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Thoughts from Dr Ruben Strayer (who provided a great deal of our PSA card information) on enforcing fasting in the ED prior to sedation. No benefit, maybe even some harm? Don’t tell the folks at Kosair.
Can they eat?
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Author Archives: Martin Huecker
The Big Fat Suprise
Cool new book arguing it is ok to eat bacon, eggs and butter. My copy is due to arrive in the mail today.
Even cooler are these old articles (below) about CAD and MI that another author posted on his website in a review of the Fat book. Check out the articles. And this one written a few years ago. You’ll be drinking guiltless Breve lattes in no time.
Best App since Spotify
Just like Spotify, the QX Read app seems too good to be true. And free. I’d pay $5 or $10 for this little guy. Thanks to Cunningham for letting me know about this one. There could be other similar apps but this one so far has no shortcomings.
The app lets you perform literature searches, follow journals, follow keywords, follow collections you or other users make. It checks for new articles using your keywords and specialty interests. Best feature is you can login with the UL Library Proxy and while you read the abstract of the article, the app is getting permission for the article and you can open the pdf in seconds. Then open the app in your cloud app to save.
I’m sure you all get as frustrated as I do trying to use your phones to search for and download articles through UL’s library website ; ).
Ketamine’s Kryptonite
I witnessed the third patient to have apnea as a side effect of ketamine administration. As in the other two cases ketamine was infused as a push, rather than the slow administration. This was not the resident, but typically and to be by the book, MDs should be the ones pushing ketamine. SLOWLY.
In this case our resident did well managing the sedation. Hypoventilation was diagnosed well before desaturation. Painful stimuli did not induce respirations as the ketamine is too good of an analgesic. We began to BVM ventilate, placed nasal trumpet, sat was never lower than 85%. Took about 8 minutes to get spontaneous respirations. We gave narcan as the patient had fentanyl prior to ketamine. As in one other case of ketamine apnea the narcan did not help, but should be attempted.
So learning point. NEVER SLAM ketamine into the patient. Dilute the 1cc (50mg-100mg) of ketamine in 10cc of saline if it will help the temptation to push it.
Also follow the algorithm below for PSA intervention. We will have the sedation review sheet and reference card finished soon.
Special
Here is a very practical algorithm. I recommend using it every shift.
Source: life in the fast lane?
Burnout
Brief description of burnout types. Not medically specific. Follow the links as well.
1. Overload: The frenetic employee who works toward success until exhaustion, is most closely related to emotional venting. These individuals might try to cope with their stress by complaining about the organizational hierarchy at work, feeling as though it imposes limits on their goals and ambitions. That coping strategy, unsurprisingly, seems to lead to a stress overload and a tendency to throw in the towel.
2. Lack of Development: Most closely associated with an avoidance coping strategy. These under-challenged workers tend to manage stress by distancing themselves from work, a strategy that leads to depersonalization and cynicism — a harbinger for burning out and packing up shop.
3. Neglect: Seems to stem from a coping strategy based on giving up in the face of stress. Even though these individuals want to achieve a certain goal, they lack the motivation to plow through barriers to get to it.
In a roundup of 11 ways to beat burnout, 99u offers this breakdown of the three main types of burnout, per the Association for Psychological Science.
Pair with this essential read on how to transcend the “OK plateau” of work, then see how sleep factors into the equation.
Here is the article itself from APS.
Reference:
http://explore.noodle.org/post/83726976259/1-overload-the-frenetic-employee-who-works?utm_content=bufferef345&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
FOAMed and Social Media in Education
At the CORD Academic Assembly there was a lot of talk about FOAMed and Social Media. I am on the social media committee with CORD and we have some informative projects on the horizon.
Here is a blog post detailing some of the FOAMed workshop with some How-To information.
Then Joe Lex and Nicholas Genes posted PRO and CON articles on the question “Is FOAMed essential to Emergency Medicine education.”
Not long articles, good to be at the forefront of these changes. And good discussion on the pluses and minuses of FOAMed
Financial Website
Hey Dr Coleman has alerted me to an informative website about investing from our perspective. Check it out.
Clinically sober
Nice post from ALIEM on sobriety and intoxication in the ED, and risk. The author seems to favor not obtaining a level. Could make for good discussion at UL.
Journal Club
Thursday March 20.
Havana Rumba Express on Bardstown, 7pm
Here are the articles.
Incision and Loop Drainage of Abscess
WJEM Treatment of Cutaneous Abscesses
Primary Closure of Mammalian Bites
Evolution of Medicine
Interesting article by a retired academic physician / “business executive.”
Jolt no more?
Well I was disappointed to see the poor sensitivity (though still better than Kernig and Brudzinski) of Jolt Accentuation test for meningitis on the recent EM Lit of Note post. Cool little article about clinical presentation of meningitis.