Head and Neck Trauma – Dr. Sizemore

• signs of basilar skull fracture: hemotympanum, raccoon eyes (intra-orbital bruising], battle sign(retroauricular bruising) or cerebrospinal fluid leak (oto- or rhinorrhea, halo/ring)
• patients with LeFort II fractures and LeFort III fractures should have a CTA to screen for BCVI
• penetrating neck trauma
  • Know anatomy associated with zones of neck (I,II,II)
  • Early airway control should be considered in patients with hard signs
  • Hard Signs > OR
  • Soft Signs > CTA
  • Zone I injuries can result in pneumothorax
• do not probe wounds with active bleeding as may dislodge clot
• if direct pressure cannot control bleeding, consider placement of a foley catheter and balloon inflation

Intro to Research: An Overview – Alyssa Thomas and Dr. Huecker

• interns, start thinking about project ideas now. Pick something that interests you
• remember, there are different type of “research” projects
• human subjects
• quality improvement
• program evaluation
• All members of the research team must have a valid CITI Human subjects and HIPPA research training
• Great resource when time for writing paper : https://www.strobe-stamenent.org

Delivering Bad News – Dr. Coleman

• These conversations are nuanced, demanding, personally impacting
• Dr. Hueckers ABCs
• Awareness: focus on this one thing, they know if you are distracted
• Blueprint: have a blueprint based on studies and based on experience, then modify based on circumstances
• Compassion: Stay composed and expect tough responses
• SPIKES, a six step protocol/mnemonic for delivering bad news mnemonic
• Set up (Structure)
  • mental rehearsal
  • sit down
  • control the situation
  • maintain eye contact
• Perception/Professionalism
  • before you tell, ask
• Invitation
  • break it down, a little at a time
• Knowledge
  • be direct, avoid “passed away”
  •  use plain language, avoid medical jargon
• Emotions
  • Keep your cool, safety first
• Summary
  • Explain what happens next
  • Ask to be excused and how to reconnect

Social Media – Dr. Capocaccia       

• Please follow us on twitter: @UofLEM and Instagram:uoflem
• Will be posting “white board talks” and conference pearls on twitter
• Please send Dr. Capocaccia any images pertaining to wellness that we can share on social media with applicants

How Emergency Doctors Think – Dr. O’Brien

• classic thinking “what does the patient have?” (obtain history, perform physical exam, differential diagnosis, testing, final diagnosis)
• in the ED, the classic model breaks down for a variety of reasons
  • chaotic environment, “anyone, anything, anytime, anywhere”
  • can average 4000 clicks over ten hour shift using EMR
  • Constant interruptions/task switching
  • Frequently responsible for ten or more patients
  • Patients are unknown
• instead, we should ask “what does the patient need?” and whether or not any immediate action is required
• pearls
  • Be the nicest, calmest person in the resuscitation room
  • Rule-out first: diagnose second
  • Focus on smaller list of smaller list of life threatening diseases related to chief complaint
  • If you can, sit at the bedside to collect history
  • Perform an uninterrupted physical exam
  • Avoid diagnostic testing when able using rule-use tool
  • Only order tests that will affect disposition/exclude life threatening/most likely
  • Allow 2-3 minutes of interrupted time to mentally process each patient
  • Mentally process one patient at a time to process disposition
  • You can carry many patients but try to carry a max of 5 “undecided” patients
  • Listen to nurses
  • Avoid the biggest obstacle to the correct diagnosis, the previous diagnosis
  • Avoid inheriting someone else’s thinking on a patient
  • High risk times – sign out, hand offs, high volume, fatigue
  • High risk patients – hostile, violent psych, drug abuse