We need to talk about something: misinformation.
Unfortunately, the world is full of it and we cannot seem to stop ourselves. The Internet was one of the greatest inventions brought forth to the modern world to allow for the rapid sharing of scientific information. We have bastardized it in time to now spread hate and grossly incorrect information. What was once a way to spread knowledge is now attacking science and what we have learned.
When we started last month's celebration of PAs for October, we discussed breaking bad news. We were then going to expand on that discussion with reference to end of life discussions. However, through some very unfortunate audio issues, we lost the original content in a way that made it so we could not present the original conversation. However, Melodie Kolmetz was gracious enough to record it again on her own and we are presenting this for our newest post.
Technically, this is the last post for PA Month here on the podcast. Fear not! There will be more PAs on podcasts coming up. However, we wanted to finish our discussion with Fred Wu since people may find this portion on contracts helpful in the immediate future.
Emergency Medicine PA Fred Wu is joining us to talk about starting and advancing a career in emergency medicine. In this two-part series, Fred is reviewing the many aspects of emergency medicine careers from finding a position that will work well for you to signing a contract.
We continue our month of celebrating PAs with a new podcast on a topic not well covered: triaging and assessment of the total joint arthroplasty (replacement) patient. To help us, we have a special guest who is an orthopedic surgery PA named Amy Jean.
Our guest today (the first for PA month here on TOTAL EM) is Adrian Banning. She is an Evidence Based Medicine (EBM) guru and is also on the JAAPA Podcast with a previous guest, Kris Maday. Today though she is here to talk to us about breaking bad news. Something most of us are experienced with but one thing few of us do well. We combine EBM and "soft skills" to better care for our patients and families in this very difficult time.
PA Week is October 6-12 this year. As PAs, we have a lot to be proud of in the 50 years of our existence but with our many advances, there still more we can do. This month, we are hosting PAs for our podcasts. However, to kick off the month, we are going to talk about the challenges that lay ahead. It is worth noting though that much of it is now possible thanks to those who came before us.
Some of us do it well, some of us do not do it at all, but we all could use improvement. The medical decision making (MDM) portion of the chart is one area we all can work on. It is quite possibly the single most important portion of the chart for multiple reasons including acting as a "hard stop" in decision making, explaining course of care and management, reviewing highlights of the visit, and even potentially helping in a legal situation. Today, we have Mike Weinstock joining us on this very important podcast.
We need to get better taking care of out patients. One of the easiest ways to get better is to work both sides of the emergency medicine realm. The main divide rests in the prehospital environment versus the emergency department. We can still see this in the rural versus urban environment. Our experiences in different realms can make us much better providers.
Today is a brief podcast about leaving the ivory tower. As a PA or physician, we have to train at such a place but with time we will leave. Not all nurses, paramedics, or others in such settings will ever see the "ivory tower" and may have their education only in rural environments or at least not at a tertiary care center. The challenge for us becomes not only getting the medical knowledge, but also how to spread it.
Today’s podcast is a little brief but covers and important topic: blood draws and patient’s rights. This comes up due to a recent incident in Salt Lake City at University Hospital when a detective of the Salt Lake City Police Department arrested Alex Wubbels, a nurse there, when the officer attempted to collect blood for testing from an unconscious patient.
“Everyone has a plan until they get punched in the mouth.” – Mike Tyson
Mental preparedness is not taught to us in emergency medicine or in healthcare generally, but it is something we are all doing to a degree. However, we need to improve our abilities and expand on them to do our jobs better. There are many approaches and everyone has their own style, but we will go over some approaches today to help improve your shifts and hopefully lead to you being a better clinician.
Everyone talks about airway all the time, and I was at first reluctant to give this talk. However, I believe it is time to talk about this important subject in a slightly different way. The last time we talked about airway management in regards to intubation was with Kris Maday (from the PAINE Podcast) in Podcast #18 where we went over the basics (a great review to listen to first if needed). There we talked mostly about rapid sequence intubation (RSI). Although commonly used, this is not for every patient. Today, we talk about RTI, which is what we need in most patients.
No matter what aspect of emergency medicine you work in (EMS, fast track, main ED, rural, remote, urban, suburban, or whatever else), you need to be a resuscitationist in my book. This is entirely my opinion, but I believe it is important one worth your time in both reading and listening.
Envision a busy night shift. It is three in the morning and somehow you still have a waiting room full of people waiting to be seen in your small ED that is hours away by ground to tertiary care. Scattered thunderstorms and overwhelmed emergency services have made it difficult to transfer out patients. You would swear it was a full moon, but when you were outside just to get a quick breath of fresh air from all the chaos you look up and it is not. Suddenly, you hear sirens in the distance and EMS reports are all coming in at once...
Tranexamic acid (TXA) is an old drug, but one that we in emergency medicine have found love for once again. In preparation for an upcoming talk at a conference, I realized I had not yet made a post regarding TXA. This is a quick summary of TXA and links to a lot of great #FOAMed resources out there you can also check out regarding the same. I have also included one bit that I have recently found very successful but with little evidence currently. Listen to the podcast for more!
After Podcast #44 regarding how to incorporate change, our friend Patrick Bafuma reached out to provide his thoughts on how to make change happen in your department. He has championed the process and has pearls that are well worth the listen.
We are having a special episode to add to what we did with Salim Rezaie on REBEL Cast recently as a guest. While we were there, we talked a lot about the TOAST trial and reviewed our own clinical use of dexamethasone. It is definitely worth your time to visit his page and listen to that podcast. However, we wanted to add our own little supplement to the #FOAMed world by adding a detailed analysis of the paper in true BEEM fashion. Please check all of this out for a more thorough understanding of the topic.
We have talked about abscess management before both here (Podcast #13) and on the Skeptics' Guide to Emergency Medicine (Podcasts #156 and #164). Even though we have talked about using antibiotics before, there has been debate on its use in smaller abscesses. Today, we cover how antibiotics are still beneficial even for the small ones given the most recent evidence out there. Listen to podcast and read this blog for all the details as we cover different points in each.
We are joined by Tyler Christifulli, a well experienced critical care paramedic and host of the Lifestar Podcast, to discuss a proposed ventilation strategy. It is worth listening to his original podcast first to get a complete picture. I would also recommend listening to Scott Weingart's Dominating the Vent lectures on his EmCrit website if you are not very familiar with ventilator management in general. A warning in advance, there is some cursing in the podcast.
Happy Fourth of July! Today we are joined by Evidence Based Medicine (EBM) rock star Ken Milne who is known for the Skeptics' Guide to Emergency Medicine (SGEM) blog and podcast. He has been a major mentor to the TOTAL EM project and to celebrate our 50th podcast he agreed to join us for a detailed discussion on FOAMed and EBM. Both SGEM and TOTAL EM are part of the Free and Open Access to Medical Education (FOAMed) movement.
Kevin Burns is back from our last podcast for another discussion, this time specifically on Point of Care Ultrasound (POCUS) and prehospital care. He is assisting with some new research and we review how POCUS could be beneficial in the EMS.
Keving Burns is one of those PAs who is on the cutting edge of prehospital care. He is the co-director of the Yale New Haven Hospital (YNHH) Emergency Medicine PA Residency program. One of his favorite aspects of emergency medicine is prehospital care and we wanted to talk to him about some of the plans for the future of PAs in emergency medicine.
Clay Smith of EM Topics joins us today for a first-ever crossover post. His amazingly well-done blog with daily posts on clinically important papers is a must to subscribe. In today's post, we cover a review he is also publishing today regarding ramping in intubations. In this RCT, there is no benefit in the primary outcome (lowest oxygen saturation) when comparing ramping versus sniffing position. However, there is a lot more to the paper as discussed in this podcast.
Brian Lin is back for the second part of our conversation with him from the 2017 SEMPA 360 conference, but this time we are talking about two subjects with a lot of dogma: the Golden Period for wound closure and dog bite closure. This brief review is designed to remind you of some of the key components in order to better care for your patients.
Brian Lin is an impressive physician with expert knowledge in wound management and care. It was well worth the visit to talk to him in person about some of the more intricate parts of wound management. At SEMPA 360 this year he gave so many pearls that there is no doubt he was a treasure to the conference. If you could not make it this year or want a reminder of some of the key points, check out the notes and listen to the podcast.