Performance Under Pressure

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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The Ottawa heart failure risk scale

A new episode of the SGEM hot off the press just went up. Ken and I spoke to Ian Stiell about his Ottawa heart failure risk scale.

Reference: Stiell et al. Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, With and Without Use of Quantitative NT-proBNP. AEM March 2017

Continue reading “The Ottawa heart failure risk scale”

Rapid Review: Ciguatera Poisoning

In the Rapid Review series, I briefly review the key points of a clinical review paper.

The topic: Ciguatera poisoning

The paper: Thompson CA, Jazuli F, Taggart LR, Boggild AK. Ciguatera fish poisoning after Caribbean travel. CMAJ Canadian Medical Association journal. 2016. PMID: 27160878 Continue reading “Rapid Review: Ciguatera Poisoning”

D-dimer for aortic dissection: the evidence

An overview of the evidence for D-dimer use in the diagnosis of aortic disection

I am really excited to announce that we are starting a new format on the EMCases Journal Jam podcast series. The plan is to take important questions about everyday clinical practice and do a deep dive into the literature to provide you with the most evidence based answer we can come up with. Most importantly, we are adding new (or, I suppose you might argue, our first ever) talent to the series: the brilliant @EMNerd_ himself, Dr. Rory Spiegel!

The first episode has just gone live. Our question: Is there a role for D-dimer testing in the workup of aortic dissection in the emergency department? I would suggest the podcast as the more entertaining and succinct way to get an answer, but because of time restraints and our desire not to bore you to death, we did not discuss every single study in the podcast. What follows are my notes for the podcast – a brief review of all the original literature I could find on the topic, arranged by year of publication. Continue reading “D-dimer for aortic dissection: the evidence”

Articles of the Month (January 2017)

Another month and another batch of articles to keep your practice informed. As always, I have no specific selection criteria. These are all just papers that I found interesting. I am always happy to receive suggestions if you encounter a paper that makes you think. And, of course, make sure to have a listen to me and Casey Parker making fools of ourselves as we try to come up with intelligent things to say about these papers on the BroomeDocs podcast. Continue reading “Articles of the Month (January 2017)”

At a loss for words (communicating with children after child abuse)

This is a guest post by Bruna Dessena, with edits by Justin Morgenstern. Bruna is an ALS paramedic from South Africa, with 26 years of clinical experience. She has worked for 17 years preparing children for court as a volunteer at the Teddy Bear clinic in Johannesburg. She has also published a book that acts as a guide to interacting with children after abuse.

You are seeing a 3 year old child with a femur fracture. You perform a rapid primary and secondary survey, confirming that there are no other life threatening injuries. The vital signs are stable. You provide rapid analgesia, starting with an intranasal dose of fentanyl as you set up for an IV. As you finish ticking off the clinical boxes in your head, a question pops into your mind: how exactly did this injury happen? Was this truly an accidental injury? And what should I say to this child? Continue reading “At a loss for words (communicating with children after child abuse)”

Rapid Review: anti-NMDA receptor encephalitis

In the Rapid Review series I briefly review the key points of a clinical review paper.

The topic: anti-NMDA receptor encephalitis

Continue reading “Rapid Review: anti-NMDA receptor encephalitis”