15 Must Have iPhone Apps for Emergency Physicians

1.  WikEM – This app from UCLA Harbor Residency is devoted to the practice of EM.  The content includes IV drip concentrations, initial approach to almost every complaint, emergency imaging, and emergency procedures.  Very easy-to-read and concise.  Cost: Free

2.    Epocrates – Easy to use app for drugs, pharmacology, pregnancy & lactation safety, and drug cost.  A nice bonus is the pill identification tool when your patient tells you, “I take the little pink pill.”  Cost: Free

3.    Medscape – From creators of WebMD, this app includes nearly every diagnosis and has a clinical, diagnostic, and treatment component.  It’s sort of like the free version of UpToDate on my iPhone.  Cost: Free

4.    Eye Handbook – This app is focused for ophthalmologists; however, some EM applicable sections are the Eye Atlas, Testing, and Patient Education.  Check out the Movies tab and download the Cheese Cartoon, an excellent distraction when calming pediatric patients or checking for extra-ocular movements.   Cost: Free

5.    Eponyms – Remember Takotsubo syndrome, Von Hippel-Lindau disease, or Alder’s sign?  This app provides a succinct description of various eponyms.  A great way to remember everything you forgot from medical school.   Cost: Free

6.    MedCalc – It helps you calculate CURB-65 Scores, fluid repletion for burns, glomerular filtration rates (GFR), and even view a dermatome map.   When you double tap an equation, it gets uploaded to your “Favorites” file for easy access.   Cost: Free

7.    Radiology 2.0 – Created by a radiologist and a medical student, this app’s subtitle is “One Night in the ED.”  It has clear CT scan images of small bowel obstruction, aortic injury, appendicitis, and more.   You can even quiz yourself by hiding the answers.   Once you review the scans, go to the discussion section and read the explanations.  Cost: Free

8.    Diagnosaurus – This app is useful when you want to expand your differential list.   All entries are organized by symptom, disease, or organ system.   For frequently viewed entries, simply click the star in the bottom right hand corner to add to your Favorites.  Cost: $0.99

9.    PediStat – When working with critical pediatric patients, it can be difficult to remember drugs dosages, tube sizes, and normal vital signs.  Simply plug in the weight, age, length/height, or Broselow Color on the first page.  You will now have accurate dosing information to resuscitate your patient.   Cost: $2.99

10. EMRA Antibiotic Guide 2011 – You may have the hard copy version but if you want to unload your pockets, you must download this app.  This amazing guide has antibiotic recommendations based upon organism, diagnosis, and organ system.  This version also has a dosing calculator to make your life easier!  Cost: $15.99 

11. Micromedex - Another useful resource for drugs and simple to use.  This includes both OTC and prescribed drugs.  The mechanism of action section is a little more in-depth compared to Epocrates.   Cost: Free

12. Pepid - This is my go-to source for all overdoses.  I appreciate the concentrated information (i.e. Pathophysiology, Diagnosis, Symptoms, Toxic levels, Treatments, Antidote, & Disposition).  Cost:  Free

13. MediBabble - Truly amazing app that helps you communicate with others. It comes in handy when getting direct yes/no questions.  The languages includes: Spanish, Cantonse, Mandarin, Haitian Creole, and Russian!  Cost:  Free

14. Antibiotic Advisor 2011  -  Another reference option for antibiotic choices.  It's similar to EMRA's guide.  Sometimes the search function can be buggy, but you can't beat the price.  Cost: $3.99

15. Ruler -  We measure a lot of things in the ED. Anything from lacerations to size of rashes.  If you don't want to carry around a real ruler, download the free ruler app.  Just search for "ruler" in the App Store or check out the link.  Cost:  Free

*FYI, I have no financial interest in any of these apps or companies.

Presentation References

Websites:

http://www.slideology.com (by Nancy Duarte)

http://www.presentationzen.com (by Garr Reynolds)

Books:

Presentation Zen by Garr Reynolds

Presentation Zen Design by Garr Reynolds

Slide:ology by Nancy Duarte

Examples of Great Lectures (a way to get ideas of how you want to craft your presentation)

Any TED (http://www.ted.com) lecture – these are a collection of talks about a wide variety of topics – they are for the most part all fantastic

Any Apple Keynote with Steve Jobs (http://www.apple.com)

Sources for images:

iStockphoto (http://www.istockphoto.com) – free image of the week and some cheaper images – however, most of images are not free

Stock.xchng (http://www.sxc.hu/) – free stock photos

Wikipedia (http://en.wikipedia.org)

Any government site – NIH/DOD/FBI/CDC – since these are government owned images; they are part of the public domain

~Courtesy of Dr. James Rhee

Best EM Residency Contest

Hi Readers,

I need your help to help my residency program win $10,000 for education and research.

Please go this website and vote everyday. You can vote once per person per day until December 15th

http://www.emp.com/2010-loma-linda-university

Truly appreciate your help!

Sam

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

I'm a subscriber at www.emedhome.com. 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.

Go to http://www.emedhome.com/ to subscribe!

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. http://www.ted.com/talks/srikumar_rao_plug_into_your_hard_wired_happiness.html Accessed 8.31.10

Originally posted in CAL/ACEP Lifeline October 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

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.