Wednesday, October 27, 2010

Key Changes: 2010 AHA Guidelines for CPR and Emergency Cardiovascular Care

I'm a subscriber at One of the best things are the Clinical Pearls they send out via email. Check out the Clinical Pearls below that is crucial for emergency medicine.

Key Changes: 2010 AHA Guidelines for CPR and Emergency Cardiovascular Care

  • Atropine is no longer recommended for routine use in the management of PEA/asystole. For symptomatic or unstable bradycardia, IV infusion of chronotropic agents is now recommended as an equally effective alternative to external pacing when atropine is ineffective.

  • Adenosine is recommended in the initial diagnosis and treatment of stable, undifferentiated regular, monomorphic wide complex tachycardia. (Editor’s note: Clinicians should be aware that adenosine should be used with significant caution in the setting of WCT in certain patients. Click Here for a previous EMedHome Clinical Pearl on this topic)

  • The BLS sequence of steps for trained rescuers has changed from “A-B-C” (Airway, Breathing, Chest compressions) to “C-A-B” (Chest compressions, Airway, Breathing) for adults and pediatric patients (excluding newborns).
  • Continuous quantitative waveform capnography is now recommended for intubated patients throughout the peri-arrest period - it is the most reliable method of confirming and monitoring correct ETT placement. Capnography can also serve as a monitor of the effectiveness of chest compressions and to detect ROSC.
  • Suctioning immediately after birth should be reserved for babies who have an obvious obstruction to spontaneous breathing or require positive pressure ventilation. There is no evidence that active babies benefit from airway suctioning, even in the presence of meconium, and there is evidence of risk associated with this suctioning. The available evidence does not support or refute the routine endotracheal suctioning of depressed infants born through meconium stained amniotic fluid.
  • There is increasing evidence of benefit of delaying cord clamping for at least 1 minute in term and preterm infants not requiring resuscitation.

Reference: Circulation, Vol. 122, Issue 18, Supp 3; November 2, 2010.

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Monday, October 25, 2010

Finding Happiness in the Emergency Department

Finding Happiness in the Emergency Department
by Sam Ko, MD, MBA
CAL/EMRA President, 2010-11

“It’s too busy in the ED these days.” “Another faker.” “Why can’t they go to their primary medical doctor?” Have you ever said these words or overheard them during a shift? It can be disheartening to work a shift and see the patient chart rack mount higher and higher, as you place a central line in the patient with septic shock, then evaluate a patient with chronic low back pain, and then examine the ears of a two-year old whose fever “came right back four hours after Tylenol was given.”

Recently, I’ve discovered the secret of being happy while working in the ED. It’s a simple idea, but has profound implications. The idea stems from Srikumar Rao’s talk, “Plug into your hard-wired happiness.” He states that our mental model of happiness is flawed. Our model is based upon the logic, “I’d be happy if...”

For example, do you remember when you were pre-med college student? You said, “I’ll be happy once I get into medical school.” Then when you were in medical school, you told yourself, “I’ll be happy once I get a high score on the boards.” Then when you were in residency, you said, “Life will be great when I’m an attending.” This mental model is flawed, because it never allows us to be happy in the current moment. Instead, we continually seek the next step to elusive happiness.

Now, can you recall a time when you were truly happy? It may have been while watching a sunset over the ocean, seeing a beautiful rainbow, or welcoming your child into the world. Why were you happy? It was because you accepted everything at that very moment. You didn’t say, “Oh, it’d be more perfect if there were less seagulls flying across the sky.”

The emergency physician’s role is to evaluate everyone who comes into the ED - regardless of how sick or not sick they appear to be - and rule out emergencies. Our realm of practice includes the most bogus visits to the most critical illnesses. The key idea is acceptance of this fact. To accept everything that is happening and every patient who comes in to the ED, no matter what. When I accept the patient with an ingrown toenail, the asymptomatic patient who meticulously measures their blood pressure at home, or the patient in DKA who doesn’t take their diabetic medications, I feel calmer and relaxed. If I don’t want to develop stress-induced hypertension, burst an aneurysm, or start loading up on benzodiazepines prior to work, I choose to accept all aspects of my field.

Every shift, we have the opportunity to relieve pain, alleviate fears, and save lives. It’s a privilege to be an emergency doctor and everything that comes along with it. So here’s the challenge: during your next shift, calmly accept everyone you see in the emergency department.

Reference: Rao, Srikumar. Accessed 8.31.10

Originally posted in CAL/ACEP Lifeline October 2010.

Monday, October 18, 2010

Top Ten Financial Tips for Graduating EM Residents

1. Save more than 20% of your income.

2. Have cash reserves for six months of expenses.

3. Automatically have savings deducted from check.

4. Take full advantage of employer's financial benefits, i.e. retirement, child care, advanced education, etc.

5. Max out your 401K, Roth IRA, or other retirement plan.

6. Review insurance policies (malpractice, disability and life insurance.)

7. Create an investment strategy based upon income, age, and risk tolerance.

8. Start an education plan for your children (529 or education IRA.)

9. Review estate planning and update your will or trust.

10. Start planning now to avoid income tax suprises next year.

Source: Lane Financial & Dew Wealth Management

Saturday, October 16, 2010

Anthony Robbins

I listen to Tony Robbins in the car. His books, Unlimited Power & Awaken the Giant Within are powerful. After listening to him, it gives me a different mental model to use and different perspective on reality.

Enjoyo this enlightening talk by Tony Robbins @ TED Conference.

Thursday, October 14, 2010

Finding your niche in Emergency Medicine

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Dr. Amal Mattu's lecture "Finding your niche in EM" is powerful. He discusses the importance of finding your unique area in emergency medicine. His tips are to:

1) Be the Expert.
2) Go into new areas that are not too saturated (like emergency EKGs)
3) Publish like crazy on a focused topic.
4) Be broad, and not too narrow.
5) Read everything on that topic.

Whether one is going into academics or community practice, it's important to have a niche. Now, go forth and specialize.