital whiteboard talks on ACLS. These videos cover:
Cardiac arrest (Vfib and Vtach)
Cardiac arrest (More of Vfib and Vtach)
Cardiac arrest (Asystole and PEA)
I love that each video is less than 15 minutes long. Also, even if you aren't a medical student, these are great refreshers. For instance, don't forget that atropine is no longer on the 2010 ACLS algorithm for asystole.
Similar to Salman Khan of the Khan Academy, which is famous for "flipping the classroom", Dr. Rahul Patwari is a one-man innovating machine at Rush University's Department of Emergency Medicine. He has been creating digital whiteboard "chalktalks" on common EM conditions for the past year, which target the senior medical student. These 2-15 minute videos are way too amazing not share with the EM community of learners. I bet these would be really great supplemental learning material for EM medical students everywhere.
The above video (Status Epilepticus) is the first of a series of at least 40 videos thus far.
Thanks to Rahul for graciously allowing me to embed and share these videos. I'll be posting about one of his videos per week.
Are you a medical student interested in EM and going to be near Atlanta in May 2013? Apply for this great opportunity! Here is the announcement from SAEM:
Opportunity: Medical Student Ambassadors to 2013 SAEM Annual Meeting
SAEM is looking for 17 energetic, responsible and enthusiastic medical students to work with the SAEM Program Committee at the Annual Meeting in Atlanta, May 15-18, 2013. This is a great opportunity to network with faculty members from EM programs around the country. If you are interested, please visit the SAEM website.
Benefits for medical student committee members:
Waiver of your registration fee to the SAEM Annual Meeting*
Learn much more about the current research and educational activities taking place in the field of EM
Have the opportunity to form relationships with faculty members from EM programs around the country.
A personal letter from the Committee Chair will be sent to your Dean of Student Affairs, acknowledging your contributions to the Program Committee.
Requirements and expectations of medical student committee members:
Arrive the late evening of May 14th and stay through 3pm on May 18th.*
Attend daily Program Committee meetings
Seeing to assigned tasks and responsibilities, which include, but are not limited to:
- Approximately 6-8 hours of responsibilities per day - Soliciting reviews - Assisting in AV needs - Facilitating workshops - Being responsive and flexible to the needs of the Program Committee
Interested medical students should submit their name and contact information to the SAEM office by emailing Michelle Iniguez at miniguez@saem.org. Please write “Medical Student Ambassadors” in the subject line and attach a very short statement of interest very short statement of interest (less than 150 words) as well as an updated electronic copy of your CV.
Deadline is February 1, 2013. Recipients will be notified by February 20, 2013.
* Travel and hotel will be the responsibility of the individual student; however, SAEM will provide the emails of other selected students to facilitate consolidating lodging expenses.
It is the selection, preservation, maintenance, collection and archiving of digital assets (1). Once you have curated the digital content you might want to share with others. There are different ways of sharing this content:
Sending out the link
Retweeting on Twitter
“Like” on Facebook
“1+” on Google+
Many others
You might also want to share your reflection of digital content. This is where this guide might help you. A personalized learning network or environment (PLN or PLE) is created when you have curated digital information and shared your reflection with others. You are collaborating when you interact with other people's posts, podcasts, or images.
Pick a topic or resource, such as an online blog, podcast, tweet, image, post on Facebook or Google+ that interests you. The source needs to be reputable and up to date. (Five criteria for evaluating Web pages).
Find an outlet. This is where you are going to write your reflection. These outlets may be set up as public (others can see your content) or private (only those with granted access can see your content). Some of these outlets may be set up where others can submit their comments for discussion. This feature may also be disabled if it is not desired. Here are a few social media outlets:
Blogs
Podcasts
Websites
Google Documents
Twitter
Storify
What’s your reflection?
What do you know about the subject (topic)?
What do they present in the online material?
What does the primary literature say?
How does it compare/contrast to you current knowledge?
How will this change your current knowledge?
Can this be applied to a different scenario?
Do you see any future controversies?
The point is to gather information to enrich your background knowledge, write your reflection, and have a discussion with others about it. A perfect example of a Personalized Learning Network in action is by a medical student, Lauren Westafer (@LWestafer) from her blog "The Short Coat".
Do it on a specific topic, so that you are seen as a trusted source or expert on that topic.
Share only the best stuff.
Do it continuously so that you are continuously providing up-to-date content.
Here's an excellent 4-minute video on the concept of Personalized Learning Network by Will Richardson(3):
Some educators might be a bit skeptical about the use of technology in education due to their unfamiliarity with this integration. These are 5 tips to help educators see how useful these tools can be. Five Things Every Teacher Should Know (4) 1. Technology integration is about more than TOOLS
Use technology to create a community
2. Tech tools come and go, so focus on mastering the FUNCTIONALITY to support 21st century learning goals: the 4Cs.
Critical thinking and problem solving
Communication
Collaboration
Creativity and innovation
3. CYCLE: Search, save, share
If you don’t know, know how to find it.
4. Technology integration requires you to embrace LEARNING
Be a sponge, don’t let the “expert” label throw you off.
5. Roll with it
Be flexible when using technology
Explore, gather some information, compare it to what you know, and share your experience with others.
Some examples of digital curators in emergency medicine:
www.lifeinthefastlane.com - “...Dedicated to providing online emergency medicine and critical care insights and education for everyone, everywhere...”
emcrit.org - An EM/critical care doctor who via a podcast explores ways to improve patient care.
prehospitalmed.com - A doctor from Australia who discusses the improvement of prehospital medicine via a podcast by expressing his opinions on podcasts, blogs, scientific literature.
www.emlitofnote.com - “Musings on publications and studies relevant to emergency medicine.” A blog run by an emergency physician who explores and gives his opinion on primary literature.
www.sinaiem.org - A website run by Mount Sinai Emergency Medicine Residency, they explore and give their impression on online content.
www.emchatter.com - “A link directory to for all things emergency medicine on the web”
The short coat a blog by a medical student who explores online information and writes her reflections online.
Javier BenÃtez, MD
References: 1. http://en.wikipedia.org/wiki/Digital_curation 2.Content Curation for Online Education 3. Personal Learning Environments And Personal Learning Networks Symposium 4. Five Things Every Teacher Should Know
When I was in medical school doing my critical care elective in EM, I remember seeing the interns preparing tubes and IVs before their shifts started. Since then it was instilled in me that coming early to the shift was essential to make sure that at least your resuscitation room was adequately set up for any major emergency coming through. With the help of a few friends, I made up a list of the equipment that should be present and working appropriately in your resuscitation room.
Not only should you have to have the appropriate equipment, but you should also make sure they are working appropriately. You may be surprised at what is missing or non-functional. The most important part of our job is to be prepared:
“Hope for the best, anticipate the worst.”
I tried looking for a proper definition and a list out there in the “interweb” that I could modify, but didn’t find one. I would recommend you get to know all of your nurses by name (especially the charge nurses) and have a good working relationship with them. It is essential, they are an integral part of the team.
1. Oxygen
There should be two outlets: make sure there are two and they work appropriately with appropriate tubing. Have the bag valve mask ready
2. Pulse ox detector
3. The CO2 detector should be ready and functional (contributed by @AndyNeill)
4. Suction with canister, yankauers, and tubing
5. Intubation kit and airway cart: lots of stuff in this cart
Endotracheal tube introducer (Bougie)
Working laryngoscope (make sure light bulb is working, straight and curve blades)
One of the most helpful articles I’ve encountered on teaching oral clinical presentations in the ED is a paper from Academic EM in 2008.
When we talk to one another, or talk to consultants about cases it is crucial for us to be concise and include all salient points of the history and physical. Because what you say (or don't say) could compromise patient care, it is important to instruct the medical student how to do this. As the paper explains, students learn to perform oral clinical presentations in other services, which are quite different from presentations in the ED. The article describes one acronym SNAPPS, developed for the outpatient setting:
S: Brief summary of the patient’s history and physical
N:Narrowing the differential to two or three etiologies
A:Analyzing the information to determine the most likely cause of the chief complaint
P:Probing the attending for knowledge by asking questions
P:Planning the patient's management
S:Selecting an issue related to the case for self-directed learning.
Important characteristics that make EM unique:
Assume that every patient has a life or limb-threatening condition
Juggle multiple patients simultaneously
Prioritize patients according to level of concern
Address patient loyalty, follow up issues, and consequences of incomplete medical records
The HPI Typically, novice students typically think to present the HPI of their case as below (in chronological order):
A better way to present should be in the order of importance (especially because the person listening likely will have waning attention span...):
After the chief complaint is stated, to save time the HPI should include all pertinent information from other sections of the history, which include PMHx, PSHx, SoHx, FmHx. These other sections are not mentioned again during the oral presentation. As students gain more knowledge, the review of systems gets smaller during the presentation. But there might be cases in which the symptoms of that section may be significant enough to be a second chief complaint as well. Medications and allergies should also be mentioned during the oral presentation. The summary statement should contain two sentences.
Chief complaint and the HPI
Include important signs, symptoms, physical findings, and labs
In the assessment and plan, the student should include the life-threatening problems first, then their etiology, and finally what labs or studies are needed.
The key principles in EM when getting a history is knowing the chief complaint, drawing a differential diagnosis BEFORE seeing the patient, acquiring pertinent data, analyzing it, narrowing the differential diagnosis, and presenting it in a succinct manner. The article is worth a look and don't forget to look at the Supplement Material, where examples are given. Related links: 1. Teaching Residents from Other Services: EM-RAP Educators Edition Rob Rogers (@EM_Educator) and Michelle Lin (@M_Lin)
Reference Davenport C, Honigman B, Druck J. The 3-minute emergency medicine medical student presentation: a variation on a theme. Acad Emerg Med. 2008 Jul;15(7):683-7. Pubmed..
If you were to take a look at my bookcases, you would classify me as a book hoarder. Yes, it’s true I have been collecting book. Some have been with me since college. Books have so much information, and I have always felt a bit paranoid about throwing them away and then not having them for a critical piece of information that I need. My collection includes books on biochemistry, physiology, anatomy, and others. To be honest, I really have not used them as much as I have used my online sources, and that’s not because I have memorized everything in these books. We are told during college and medical school that we must memorize everything. With the explosion of information, however, it is more practical to know the specific question for which you need the answer for and have reliable sources. The goal is to memorize as much as possible, but also know how to find information in the most efficient manner.
Nowadays, books are already in the internet; MDconsult and AccessMedicine are two of my main sources. They contain all the textbooks I would ever need to answer my questions. There is also UpToDate which contains tons of current articles as well. I have used these sources for years, but getting rid of my books never really crossed my mind. I’ve become quite comfortable with reading texts online, downloading pdf files, and directly taking notes on the actual files. I also use Evernote to curate interesting articles (see Academic Life in EM's shared Evernote notebook link).
Recently, Dr. Mike Cadogan (@sandnsurf), from Life in the Fast Lane, participated in a debate stating that physical textbooks are essentially dead. I watched this video and stared back at my bookcases. I realized that I should not fear not having the textbooks. More than enough textbooks are online. The internet allows me to go almost anywhere and still have access to these digital texts.
Currently, medical school, residency, and CME curricula are also moving online. This includes online lectures, podcasts, and videos. Respected physicians are even demonstrating procedures online. Learning is just not the same as it used to be. It's no longer about sitting in a lecture hall or reading a heavy textbook for hours. Now we can easily learn and collaborate with people worldwide in real-time and asynchronously through such social media platforms as Twitter or Google+.
This post is an ode to the physical being of my textbooks. They have now passed on to a better space (cyberspace), and I have learned to live without them. They taught me a lot, we were together through the good and bad. They used to accompany me to the anatomy lab, spend long sleepless nights together, and sometimes I would even wake up with my forehead against them. So, I agree with Mike 100%. Textbooks ARE dead. Farewell my friends, spread your hard and softcovers in book-heaven.
Case # 4: Palpitations A 25 year old woman presents with palpitations, sweating, and shortness of breath since this morning. 6 days ago she had syncopized, was shocked out of V-tach by EMS, and eventually had a defibrillator placed for an unknown arrhythmia. Now, she feels her heart beating in her chest, looks diaphoretic, is tachypnic, but her pulse is 58 and regular.
I looked on the monitor and she was beating away at about 60 bpm and it looked normal sinus rhythm. An EKG showed this:
Join me on G+. I edited the grainy picture I took on my phone to what you see above in 2 minutes
The EKG was normal sinus rhythm and looked entirely normal except for this odd pattern in V2 (and somewhat in V1). Could it be a saddle-back? Is this Brugada syndrome?
I opened the Paucis Verbis card about Brugada by Michelle Lin on Academic Life in EM on my iPad and saw this:
I called the electrophysiologist, and I sent the EKG to his phone. I told him that I thought she had Brugada syndrome, and he told me it was something close, but not quite - because in V2 the J-point is not > 2mm. The patient would be fine because she already had the AICD placed. Some ativan, reassurance, and encouragment to call her insurance company to inquire about her outpatient mental health benefits fixed the problem. You'd be anxious too if you literally died earlier that week.
I went home after the shift and opened Dr. Smith's EKG Blog, searched Brugada and learned that the pattern could be unmasked by common occurances like fever, cocaine, propofol, and lidocaine. "Get this patient some Tylenol. We need to break his fever, STAT" I imagined myself saying next time I had a saddle-back with fever.
Brugada has a high incidence of sudden cardiac death. Although this was not a true Brugada, this patient who had an EKG that sure looked a lot like Brugada had suffered from sudden cardiac death. I'll leave the specific rules of diagnosing Brugada to the cardiologists - the saddleback is my can't miss diagnosis.
This is a guest series by Dr. Timothy Peck, who is launching his own blog at ModernEM.blogspot.com. Check it out!
This is a question that I’ve gotten a few times over the years. You’ve got a patient in AFIB that has been rate controlled after a bolus of...
online dating chat rooms,free online dating chat,online dating chat tips,dating sites chat,chat avenue dating,online games dating,online chat singles,love dating
online dating chat rooms,free online dating chat,online dating chat tips,dating sites chat,chat avenue dating,online games dating,online chat singles,love dating
