TOTAL EM - Tools Of the Trade and Academic Learning in Emergency Medicine

We are a FOAMED project devoted to providing TOTAL care everywhere. This is done by sharing the Tools Of the Trade and Academic Learning in Emergency Medicine (TOTAL EM). We believe in education for emergency medicine professionals and the public.
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TOTAL EM - Tools Of the Trade and Academic Learning in Emergency Medicine



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Jan 16, 2018

Back in April 2017 we went to SEMPA 360 and we have been saving some pearls just for a reminder of what SEMPA can offer when it comes to a conference.  The long wait is over and to help support our SEMPA friends we have an interview of some quick pearls from expert Robert Dachs.

Jan 9, 2018

Dental pain is a common complaint in emergency medicine.  Often, it is seen as a non-emergent complaint and there is truth to that issue.  However, dental pain can be life threatening and has some key points we will discuss in this podcast.  The first step is to remember 3-2-1.

Jan 2, 2018

​2017 has been an intriguing year.  For the blog and podcast specifically, there have been many accomplishments.  Goals have been obtained faster than planned and we still are striving for even more success.  Today, we are talking about something that is not in medicine much but we see it elsewhere such as the military and firefighting: the after action review (AAR).  However, a traditional AAR can sometimes be difficult to perform at it takes a long time.  In critical events there is an abbreviated version known as the "hot offload" which is being promoted by some such as Ashley Liebig.  However, it is worth noting there are some key differences.

Dec 26, 2017

Working in emergency medicine is always a challenge, but when you work solo it can make you feel like a lone wolf.  In reality, there is always help somewhere.  New grad and EMPA Aaron Inouye is in a relatively unique scenario.  Not only does he work in the challenging environment of a single-coverage EM provider, he does so as a new graduate.  Listen to this interview no matter your career as you may find some fascinating pearls you were not expecting.

Dec 19, 2017

We are joined by a specialist in child abuse and neglect, Tom Balga, who is a fellow EMPA.  Child abuse and neglect is not a fun subject, but it is very important as we can truly change lives.  In this blog and podcast we cover some of the essentials that can be easily carried over to your next shift.

Dec 12, 2017

We hear plenty on the news about the opioid crisis, but we are hearing more and more about exposure to these opiates potentially harming first responders and even those in the emergency department.  It begs the question, how much is enough in regards to personal protective equipment (PPE)?

Dec 5, 2017

Risk management expert Kevin Klauer joins us today with some rapid fire documentation pearls.  We had a similar discussion focused on the MDM when we had Mike Weinstock on back in September.  Hopefully, we will have both experts (and others) back again in the future but this was a great talk focusing on some key pearls that we can all bring on the next shift.

Nov 28, 2017

​Practice makes permanent and only perfect practice makes perfect.  There have been recent conversations on "deliberate practice" which has hit FOAMed with Scott Weingart's interview of Anders Ericsson and subsequent posts.  This post is not going to delve in that topic, but rather how we should be teaching and training when it comes to procedures.

Nov 21, 2017

​There have been recent requests for further discussion of the neurological exam.  Specifically, how to do a brief neurological exam in the emergency department, how to perform a HINTS exam, and documenting the exams performed. 

Nov 14, 2017

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.

Nov 7, 2017

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.

Oct 31, 2017

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.

Oct 24, 2017

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.

Oct 17, 2017

​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.

Oct 10, 2017

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.

Oct 3, 2017

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.

Sep 26, 2017

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.

Sep 19, 2017

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.

Sep 12, 2017

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.

Sep 5, 2017

​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.

Aug 29, 2017

“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.​

Aug 22, 2017

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.

Aug 15, 2017

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...

Aug 8, 2017

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!

Aug 1, 2017

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.

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