Simple Kind of ED (SKED)

急診醫師專訪系列之二（下集）

• 受訪者姓名：簡立建（急專編號：A00975）
• 台灣外傷醫學會理事長（第九屆）
• 台北市立聯合醫院和平院區緊急醫療部災難醫學科主任
• 訪談年份：2016
• 現階段想鑽研的知識領域：醫療政策
• 推薦閱讀書目：
• • How Doctors Think
  • • 作者：Jerome Groopman
    • 中譯名「醫生，你確定是這樣嗎？」（譯者：廖月娟），天下文化出版
    • 陳國智醫師blog推薦文 http://juice119.pixnet.net/blog/post/16548881-%E5%A5%BD%E6%9B%B8%E4%BB%8B%E7%B4%B9%3A-%E9%86%AB%E7%94%9F%EF%BC%8C%E4%BD%A0%E7%A2%BA%E5%AE%9A%E6%98%AF%E9%80%99%E6%A8%A3%E5%97%8E-(how-doctors-th
    • 另有一本相似書名
    • • How Doctors Think: Clinical Judgment and the Practice of Medicine
      • 作者：Kathryn Montgomery
  • 偵探小說
• 推薦的醫學會議？Annual USC National Trauma, Emergency Surgery & Surgical Critical Care Symposium
  • http://www.surgery.usc.edu/acutecare/acutecaresurgerysymposium.html
• 避免事後諸葛、體會「臨床裁量權」、share decision making

急診醫師專訪系列之二（上集）

• 受訪者：簡立建（急專編號：A00975）
• 台灣外傷醫學會理事長（第九屆）
• 台北市立聯合醫院和平院區緊急醫療部災難醫學科主任
• 訪談年份：2016
• 最一開始想走急診的原因：Trauma
• 防止burnout的祕訣：別太在意收入
• 面試新進住院醫師時想問的問題：你為什麼想來急診？
• 現代急診醫師最應具備的能力：溝通、觀察的能力

• 受訪者：Jessica Mason
• 急專訓練：Emergency Medicine Class of 2016，MetroHealth Medical Center, Cleveland, Ohio
• • http://www.metrohealth.org/emergency-medicine/meet-the-residents
• 現職：Medical Education Fellowship, Department of Emergency Medicine, UCSF
• • http://emergency.ucsf.edu/education/fellowship-programs/medical-education
• 目前參與錄製的Podcast節目
• • Med Forum
  • • https://itunes.apple.com/us/podcast/med-forum-podcast-episodes/id570096303
    • http://medforum.libsyn.com/
  • The Hippo EM Resident Call Room
  • • https://www.facebook.com/emresidentcallroom/
    • https://itunes.apple.com/us/podcast/hippo-em-resident-call-room/id729067988
    • http://hippoem.libsyn.com/
  • This Won't Hurt A Bit
  • • http://www.wonthurtabit.com/ 
    • https://itunes.apple.com/us/podcast/episodes-this-wont-hurt-a-bit/id1047494657
  • EM:RAP https://www.emrap.org/
  • EM:RAP HD https://www.youtube.com/user/EMRAPMEDICAL
  • • How to do a lateral canthotomy? https://www.youtube.com/watch?v=tgQaKVGynFA

• Reuben Strayer: Leisurely Laryngoscopy (SMACC DUB)

• • Position

  • • head at head of bed, or beyond (occiput off)

    • ear to sternal notch

    • head of bed up

    • • Levitan RM, Mechem CC, Ochroch EA, Shofer FS, Hollander JE. Head-elevated laryngoscopy position: improving laryngeal exposure during laryngoscopy by increasing head elevation. Ann Emerg Med. 2003;41(3):322-30.

    • look into the mouth; not get into the mouth

  • Start laryngoscopy early (but with deliberated slowness)

  • Incremental Goal Directed Tracheal exposure (IGDT)

  • • lead with suction

    • soft palate → uvula → posterior wall → epiglottis → interarytenoid notch

    • ELM (external laryngeal manipulation)

  • Eschmann Introducer (Gum Elastic Bougie)

  • Assistant

  • • 拉嘴角

    • Jaw Thrust Maneuver

    • • Corda, David M., Kevin T. Riutort, Alex J. Leone, Mueez K. Qureshi, Michael G. Heckman, and Sorin J. Brull. "Effect of Jaw Thrust and Cricoid Pressure Maneuvers on Glottic Visualization during GlideScope Videolaryngoscopy." Journal of Anesthesia J Anesth 26.3 (2012): 362-68.

    • 3 Finger Tracheal Palpation

    • • Gamble, Jonathan J. "Three-Finger Tracheal Palpation to Guide Endotracheal Tube Depth in Children." Pediatric Anesthesia Paediatr Anaesth 24.12 (2014): 1312-313.

      • Mckay, William P., Jim Klonarakis, Vladko Pelivanov, Jennifer M. O’Brien, and Chris Plewes. "Tracheal Palpation to Assess Endotracheal Tube Depth: An Exploratory Study." Can J Anesth/J Can Anesth Canadian Journal of Anesthesia/Journal Canadien D'anesthésie 61.3 (2013): 229-34.

• Scott Weingart: Post-Intubation Sedation (SMACC DUB)

• • 止痛先於鎮靜

  • • 1mg hydromorphone ivp, then 0.5mg ivp q10min

    • Neuro problem: choose Fentanyl

  • Scott推薦在急診先用Propofol（Dexmedetomidine生效較慢）

  • Pain cannot be a “pressor”

  • RASS score

  • 使用Rocuronium，請別讓病人流淚！
• dasSMACC: 20170626~0629

• 急診就診信任基礎薄弱
• 退掛＆自動出院（AAD）
• • 激烈的抗議手段 vs. 不看最好
  • 何時不能自己退掛
  • • 119送入
    • 院內其它單位轉入
    • 自傷傷人行為
  • 退掛的真正理由
  • • 換取提早看診的手段 vs. 真的不想看
• 在急診等待手術者的疼痛問題
• • 真的痛 vs. 換取注意力的手段
• 老人主訴胸悶
• • 總是找不到原因時要想到depression
  • • 和家人互動關係
    • 失能後的憂鬱（e.g. 中風後）

• 報名網址 http://goo.gl/forms/oMFfhGJ8H7
• Facebook活動頁面 https://www.facebook.com/events/1006877126014570/

每月收聽的急診Podcast清單：

• EMCrit http://emcrit.org/
• ERCast http://blog.ercast.org/
• EM:RAP （付費訂閱） https://www.emrap.org/
• EMCast （付費訂閱EMedHome.com） http://www.emedhome.com/cme_emcast.cfm

目前使用的android app.: AntennaPod http://antennapod.org/

由侯勝文醫師介紹Spinal Motion Restriction（譯為『脊椎減移』） Introducing Spinal Motion Restriction into Taipei EMSS P.S. 網頁可下載slides (.pdf)及影片（.wmv）