TOTAL EM - Tools Of the Trade and Academic Learning in Emergency Medicine

​Every time we transfer the care of a patient, we are performing in many ways a high risk maneuver. It is so second nature to many that we do not think about the risks. However, according to the Joint Commission up to 80% of serious preventable medical errors are attributed to poorly communicated handoffs. It begs the question, how do we better transition the care of patients within the emergency department (ED).

We are medical professionals and we want to help our family and friends as much as we help our patients. However, there is a real challenge to balance how you help a family member or friend when they have medical questions or concerns. After all, most likely you are not their primary care provider (PCP).

​Most of us are having issues with using opiates in general given problems with misuse and abuse. However, more recently we are experiencing significant shortages. We discuss some key articles in recent literature (almost exclusively 2017) to help discuss alternatives to using opiates in pain control.

​We are no stranger to controversial subjects here at TOTAL EM, but one that already has a significant division in emergency medicine is the use of pelvic exams. Most people fall into one of two camps: to do one, or not to do one in the event of vaginal bleeding. The big factor in more recent medical history has been with the availability of ultrasound to supplement or fully replace the pelvic exam. Michelle Perkins, who has co-authored some of our most well visited posts, joins us in this discussion.

​​Night shift can be rewarding and some of us choose to do it all the time. There is little to no administration, the crew tends to be more relaxed (but obviously place variant), the cases can be a bit more interesting, the patients are very different from the daytime (both good and bad), and it can there are the small things that is hard to list but you can truly appreciate with time (watching meteor showers and shopping while the rest of the world is asleep) are only a few of the bonuses. However, it also has its challenges and it is hard to get into the routine. We discuss some tips from friends, other media, and research in this review.

​What do you do when the dead are awake? It is confusing terminology, but patients may develop consciousness and be alert during cardiac arrest while receiving chest compressions. In the literature, this is often reported as cardiopulmonary resuscitation induced consciousness (CPR-IC) The phenomenon is overall rare but reports are increasing with time. In this blog and podcast we talk about how to manage such patients.

Most of us working any length of time in emergency medicine are either familiar with or perform the (extended) Focused Assessment of Sonography in Trauma (eFAST). Some keep with the original FAST exam which does not include the lungs, and we will talk more about why you want to include the lungs in a separate podcast. However, after having just returned from 2018 AASPA Conference where we taught participants about many clinically important exams, there were some details of the eFAST that simply could not be covered simply due to time. This podcast is devoted to providing some quick tips to improve your exam no matter your practice level.

Back in April 2017 we went to SEMPA 360 and we have been saving some pearls just for a reminder of what SEMPA can offer when it comes to a conference. The long wait is over and to help support our SEMPA friends we have an interview of some quick pearls from expert Robert Dachs.

Dental pain is a common complaint in emergency medicine. Often, it is seen as a non-emergent complaint and there is truth to that issue. However, dental pain can be life threatening and has some key points we will discuss in this podcast. The first step is to remember 3-2-1.

​2017 has been an intriguing year. For the blog and podcast specifically, there have been many accomplishments. Goals have been obtained faster than planned and we still are striving for even more success. Today, we are talking about something that is not in medicine much but we see it elsewhere such as the military and firefighting: the after action review (AAR). However, a traditional AAR can sometimes be difficult to perform at it takes a long time. In critical events there is an abbreviated version known as the "hot offload" which is being promoted by some such as Ashley Liebig. However, it is worth noting there are some key differences.