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

​We continue our month of celebrating PAs with a new podcast on a topic not well covered: triaging and assessment of the total joint arthroplasty (replacement) patient. To help us, we have a special guest who is an orthopedic surgery PA named Amy Jean.

Our guest today (the first for PA month here on TOTAL EM) is Adrian Banning. She is an Evidence Based Medicine (EBM) guru and is also on the JAAPA Podcast with a previous guest, Kris Maday. Today though she is here to talk to us about breaking bad news. Something most of us are experienced with but one thing few of us do well. We combine EBM and "soft skills" to better care for our patients and families in this very difficult time.

PA Week is October 6-12 this year. As PAs, we have a lot to be proud of in the 50 years of our existence but with our many advances, there still more we can do. This month, we are hosting PAs for our podcasts. However, to kick off the month, we are going to talk about the challenges that lay ahead. It is worth noting though that much of it is now possible thanks to those who came before us.

Some of us do it well, some of us do not do it at all, but we all could use improvement. The medical decision making (MDM) portion of the chart is one area we all can work on. It is quite possibly the single most important portion of the chart for multiple reasons including acting as a "hard stop" in decision making, explaining course of care and management, reviewing highlights of the visit, and even potentially helping in a legal situation. Today, we have Mike Weinstock joining us on this very important podcast.

We need to get better taking care of out patients. One of the easiest ways to get better is to work both sides of the emergency medicine realm. The main divide rests in the prehospital environment versus the emergency department. We can still see this in the rural versus urban environment. Our experiences in different realms can make us much better providers.

Today is a brief podcast about leaving the ivory tower. As a PA or physician, we have to train at such a place but with time we will leave. Not all nurses, paramedics, or others in such settings will ever see the "ivory tower" and may have their education only in rural environments or at least not at a tertiary care center. The challenge for us becomes not only getting the medical knowledge, but also how to spread it.

​Today's podcast is a little brief but covers and important topic: blood draws and patient's rights. This comes up due to a recent incident in Salt Lake City at University Hospital when a detective of the Salt Lake City Police Department arrested Alex Wubbels, a nurse there, when the officer attempted to collect blood for testing from an unconscious patient.

"Everyone has a plan until they get punched in the mouth." – Mike Tyson Mental preparedness is not taught to us in emergency medicine or in healthcare generally, but it is something we are all doing to a degree. However, we need to improve our abilities and expand on them to do our jobs better. There are many approaches and everyone has their own style, but we will go over some approaches today to help improve your shifts and hopefully lead to you being a better clinician.​

Everyone talks about airway all the time, and I was at first reluctant to give this talk. However, I believe it is time to talk about this important subject in a slightly different way. The last time we talked about airway management in regards to intubation was with Kris Maday (from the PAINE Podcast) in Podcast #18 where we went over the basics (a great review to listen to first if needed). There we talked mostly about rapid sequence intubation (RSI). Although commonly used, this is not for every patient. Today, we talk about RTI, which is what we need in most patients.

No matter what aspect of emergency medicine you work in (EMS, fast track, main ED, rural, remote, urban, suburban, or whatever else), you need to be a resuscitationist in my book. This is entirely my opinion, but I believe it is important one worth your time in both reading and listening. ​Envision a busy night shift. It is three in the morning and somehow you still have a waiting room full of people waiting to be seen in your small ED that is hours away by ground to tertiary care. Scattered thunderstorms and overwhelmed emergency services have made it difficult to transfer out patients. You would swear it was a full moon, but when you were outside just to get a quick breath of fresh air from all the chaos you look up and it is not. Suddenly, you hear sirens in the distance and EMS reports are all coming in at once...