Articles of the year (EMU 2018)

Hand out for the articles of the year lecture at EMU 2018

I love evidence based medicine, but I definitely understand the criticism that EBM nerds like myself can come across as very negative. Thrombolytics don’t work. BNP isn’t helpful. Stress testing is a sham. Idarucizumab? Yeah right. I think this scientific criticism is crucial, but I understand that it isn’t always fun. So when I was asked to present my favourite articles of the year at the North York General Emergency Medicine Update, I decided to stay entirely positive. I only chose papers that were potentially  practice changing, but more importantly, that could have a positive impact on clinical practice. These are the papers I chose.

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Embracing Science: #dasSMACC Hardcore EM handout

A handout for the EBM portion of the Hardcore EM seminar at #dasSMACC

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Sweet 16 (papers of the year for NYGH EMU 2017)

At this year’s North York General Emergency Medicine Update, I was asked to review the most important emergency medicine literature from the past year. These are the 10 papers I decided to talk about. If you have questions or comments, please join the discussion at the bottom of the post.

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Performance Under Pressure

Improving your performance in high pressure situations

How well do you perform when the pressure is high? This is one of my favorite emergency medicine topics. Emergency personnel pride themselves on thriving under pressure. Doctors like to think of themselves as perfect, maybe even god-like. Combine the two, and you can imagine the ego of the average emergency physician. But underneath all that bravado, we are all human. We all experience stress, and we all respond to stress in distinctly human ways.

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Lecture handout: Social Media in Medicine (University of Toronto Anesthesia and Surgery Faculty Development Day)

This handout accompanies the social media in medicine seminar as part of the University of Toronto Anesthesia and Surgery Faculty Development Day. It is primarily a collection of links to good resources explaining FOAM and how you can get involved in this fantastic online medical community. Continue reading “Lecture handout: Social Media in Medicine (University of Toronto Anesthesia and Surgery Faculty Development Day)”

Mending Medical Myths (lecture notes for St. Pauls Emergency Medicine Update 2016)

Medical myths matter. All of our decisions, although they often seem small to us in the middle of a busy shift, have real impacts on people’s lives. To be a truly expert clinician, you have to understand not just what to do, but why you are doing it.

The primary myth covered in this talk was the use of topical anaesthetics in the management of simple corneal abrasions. The full handout and list of articles can be found here.

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I also covered Salter-Harris 1 injuries, the myth that ligament is stronger than bone, and that concept that not all of these injuries need a cast. A full handout with references on the topic can be found here.

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If you are interested, a few of the other medical myths that I mentioned during the talk were:

The use of PPIs for upper GI bleeds

The benefit for stress testing in low risk cardiac patients

As physicians, we are trusted sources of medical information. We are relied upon not just by our patients, but also our families and friends to be knowledgeable and credible sources of information about health. We should all probably be aware of common medical myths, such as the need to drink 8 glasses of water a day, the idea that we only use 10% of our brains, or the thought that eating turkey might make you sleepy, because even these seemingly benign misunderstandings can have tremendous impacts on people’s lives. For a short, fun read on some of these topics, see:

Vreeman RC, Carroll AE. Medical myths. BMJ (Clinical research ed.). 335(7633):1288-9. 2007. PMID: 18156231 [free full text]

Charles Sidney Burwell, the dean of Harvard medical school at the time, famously said, “Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don’t know which half is which.” This may still be true today, but I don’t think this has to be true. If we taught the complexity of science, rather than just a collection of facts, we wouldn’t be wrong. We would understand the need for replication of studies and the limitations of p values. We would be able to differentiate treatments with great evidence (ASA in MI) from those with bad evidence (tamsulosin for renal colic), and we wouldn’t be so surprised by the constant updates that are part of the normal scientific process.

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There is a lot of evidence to keep track of and not many of us are laden with free time. How is one supposed to keep up with everything? In this day and age, I think the answer is crowdsourcing the work. There are so many great, free EBM resources available not that I don’t think there is any excuse in falling behind. This handout covers my favourite sources of evidence based medicine and critical appraisal.

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If anyone takes up my challenge and finds an interesting answer while exploring why we do what we do, feel free to contact me and we can share it here with everyone else. You can use this contact page or else e-mail me at first10em at gmail dot com.

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Surviving the first 10 minutes (lecture notes for North York Emergency Medicine Update)

Lecture notes to accompany 2016 NYGH EM Update talk on performance under pressure and mental practice: Surviving the first 10 minutes

In this talk, we focused on mental practice as a technique to help improve our performance under pressure. For the full notes and references on performance under pressure and mental practice, see this blog post.

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We want to use mental practice to ensure that we have all the resources we need, in order to deal with the demands placed on us.

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Resources greater than demands is a challenge First10EM.PNG

We discussed three cases to demonstrate the role of mental practice:

In order to make mental practice work for you, you want a simple script that guides you through your approach to the patient. Most importantly, the script needs to be specific to you, taking into account your skills and your practice environment. Then, to practice, you should actually picture yourself in the resuscitation room and visualize not just the steps, but specifically how you are going to get each step done. Where in the room is the required equipment? How does the equipment work? How are you going to organize your team? Who is doing what, in what order?

I think this kind of dedicated practice, combined with the simplified action script for you to fall back on when under pressure, will ensure that you have the resources you need to meet the crazy demands of emergency medicine.