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Chapter 38 - Appendicitis strikes back: Next level diagnosis, myths, and management Appendicitis in the ED01 Dec 202401:01:30

Dr. David Turay, trauma consultant physician at Mayo Clinic, sits down with Alex and Venk to talk about appendicitis!  Have you wondered about ultrasound vs CT imaging? antibiotics only vs operative care? what labs to order? we will go over it in this chapter of Always on EM!

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  • 2013 British Journal of Surgery - C-W Yu, Systematic reivew and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein, and white blood cell count for suspected acute appendicitis
Chapter 37.5 - Nonaccidental trauma in children, part two.14 Nov 202400:59:42

Dr. Mark Mannenbach, emeritus pediatric emergency physician, former chairperson of pediatric emergency medicine at Mayo Clinic and career long advocate for children comes back on the show to talk through nonaccidental trauma in children in a two part series. 

In this second part, we talk through mimics of abuse, second victim syndrome related to caring for children of abuse, some aspects of neglect, and more. 

 

CONTACTS

x- @AlwaysonEM; @VenkBellamkonda

YouTube - @AlwaysonEM; @VenkBellamkonda

Instagram - @AlwaysonEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysonEM@gmail.com

 

REFERENCES

1. Sugar NF, Taylor JA, Feldman KW. Bruises in infants and toddlers: those who don't cruise rarely bruise. Puget Sound Pediatric Research Network. Arch Pediatr Adolesc Med. 1999 Apr; 153(4):399-403

Chapter 32 - You’re invited to our block party! - Emergency department Ultrasound guided regional anesthesia01 Jul 202401:05:30

Dr. Lacey Shiue, emergency ultrasound faculty, sits down with Alex and Venk to talk through ultrasound guided nerve blocks and plane blocks. We talk through key differences in commonly used medications, how to manage toxicity from those medications as well as a detailed discussion of several different specific blocks including: Erector Spinae Plane Block, Fascia Iliaca Compartment Block, Supraclavicular Block, Interscalene Block among others. In addition, she discusses the keys to advancing an emergency regional anesthesia program.

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

RESOURCES FOR PRACTICE:

 

REFERENCES:

  1. American College of Emergency Physicians Policy Statements: Ultrasound-Guided Nerve Blocks, published April 2021. Document accessed June 20, 2024 via: https://www.acep.org/patient-care/policy-statements/ultrasound-guided-nerve-blocks
  2. American College of Emergency Physicians Policy Statements: Guideline for ultrasound transducer cleaning and disinfection, approved April 2021. Document accessed June 20, 2024 via: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.acep.org/siteassets/new-pdfs/policy-statements/guideline-for-ultrasound-transducer-cleaning-and-disinfection.pdf 
  3. Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement. J Ultrasound Med. 2020; online before print. https://doi.org/10.1002/jum.15653 
  4. Ramesh S, Ayyan SM, Rath DP,Sadanandan DM. Efficacy and safety of ultrasound-guidederector spinae plane block compared to sham procedure inadult patients with rib fractures presenting to the emergencydepartment: A randomized controlled trial. Acad Emerg Med.2024;31:316-325. doi:10.1111/acem.14820
  5. New York School of Regional Anesthesia: Ultrasound-guided fascia iliaca nerve block. Accessed June 21, 2024 via: https://www.nysora.com/techniques/lower-extremity/ultrasound-guided-fascia-iliaca-block/ 
  6. Downs T, Jacquet J, Disch J, Kolodychuk N, Talmage L, Krizo J, Simon EL, Meehan A, Stenberg R. Large Scale implementation of fascia iliaca compartment blocks in an emergency department. West J Emerg Med. 2023 May 3;24(3):384-389
  7. Makkar JK, Singh NP, Bhatia N, Samra T, Singh PM. Fascia iliaca block for hip fractures in the emergency department: meta-analysis with trial sequential analysis. Am J Emerg Med. 2021 Dec:50:654-660
  8. Rukerd MRZ, Erfaniparsa L, Movahedi M, et al. Ultrasound-guided femoral nerve block versus fascia iliaca compartment block for femoral fractures in emergency department: a randomized controlled trial. Acute Med Surg. 2024 Mar 6;11(1):e936
  9. Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013 Jun;20(6):584-91
  10. Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, Benger J. Randomised trial of the fascia iliaca block versus the 3-in-1 block for femoral neck fractures in the emergency department. Emerg Med J. 2015;32:685-689
  11. Schulte SS, Fernandez I, Van Tienderen R, Reich MS, Adler A, Nguyen MP. Impact of the fascia iliaca block on pain, opioid consumption, and ambulation for patients with hip fractures: a prospective, randomized study. J Orthop Trauma. 2020 Oct;34(10):533-538

 

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

 

Grand Rounds - Dr. Matthew Hamilton - The History of Homosexuality and Medicine15 Jun 202400:45:10

In this final chapter of the academic year 2023-2024, we celebrate our graduating EM class of residents by spotlighting a senior capstone presentation by Dr. Matthew Hamilton covering the intersection of homosexuality and medicine. In this presentation, he aims for the learner to be able to recognize pivotal movements in LGBTQ+ history and civil rights; describe structural mechanisms that excluded gay people from medicine for over 150 years; and to be able to recognize and mitigate ongoing threats to the health and wellbeing of LGBTQ+ people. Please tune in to learn more from one the great graduating senior emergency medicine resident physicians at Mayo Clinic!

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

Chapter 31 - Legal landmines and lifeboats: Understanding legal risk in emergency medicine01 Jun 202401:05:33

Alex and Venk talk through the medicolegal aspects of practicing emergency medicine with emergency physician and attorney, Dr. Rachel Lindor. She is previous chair of research for Mayo Clinic Emergency Medicine in Scottsdale Arizona and holds both MD & JD degrees. She outlines how the most commonly litigated conditions (MI, orthopedics etc) still only accounts for about 1/5 of medicolegal cases in the United States and the importance of certain key behaviors in our practice to maintaining legal safety. Check it out!

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

REFERENCES & LINKS

  • Heaton HA, Campbell RL, Thompson KM, Sadosty AT. In support of the medical apology: the nonlegal arguments. Journal of Emergency Medicine 2016. 51(5)605-609
  • Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and Physicians’ attitudes regarding the disclosure of medical errors. JAMA 2003;289:1001-7
  • Carlson JN, et al. Provider and Practice Factors associated with emergency physicians being named in a malpractice claim. Ann Emerg Med. 2018;71:157-164
  • Sachs. Malpractice claims: It’s a crapshoot-Time to stop the self-blame and ask different questions. Ann Emerg Med. 2018;71(2):165-167
  • Weinstock & Jolliff.  High-Risk Medicolegal Conditions in Pediatric Emergency Medicine. Emerg Med Clin N Am. 39(2021) 479-491
  • Selbst, et al. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers.  Pediatr. Emerg Care. 2005 Mar;21(3):165-9
  • Wong, et al. Emergency Department and Urgent Care Malpractice Claims 2001-2015. West JEM. 2021. 22(2): 333-8

 

Grand Rounds - Dr. John Wilson - Updates in Tuberculosis "The gift that keeps on giving"14 May 202400:53:34

Dr. John Wilson, consultant in the division of infectious diseases at Mayo Clinic, and professor of medicine, director of Tuberculosis consultations at Mayo Clinic presents updates in Tuberculosis for Mayo Clinic Emergency Medicine Grand Rounds back in February. 

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

Chapter 30 - Two minutes to midnight: Critical overview of hemoptysis01 May 202401:09:31

Dr. Dagny Anderson, a specialist in the division of pulmonary and critical care medicine at Mayo Clinic, joins Alex and Venk to talk about both life threatening hemoptysis and non-lifethreatening hemoptysis. In this chapter we review what we need to be doing in the emergency department, while also shedding light on what our teammates in other specialties can offer the patients downstream. Join for this colorful journey of how to manage the situation when no one likes what is coming out of the patient's mouth.

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

REFERENCES

  • Gopinath B, et al. Nebulized vs IV Tranexamic Acid for Hemoptysis - A pilot randomized controlled trial. Chest 2023;163(5):1176-1184
  • Wand O, Guber E, Guber A, Epstein Schochet G, Israeli-Shani L, Shitrit D. Inhaled Tranexamic Acid for Hempotysis Treatment: A randomized controlled trial. Chest 2018;154(6):1379
  • Ibrahim WH. Massive Hemoptysis:The definition should be revised. Eur Respir J. 2008 Oct;32(4):1131-2
Grand Rounds - Dr. Michael Wilson - What your psychiatrist isn't telling you about suicide prevention in the ED14 Apr 202401:12:55

Whether or not emergency physicians believe that patients with thoughts of self-harm belong in the ED, they are coming to your ED anyway. According to the Centers for Disease Control, ED visit rates for nonfatal self-harm increased 42% among persons 10 years or older, and visits for suicidal ideation, self-directed violence, or both increased 25.5% from 2017-2018. That’s an increase of more than 1% per month pre-COVID. This solutions-oriented talk will discuss some of the science behind suicide prevention in the ED, and will present techniques that you can use to reduce risk in your ED.

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Chapter 29 - How to save a life - A primer on ECPR and ED ECMO01 Apr 202401:19:38

Dr. Suraj Yalamuri, Mayo Clinic Anesthesiology Critical Care and Cardiovascular Medicine Consultant, joins Alex and Finch to talk about the fundamentals of ECMO and ECPR. This is a great way to get caught up on this emerging science so that you'll be ready to provide the best resuscitative care for your patients when your system is ready too. 

Grand Rounds - Dr. Rebecca Leff - Fit for Purpose: Emergency Medicine Physicians and Humanitarian Response in Complex Emergencies14 Mar 202401:05:47

Dr. Leff shares, in her senior resident capstone presentation, a primer on humanitarian efforts, what are basic principles of aid, how to identify the key health needs of populations affected by crises and how EM clinicians can respond to those needs with the greatest impact. She will discuss how to engage responsibly and to anticipate how humanitarianism will develop and adapt in the future to improve responsiveness. 

Chapter 28 - Cant stop the bleeding - Mastering epistaxis01 Mar 202401:23:50

Dr. Mike Olson, former EM PA and now ENT attending sits down to talk about epistaxis with Alex and Venk. We go through a pragmatic approach to epistaxis, discuss some nuance cases including telangiectasia, hypertension, and anticoagulation. 

interventions are key, what patients are most likely to suffer a bad outcome and more.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  • Ingason AB, et al. Warfarin is associated with higher rates of epistaxis compared to direct oral anticoagulants: a nationwide propensity score-weighted study. J Intern Med. 2022 Sep;292(3):501-511
  • Thomg JF, et al. A prospective comparative study to examine the effects of oral diazepam on blood pressure and anxiety levels in patients with acute epistaxis. Journal of Laryng & Otol. 2007. (121)124-129
  • Terakura M et al. Relationship between blood pressure and persistent epistaxis at the emergency department: a retrospective study. J Am Soc Hypertens. 2012 Jul(4):291-295
  • Lee CJ, et al. Evaluation of the relationship between blood pressure control and epistaxis resource after achieving effective hemostasis in the emergency department. J Acute Med. 2020 mar 1;10(1)27-39

 

Chapter 27.5 - Unbundling the bundle - Part two of sepsis14 Feb 202401:08:26

Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. This is the second part of the two part series.

Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. We review the PROCESS, PROMISE, and ARISE trials and provide pragmatic approach to your septic patients. 

So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes.

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

Intravascular volume assessment

  • Azadian M, Win S, Abdipour A, et al. Mortality benefit from the passive leg raise maneuver in guiding resuscitation of septic shock patients: A systematic review and meta-analysis of randomized trials. J Intensive Care Med. 2022 May;37(5):611-617
  • Spiliotaki E, Saranteas T, Moschovaki N, et al. Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: a critical analysis review. J Clin Ultrasound. 2022 Jun;50(5):733-744

 

Chest radiography paper referenced

  • Poku JK, Bellamkonda-Athmaram VR, Bellolio F, Nestler DM, Stiell IG, Hess EP. Failure of prospective validation and derivation of a refined clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome. Acad Emerg Med. 2012 Sep;19(9):E1004-10

 

Albumin

  • Caironi P, Tognoni G, Masson S, Fumagalli R, Presenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L, ALBIOS Study Investigators. Albumin Replacement in patients with severe sepsis or septic shock. NEJM. 2014;370(15):1412
  • Xu JY, Chen QH, Xie JF, Pan C, Liu SQ, Huang LW, Yang CS, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB. Comparison of the effects of albumin and cyrstalloid on mortality in adult patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials. Crit Care. 2014;18(6):702
  • Jiang L, Jiang S, Zhang M, Zheng Z, Ma Y. Albumin versus other fluids for fluid resuscitation in patients with sepsis: A meta-analysis. PloS One. 2014;9(12):e114666

 

Unbundling studies

  • ProCESS Trial: ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, PIke F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC. A randomized trial of protocol based care for early septic shock. NEJM  2014;370(18):1683
  • ProMISE Trial: Mouncey PR, Osborn ™, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM, ProMISe Trial Investigators. Trial of early, goal directed resuscitation for septic shock. NEJM 2015;372(14):1301
  • ARISE Trial: ARISE investigators, ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, WEbb SA, Williams P. Goal-directed resuscitation for patients with early septic shock. NEJM 2014;371(16):1496
  • Angus DC, Barnato AE, Bell D, Bellomo R, Chong CR, Coats TJ, Davies A, Delaney A, Harrison DA, Holdgate A, Howe B, Huang DT, Iwashyna T, Kellum JA, Peake SL, Pike F, Reade MC, Rowan KM, Singer M, Webb SA, Weissfeld LA, Yealy DM, Young JD. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS, and ProMISE investigators. Intensive Care Med. 2015 SEp;41(9):1549-60
  • PRISM Investigators. Early Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis. NEJM 2017
  • Lu Y, Zhang H, Teng F, Xia WJ, SUn GX, Wen AQ. Early goal-directed therapy in severe sepsis and septic shock: A meta-analysis and Trial sequential analysis of randomized controlled trials. J Intensive Care Med. 2018;33(5):296

 

Vitamin C

  • Sevransky JE, et al. Effect of vitamin C, thiamine, and hydrocortisone on ventilator- and vasopressor-free days in patients with sepsis: The VICTAS randomized clinical trial. JAMA. 2021 Feb 23;325(8):742-750

 

Chapter 37 - Nonaccidental trauma in children, part one.01 Nov 202401:21:24

Dr. Mark Mannenbach, emeritus pediatric emergency physician, former chairperson of pediatric emergency medicine at Mayo Clinic and career long advocate for children comes back on the show to talk through nonaccidental trauma in children in a two part series. 

In this first part, we talk through the approach to sharing the concern that you have with the family, keys to the physical examination, the role of additional testing such as serum, urine, and radiograph. 

CONTACTS

x- @AlwaysonEM; @VenkBellamkonda

YouTube - @AlwaysonEM; @VenkBellamkonda

Instagram - @AlwaysonEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysonEM@gmail.com

Chapter 27 - Machiavelli's Hectic Fever - Part one of sepsis01 Feb 202401:08:25

Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes.

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

SOFA Score:

  • Vincent JL, MOreno R, Takala J, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction / failure. On Behalf of the working group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10
  • Vincent JL, de Mendonca A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction / failure in intensive care units: results of a multicenter, prospective study. Working group on ‘sepsis-related problems’ of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-1800
  • Ferreira FL, Bota DP, Bross A, Merlot C, Vincent JL. Serial evaluation of the SOFA score to predict outcomes in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8
  • Cardenas-Turanzas M, Ensor J, Wakefield C, Zhang K, Wallace SK, Price KJ, Nates JL. Cross-validation of a sequential organ failure assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care. 2012 Dec;27(6):673-80

qSOFA score

  • Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762-774
  • Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and SEptic Shock (Sepsis-3). JAMA. 2016;315(8):775-787
  • Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 Criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA. 2017;317(3):301-308
  • Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290-300

Comparing Prognostic scores

  • Henning DJ, Puskarich MA, Self WH, Howell MD, Donnino MW, Yealy DM, Jones AE, Shapiro NI. An Emergency Department validation of the SEP-3 Sepsis and Septic Shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med. 2017 Oct;70(4):544-552

IDSA concern

  • Rhee C, Chiotos K, Cosgrove SE, Heil EL, Kadri SS, Kalil AC, Gilbert DN, Masur H, Septimus EJ, Sweeney DA, Strich JR, Winslow DL, Klompas M. Infectious diseases society of america position paper: Recommended revisions to the National Severe Sepsis and Septic Shock early management bundle (SEP-1) Sepsis Quality Measure. Clin Infect Dis. 2021 Feb 16;72(4):541-552

About Barcelona Declaration

  • Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care. 2003;7:1-2

1- hour surviving sepsis bundle guidance

  • Freund Y, Khoury A, Mockel M, et al. European Society of Emergency Medicine position paper on the 1-hour sepsis bundle of the Surviving Sepsis Campaign: expression of concern. Eur J Emerg Med. 2019 Aug;26(4):232-233

Early Goal Directed Therapy

  • Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM. 2001 Nov 8;345(19):1368-77

SEP - 1 Quality Measure

Affordable care act

Fluids for sepsis in concerning populations

  • Pence M, Tran QK, Shesser R, Payette C, Pourmand A. Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis. Am J Emerg Med. 2022 May:55:157-166
  • Zadeh AV, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis. Am J Emerg Med. 2023 Nov:73:34-39

 

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

 

Grand Rounds - Dr. Dougie Moss - Chart-onomics14 Jan 202400:48:02

In this chapter, Dr. Dougie Moss, final year EM resident presents his Capstone presentation on best charting practices to match reimbursement to the care we deliver. Take a listen to better understand the new billing expectations of our documentation.

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Chapter 26 -Sick young person with spots - Meningococcemia in the ED01 Jan 202401:01:40

Alex and Venk talk through a previous case where they care for a young person with meningococcemia on a night shift. We review the disease, what to watch for, how to treat it, and go over some of the residue after being part of a case like this. We also review some of the considerations regarding ECMO for severe sepsis.

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  • Heckenberg SG, et al. Clinical features, outcome and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore) 2008. 87(4):185
  • Brechot N, Hajage D, et al. Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study. Lancet 2020. 396(10250)545-552
  • Ling RR, Ramanathan K, et al. Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: a systematic review and meta-analysis with individual participant data meta-regression analysis. Crit Care 2021. Jul 14;25(1):246

 

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Grand Rounds - Dr. Aaron Klassen - Out of hospital cardiac arrest - Challenges and Changes14 Dec 202301:00:12

It is no surprise that outcomes are poor for patients who already meet one definition for 'death' even before the point of their first medical contact. But for nearly half of certain patients with out-of-hospital cardiac arrest, good neurologic outcomes can be achieved. And while patients with in-hospital cardiac arrest are also very likely to suffer a poor outcome, there is some reason to believe that some out-of-hospital cardiac arrest patients might have a better chance of survival. During this discussion, we will discuss why this might be, while also challenging assumptions about topics including epinephrine, airway management, and the risks and benefits of transporting patients in cardiac arrest. We will also look to future directions in cardiac arrest management.

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Chapter 25 - The one where Alex finally gets to ask about REBOA - Hematomas01 Dec 202301:18:07

This chapter we talk with Dr. Henry Schiller, trauma surgeon and professor of surgery at Mayo Clinic, about a variety of hematomas including Morel Lavellee lesions, retroperitoneal hematomas, rectus sheath and more! Alex even gets to ask a question about REBOA that he has been hoping to do for a long time. 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  • Nickerson TP, Zielinski MD, Jenkins DH, Schiller HJ. The Mayo Clinic Experience with Morel-Lavallee lesions: Establishment of a practice management guideline. J Trauma Acute Care Surg. 2012. Vol 76, Number 2 493-497
  • Demetriades D, Chan LS, Velmahos G, Berne TV, Cornwell III EE, Belzberg H, Asensio JA, Murray J, Berne J, Shoemaker W. TRISS methodology in trauma: the need for alternatives. British Journal of Surgery 1998, 85,379-384
  • Meyer DM, Jessen ME, Grayburn PA. Use of echocardiography to detect occult cardiac injury after penetrating thoracic trauma: A prospective study. J Trauma. 1995 Nov;39(5):902-7

 

 

 

Grand Rounds - Dr. Heather Murray - Diagnostic error in the ED - Lets talk about it14 Nov 202300:59:11

In this episode, Dr. Heather Murray, from Queen's University Department of Emergency Medicine presents the landscape of diagnostic errors in emergency medicine from the perspective of why they might occur, what can be done when they happen, and how we might minimize them in the future. 

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

REFERENCES

ARHQ report and responses:

Recovering from error:

 

General resources on Diagnostic Error:

 

Cognitive biases:

 

Better teams in EM:

 

Selected references for artificial intelligence in medicine:

 

Chapter 24 - In the heat of the moment - Neonatal fever01 Nov 202300:56:43

Neonatal fever can raise the temperature of the entire clinical pod along with the baby, but it doesnt have to. Join as Dr. Meghan Cain, chair of the division of pediatric and adolescent emergency medicine at Mayo Clinic, talks through the nuances of evaluating fever concerns in neonates of different ages and risk profiles and empowers you to be cool as a cucumber in these situations.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  • Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods Jr CR. Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics. 2021 Aug;148(2):e2021052228
  • Powell EC, Mahajan PV, Roosevelt G, Hoyle Jr JD, Gattu R, Cruz AT, Rogers AJ, Atabaki S, Jaffe DM, Casper TC, Ramilo O, Kuppermann N. Epidemiology of bacteremia in febrile infants aged 60 days and younger. Ann Emerg Med. 2018 Feb;71(2):211-216
  • Mahajan P, Browne LR, Levine DA, Cohen DM, Gattu R, Linaki JG, Anders J, Borgialli D, Vitale M, Dayan PS, Casper TC, Ramilo O, Kuppermann N. Risk of bacterial coinfections in febrile infants 60 days and younger with documented viral infections. J Pediatr. 2018 Dec:203:86-91.e2
Grand Rounds - Dr. Arya Mohabbat - Central Sensitization: a syndrome of multiple difficult-to-explain chronic debilitating symptoms14 Oct 202301:01:01

So many people come to emergency departments with unexplained recurrent pains, fatigues, gastrointestinal symptoms and more - when there seems like no way we can help them, Dr. Mohabbat offers us some insight into what might be happening and how we can help be a positive experience in these patient's and family's lives. Listen to this grand rounds on Central Sensitization and be a better doctor for this large segment of the population.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

Chapter 23 - A mother’s love -Peripartum Cardiomyopathy01 Oct 202301:25:13

Dr. Katie Young, co-director of the cardioobstetrics clinic here at Mayo Clinic sits down to talk about peripartum cardiomyopathy. This is something we will likely consider many times in our careers for patients with shortness of breath in and around late pregnancy. Find out what interventions are key, what patients are most likely to suffer a bad outcome and more.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  • Gierula J, et al. Prospective evaluation and long-term follow up of patients referred to secondary care based upon natriuretic peptide levels in primary care. European Heart Journal – Quality of Care and Clinical Outcomes. 2019. 5, 218-224
  • Bay M, et al. NT-proBNP: A new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function. Heart. 2003. 89,150-154
  • Dockree S, et al. Pregnancy reference intervals for BNP and NT-pro BNP – changes in natriuretic peptides related to pregnancy. Journal of Endocrine society. 2021. 5(7)1-9
  • Mueller C, et al. Heart failure association of the European society of cardiology practical guidance on the use of natriuretic peptide concentrations. European Journal of Heart Failure. 2019. 21, 715-731
  • Ravichandran J, et al. High-sensitivity cardiac troponin I levels in normal and hypertensive pregnany. American J of Medicine. 2019. 132,362-366
  • High sensitivity troponin T and I among pregnant women in the US – the National Health and Nutrition Examination Survey. JAMA Cardiology. 2023. 8(4)406-408
  • Tweet MS, et al. Spontenaoues Cardic Artey Dissection associated with pregnancy. Journal of the American College of Cardiology. 2017. 70,426-435
  • Baggish AL, et al. The differential diagnosis of an elevated amino-terminal Pro-B-Type Natriuretic Peptide level. Am J Cardiol. 2008. 101,43A-48A
  • Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute Respiratory Failure – the Blue Protocol. Chest. 2008. 134,117-125
  • Smit MR, et al. Comparison of linear and sector array probe for handheld lung ultrasound in invasively ventilated ICU patients. Ultrasound in Med & Biol. 2020. 46(12)3249-3256
  • Haller EP, Nestler DM, Campbell RL, Bellamkond VA. Point-of-care ultrasound findings of acute pulmonary embolism: McConnell sign in the emergency medicine. JEM. 2014. 47(1)e19-e24
  • Halpern DG, et al. Use of medication for cardiovascular disease during pregnancy:JACC State of the Art Review. J Am Coll Cardiol. 2019. Feb, 73(4)457-476
  • Loyanga-Rendon RY, et al. Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. 2014. Circ Heart Failure. 7,300-309
  • Adedinsewo DA, et al. Detecting cardiomyopathies in pregnancy and the postpartum period with an electrocardiogram-based deep learning model. European Heart Journal – Digital Health. 2021. 2,586-596
  • Zieleskiewicz L., et al. Lung ultrasound-guided management of acute breathlessness during pregnancy. Anesthesia. 2013. 68,97-101
  • Balaceanu A. B-type natriuretic peptides in pregnant women with normal heart or cardiac disorders. Medical Hypotheses. 2018. 121,149-151
Grand Rounds - Dr. Alex Niven - Difficult airway management, an intensivist’s perspective14 Sep 202301:00:47

In this chapter, Dr. Alex Niven, renowned critical care physician and educator, provides a mirror for us to see our current state of emergency airway management - for its opportunities for improvement, innovations and best practices. This evidence fueled presentation is a must-listen for any emergency healthcare physician or provider.

CONTACTS

Youtube -https://www.youtube.com/@AlwaysonEM 

X - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Chapter 36 - The Butterfly Effect - Principles of Supply Chain Management14 Oct 202400:49:19

Dr. Pritish Tosh, consultant physician in Infectious Diseases, and Supply Chain Management specialist for Mayo Clinic talks through the relationship between our clinical delivery of care and the strength of our supply chain practices. Our recent experiences with facemasks in the pandemic, the daily threats to medication access, and the events of recent longshoreman strike as well as Hurricane Helene damage to saline production locations has shown us how valuable it is to understand our supply chain. In this chapter, Alex and Venk, get schooled on the importance of this understanding, the basics of how to assess the stability of supply chain, and how to be advocates for a healthy supply chain infrastructure moving forward.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

 

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Chapter 22 -Did she just say hemosuccus pancreaticus? - Gastrointestinal bleeding in the emergency department01 Sep 202301:42:41

Dr. Nayantara Coelho-Prabhu, Mayo Clinic gastroenterologist specializing in the care of patients with gastrointestinal bleeding and endoscopy, talks through many aspects of acute GI bleeding. She helps to clarify the prioritization of medications, when to incorporate imaging, broadens our differentials for upper and lower GI bleeding, gives mindblowing advice on stool guiac testing and SO much more in this over-stuffed (or should we say constipated) chapter of Always on EM. There is also a special cameo from Dr. Luke Wood going over how to insert a Minnesota tube (esophageal balloon tamponade device)!

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

RECOMMENDATION:

 

REFERENCES:

  • Drescher MJ, Stapleton S, Britstone Z, Fried J, Smally AJ. A call for reconsideration of the use of fecal occult blood testing in emergency medicine. Journal of Emerg Med. 2020. 58(1)54-58
  • Mathews BK, Ratcliffe T, Sehgal R, Abraham JM, Monash B. Fecal Occult Blood testing in hospitalized patients with upper gastrointestinal bleeding. Journal of Hospital Medicine. 2017. 12(7)567-569
  • Harewood GC, McConnell JP, Harrington JJ, Mahoney DW, Ahlquist DA. Detection of occult upper gastrointestinal bleeding: performance in fecal occult blood tests. Mayo Clin Proc. 2002 Jan;77(1):23-28
  • Blatchford O, et al. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000. Oct 14;356(9238):1318-21
  • Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of scotland: case ascertainment study. BMJ 1997. Aug 30;315(7107):510-4
  • Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007 Sep;25(7):774-9
  • Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917
  • Roberts I, Shakur-STill H, Afolabi A, et al. Effects of High-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet 2020. 395(10241):1927-1936
  • Aziz M, Haghbin H, Gangwani MK, Weissman S, Patel AR, Randhawa MK, Samikanu LB, Alyousif ZA, Lee-Smith W, Kamal F, Nawras A, Howden CW. Erythromycin improves the quality of esophagogastroduodenoscopy in upper gastrointestinal bleeding: a network meta-analysis. Dig Dis Sci 2023. Apr;68(4):1435-1446
  • Abraham NS, Barkun AN, Sauer BG, et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. Am J Gastroenterol 2022;00:1-17
  • Vigano GL, Mannucci PM, Lattuada A, Harris A, Remuzzi G. Subcutaneous desmopressin (DDAVP) shortens the bleeding time in uremia. Am J Hematol 1989. May;31(1):32-5
  • Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FL, Soares-Weiser K, Uribe M. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev 2010. Sep 8;2010(9):CD002907
  • Gao Y, Qian B, Zhang X, Liu H, Han T. Prophylactic antibiotics on patients with cirrhosis and upper gastrointestinal bleeding: A meta-analysis. PLoS One 2022. Dec 22;17(12):e0279496
  • Steffen R, Knapp J, Hanggi M, Iten M. Use of the REBOA catheter for uncontrollable upper gastrointestinal bleeding with hemorrhagic shock. Anaesthesiologie 2023. May;72(5):332-337
  • Sato M, Kuriyama A. Countering hemorrhagic shock due to duodenal variceal rupture with resuscitative endovascular balloon occlusion of the aorta. Am J Emerg Med 2023. Feb;64:204.e1-204.e3

Grand Rounds - Dr. Shannon McNamara - Safety 1 to Safety 2 - A paradigm shift to improve performance in a complex world14 Aug 202300:59:22

Is healthcare more like an airplane, a flock of birds, or a mayonnaise? Why does it matter? In this talk, Dr. McNamara, emergency physician and patient safety champion, explores the question through the story of how she found herself at the intersection of complexity theory, safety science, and emergency medicine. She will discuss multiple perspectives on safety science, including specific strategies for clinicians to apply in their daily practice to survive amidst the complexity.

CONTACTS

X (formerly Twitter) - @AlwaysOnEM; @VenkBellamkonda; @ShannonOMac

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

Chapter 21 - Chickity Check Yo’ Self Before Yo’ Wreck Yo Self! Tick borne infections01 Aug 202301:01:57

Drs. Alex Finch and Venk Bellamkonda talk through tick related infectious diseases including Lyme Disease, Rocky Mountain Spotted Fever, Ehrlichiosis, Babesiosis and more! Tick related illnesses are prevalent this time of year, so take a moment to brush up on how to manage them.

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

Society guidelines:

  • United States
    • CDC
      • Tickborne diseases of the US
      • Anaplasmosis - information for healthcare providers
      • Babesiosis - resources for healthcare professionals
      • Ehrlichiosis
      • Lyme Disease
      • RMSF
      • A reference manual for healthcare providers 2017
    • American Academy of Pediatrics has several publications on babesiosis, borrelia infections other than Lyme, Ehrlichia, anaplasma, Lyme itself, RMSF
    • Infectious Disease society of America
      • Clinical practice guideline on diagnosis and management of babesiosis 2020
    • Canada
      • Canadian pediatric society 
        • Practice point on Lyme disease in Canada - focus on children 2021
      • Society of OB / Gyn of Canada
        • Committee opinion for management of tick bites and Lyme disease during pregnancy 2020
      • Australia - New Zealand
        • Australian government department of health released An Australian guideline on the diagnosis of overseas - acquired Lyme disease / borreliosis in 2015
      • Japan 
        • choosing wisely Japan - Lyme disease 2018
      • India
        • Department of health research - Indian council of medical research (ICMR) - guidelines for diagnosis and management of rickettsial diseases in India in 2015
      • UK
        • National institute for health and care Excellence (NICE) 
          • quality standards on Lyme disease 2019
          • Guideline on Lyme disease 2018
        • British Infection Association (BIA)
Grand Rounds - Dr. Kharmene Sunga - Can You Hear Me Now? How To Speak Like An Emergency Physician14 Jul 202300:58:19

Dr. Kharmene Sunga, Mayo Clinic emergency medicine consultant physician, specializing in simulation, diversity equity and inclusion, and education shares a guide for how to communicate (both through listening and speaking) most effectively when it counts. 

 

TEASER

There's no place like the Emergency Department. Patients are in pain, scared, and anxious. Staff are distracted, fatigued, frustrated - and sometimes, well, also scared and anxious. How can Emergency Physicians speak to rise above the fray, to best care for patients, lead a team, and ensure that everyone feels heard? Join Dr. Kharmene Sunga as she discusses insights from sources ranging from medicine to business and even child psychology to cut through the proverbial noise.

 

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

 

Chapter 20 - Relaxin to the maxin - Intrathecal baclofen pumps in the ED01 Jul 202301:07:32

Ms Lisa Beck, assistant professor of nursing and a clinical nurse specialist in the department of physical medicine and rehabilitation, shares her experiences over a career in caring for persons with intrathecal baclofen pumps for managing spinal cord injury related spasticity. Baclofen related complications such as withdrawal and overdose can both be fatal and pump specific complications as well require timely expertise from the emergency care team – but not often discussed in emergency medicine. Check out the episode to learn more!

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  1. Singh NK, Agarwal A, Salazar L, Henkle JQ. Osborn waves in hypothermia induced by baclofen overdose. BMJ Case Rep 2009; 2009.
  2. Sullivan R, Hodgman MJ, Kao L, Tormoehlen LM. Baclofen overdose mimicking brain death. Clin Toxicol (Phila) 2012;50:141
  3. Alden TD, Lytle RA, Park TS, et al. Intrathecal baclofen withdrawal: a case report and review of the literature. Childs Nerv Syst 2002;18:522
Grand Rounds - Dr. Laura Walker & Dr. Katharina Kohler - Network Science Applied to Healthcare14 Jun 202301:31:47

This is really two separate episodes put together - Dr. Walker delivered grand rounds on network science applications to emergency medicine and it was inspiring. Though because it was such a visual talk, Alex and I had a conversation with her and Dr. Kohler to better understand the topic and present it in a more easily digestable state for you. Both experiences are presented here for your interest.

Chapter 19 - Sugar, we’re goin down swinging! - Pediatric diabetic ketoacidosis01 Jun 202301:24:26

Dr. Mark Mannenbach, emeritus pediatric emergency medicine faculty of Mayo Clinic and former chairperson of the division of pediatric emergency medicine sits down with Alex and Venk to talk about pediatric diabetic ketoacidosis. We review tips and tricks from a lifetime of caring for sick kids, discuss our Mayo Clinic practice guideline, cerebral edema diagnosis and management, compare the care of pediatric DKA with that of adult DKA and more - Check out this ultra-sweet chapter!

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  1. Wolfsdorf JI, Allgrove J, Craig M, et al. Hyperglycemic crises in pediatric patients with diabetes; a consensus statement from the International Society for Pediatric and Adolescent Diabetes. Pediatr Diabetes. 2014;15(S20):154-179.
  2. Neu A, Hofer SE, Karges B, et al. Ketoacidosis at diabetes onset is still frequent in children and adolescents. Diabetes Care. 2009;32:1647-1648. doi: 10.2337/dc09-0553. Epub 2009 Jun 23. PMID: 19549730.
  3. Kuppermann N, Ghetti S, Schunk JE, et al. Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis. N Engl J Med. 2018;378:2275-2287
  4. Long B. Lentz S, Koyfman A, Gottlieb M. Euglycemic diabetic ketoacidosis: etiologies, evaluation and management. Am J Emerg Med. 2021 Jun;44:157-160
  5. Glaser N, Barnett P, McCaslin I. Risk factors for cerebral edema in children with diabetic ketoacidosis: The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001;344:264-269.
  6. Soto-Rivera CL, Asaro LA, Agus MSD, DeCourcey DD. Suspected cerebral edema in diabetic ketoacidosis: Is there still a role for head CT in treatment decisions? Pediatr Crit Care Med. 2017 Mar;18(3):207-212
  7. Wilkinson K, Sanghamitra S, Nair P, Sanchez J, Ambati S. Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA. J Pediatr Endocrinol Metab. 2022 Sep 29;35(10):1257-1263
Grand Rounds - Kyle Hess, PharmD - High Dose Insulin therapy for calcium channel and beta blocker overdose14 May 202300:40:35

This is a recording of Dr. Kyle Hess, emergency medicine pharmacy resident, speaking at grand rounds on the utility of high-dose insulin therapy for selected cardiac medication overdoses. 

 

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Chapter 18 - a Joint Venture - A guided tour of Rheumatoid Arthritis01 May 202301:35:29

Rheumatoid arthritis is a challenging disease with variable presentations and complex medications that can make providing emergency care challenging. Dr. John Davis, Vice Chair of Division of Rheumatology at Mayo Clinic sits down with us to help us move easier through RA for our patients.

 

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  1. Kaeley et al. The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Research & Therapy. 2020;22:1
  2. Horton SC, Tan AL, Wakefield RJ, et al. Ultrasound-detectable grey scale synovitis predicts future fulfillment of the 2010 ACR/EULAR RA classification criteria in patients with new onset undifferentiated arthritis. RMD Open 2017;3:e000394
  3. https://youtu.be/7YqGIl6Oqbk - industry sponsored video on POCUS for rheumatoid arthritis. I recommend jumping to the 20 minute mark and watch this area for examples of ultrasounds and the use of the grey scale evaluation for synovitis.

 

 

Grand Rounds - Dr. Alyson McGregor - How sex and gender based research impacts the delivery of emergency care14 Apr 202300:57:18

Dr. Alyson McGregor is an emergency physician and champion for health equity with regards to sex and gender. She gave an important and incredible talk to our department about the importance of recognizing the differences between sexes and genders and how that can and should impact our clinical care and research.

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda; @McGregorMD

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Dr. McGregor’s website: www.alysonmcgregormd.com

Chapter 35 - Diffusing the fuse - Violence in the emergency department01 Oct 202401:14:07

Dr. Sarayna McGuire is an emergency physician who has been investigating workplace violence in the ED and in the prehospital setting. She and Dr. Casey Clements, who is the chief safety officer for Rochester Mayo Clinic campus talk with Venk and Alex about the violence in the emergency department. The scope of the problem is staggering, the impact ripples broadly into the community, and we all have the opportunity to intervene and change the trajectory of how life unfolds – learn the what, the why, and the how in this cant-miss chapter of Always on EM

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda;

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

LinkedIn - Sarayna McGuire

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  • Pompeii LA, Schoenfisch AL, Lipscomb HJ, Dement JM, Smith CD, Upadhyaya M. Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six U.S. hospitals. Am J Ind Med. 2015 Nov;58(11):1194-204
  • McGuire SS, Finley JL, Gazley BF, Mullan AF, Clements CM. The team is not okay: Violence in emergency departments across disciplines in a health system. West J Emerg Med. 2023 Feb 1;24(2):169-177
  • Speroni KG, Fitch T, Dawson E, Dugan L, Atherton M. Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. J Emerg Nurs. 2014 May;40(3):218-28
  • McGuire SS, Mullan AF, Clements CM. Unheard victims: multidisciplinary incidence and reporting of violence in an emergency department. West J Emerg Med. 2021 May 7;22(3):702-709

 

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Chapter 17 - LactatED: A stat consult on optimizing lactation in the ED01 Apr 202301:03:54

Possibly the first ever podcast dedicated to optimizing the experience of lactating persons in the ED, Alex and Venk sit down with Dr. Sarah Dodd, assistant professor of anesthesiology at Mayo Clinic and passionate champion for optimizing the care of lactating persons throughout healthcare. Lengthy ED visits have the potential to begin a cascade that hastens the end of milk production, and is a significant source of stress for lactating persons and families. We have an opportunity to do better. Learn how to navigate medications, procedural sedation, long ED length-of-stay and more!

 

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Grand Rounds - Dr. Laura Burke - Emergency Physicians as leaders of high-value healthcare14 Mar 202300:49:56

Dr. Laura Burke is a health sciences researcher and assistant professor of emergency medicine at Harvard Medical School. She gave a reaffirming grand rounds talk to us, packed full of evidence to support the concept that emergency medicine and emergency physicians provide an incredible quality of service and value to the healthcare system overall. Listen in!

 

Articles she references throughout are listed below in chronological order.

 

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda; @LauraBurke20

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  • Li G, Lau JT, McCarthy M, Schull MJ, Vermeulen M, Kelen GD. Emergency Department Utilization in the United States and Ontario, Canada. Acad Emerg Med June 2007, Vol 14, No. 6
  • Papanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018;319(10):1024-1039
  • Papanicolas I, Woskie LR, Orlander D, Orav EJ, Jha AK. The Relationship between health spending and social spending in high-income countries: How does the US compare? Health Aff (Millwood). 2019 Sep;38(9):1567-1575
  • Zhou RA, Baicker K, Taubman S, Finkelstein AN. The uninsured do not use the emergency department more – they use other care less. Health Affairs (Millwood). 2017 Dec;36(12):2115-2122
  • Smulowitz PB, Lipton R, Wharam JF, Adelman L, Weiner SG, Burke L, Baugh CW, Schuur JD, Liu SH, McGrath ME, Liu B, Sayah A, Burke MC, Pope JH, Landon BE. Emergency department utilization after the implementation of Massachussetts health reform. Annals of Emergency Medicine. 2011 Sep;58(3):225-234
  • Singer AJ, Thode HC, Pines JM. US Emergency Department visits and hospital discharges among uninsured patients before and after implementation of the Affordable Care Act. JAMA Network Open. 2019 Apr 5;2(4):e192662
  • Brook, Robert H., Emmett B. Keeler, Kathleen N. Lohr, Joseph P. Newhouse, John E. Ware, William H. Rogers, Allyson Ross Davies, Cathy D. Sherbourne, George A. Goldberg, Patricia Camp, Caren Kamberg, Arleen Leibowitz, Joan Keesey, and David Reboussin, The Health Insurance Experiment: A Classic RAND Study Speaks to the Current Health Care Reform Debate. Santa Monica, CA: RAND Corporation, 2006. https://www.rand.org/pubs/research_briefs/RB9174.html.
  • Vogel JA, Rising KL, Jones J, Bowden ML, Ginde AA, Havranek EP. Reasons patients choose the emergency department over primary care: A qualitative metasynthesis. J Gen Intern Med. 2019 Nov; 34(11):2610-2619
  • Chou SC, Gondi S, Baker O, Venkatesh AK, Schuur JD. Analysis of a commercial insurance policy to deny coverage for emergency department visits with nonemergent diagnoses. JAMA network Open. 2018 Oct 5;1(6):e183731
  • Raven MC, Lowe RA, Maselli J, Hsia RY. Comparison of presenting complaint vs discharge diagnosis for identifying nonemergency emergency department visits. JAMA. 2013 Mar 20;309(11):1145-53
  • Arnetz BB, Goetz C, vanSchagen J, Baer W, Smith S, Arnetz JE. Patient-reported factors associated with avoidance of in-person care during the COVID-19 pandemic: Results from a national survey. PLoS One. 2022 Aug 5;17(8):e0272609
  • Sharma M, Lioutas VA, Madsen T, Clark J, O’Sullivan J, Elkind MSV, Willey JZ, Marshall RS, Selim MH, Greer D, Tirschwell DL, Burton T, Boehme A, Aparicio HJ. Decline in stroke alerts and hospitalisations during the COVID-19 pandemic. Stroke Vascular Neurology. 2020 Dec;5(4):403-405
  • Bradley CJ, Neumark D, Walker LS. The effect of primary care visits on other health care utilization: A randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia. J Health Economics. 2018 Nov;62:121-133
  • Peikes D, Dale S, Ghosh A, Taylor EF, Swankoski K, O’Malley AS, Day TJ, Duda N, Singh P, Anglin G, Sessums LL, Brown RS. The comprehensive primary care initiative: effects on spending, quality, patients and physicians. Health Affairs (Millwood). 2018 Jun;37(6):890-899
  • Song Z, Gondi S. Will increasing primary care spending alone save money? JAMA. 2019 Oct 8;322(14)1349-1350
  • Weinik RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs (millwood). 2010 Sep;29(9):1630-6
  • Wang B, Mehrotra A, Friedman AB. Urgent care centers deter some emergency department visits but, on net, increase spending. Health Affairs (Millwood). 2021 Apr;40(4):587-595
  • Pitts SR, Pines JM, Handrigan MT, Kellermann AL. National trends in emergency department occupancy, 2001-2008:effect of inpatient admissions versus emergency department practice intensity. Annals of Emergency Medicine. 2012 Dec;60(6):679-686
  • Burke LG, Wild RC, Orav EJ, Hsia RY. Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? An observational study among US Medicare beneficiaries. BMJ Open. 2018 Jan 30;8(1):e019357
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  • Gani F, Canner JK, Pawlik TM. Assessing coding practices for gastrointestinal surgery over time in the United States. Surgery. 2018 Sep;164(3):530-538
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  • Paul Genberg. The Value of Being a Generalist. Forbes. June 3, 2021
Chapter 16 - Sorry Taylor, there is no bad blood - a discussion on transfusions01 Mar 202301:53:03

Dr. Justin Kreuter, Transfusion Medicine attending at Mayo Clinic, joins Alex and Venk on the podcast to talk about transfusion in its many dimensions. We talk through a model of evaluation for patients with life threatening bleeding, how to interpret tests, the science behind the 1:1:1 ratio of trauma transfusion practice and much much more!

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda; @KreuterMD

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @KreuterMD

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

  1. Lab medicine rounds podcast link: https://news.mayocliniclabs.com/homepage/podcasts-2/lab-medicine-rounds/
  2. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, plaeteles, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma – the PROPPR Randomized Clinical Trial. JAMA. 2015; 313(5):471-482
  3. Holcomb JB, Del Junco DJ, Fox EE, et al. The prospective observational multicenter major trauma transfusion (PROMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013 Feb;148(2):127-136
  4. J-Y Borg et al. FEIBA in the treatment of acquired hemophilia A: results from the prospective multicentre French ‘FEIBA dans l’hemophilie A acquise’ (FEIBHAC) registry. Haemophilia. 2015 May;21(3):330-337
  5. Sharp G, Young CJ. Point of care viscoelastic assay devices (rotational thromboelastometry and thromboelastography): a primer or surgeons. Anz J Surg. 2019 Apr;89(4):291-295
  6. Hospital Liaison Committee for Jehovah’s Witnesses: https://www.jw.org/en/medical-library/strategies-downloads/hospital-liaison-committees-jehovahs-witnesses/
Grand Rounds - Dr. Amy Zeidan - Health and health rights of immigrants in the US14 Feb 202300:52:31

In this episode, Alex and Venk give the virtual stage to Dr. Amy Zeidan from Emory University. She is an experienced and passionate advocate for helping those most in need - particularly immigrants to the United States. She gave Grand Rounds to our department January 24, 2023 and we share that with you here.

 

Summary

The United States immigration system is exceedingly complex and results in barriers to care for structurally vulnerable immigrant populations. Immigration status alone is a social determinant of health with historical, economic, social and political implications related to healthcare 'access'. As a result, the emergency department may be one of the most reliable and safe points of entry into the health system for immigrant populations, as 'access' to routine care may seem unattainable. EM physicians are well positioned to provide high quality and structurally competent care to immigrant populations seeking care in the ED, as well as facilitating community-academic partnerships to address external barriers to care. Doctor Zeidan will provide an overview of the US immigration system, how it impacts health seeking behaviors, and discuss strategies and considerations for care delivery for immigrant populations.

 

Objectives: 1) Explore the structure and context of the US immigration system and how this impacts the health of immigrants 2) Discuss the barriers to care faced by immigrants that impact health seeking behaviors (both inside and outside of the hospital) 3) Consider the role of EM physicians in supporting the health rights of immigrants on shift and beyond the hospital

 

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @Amyjwal

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

 

Chapter 15 - Don’t Stop Me Now! - Preexcitation and WPW01 Feb 202301:07:00

Dr. Abhishek Deshmukh, Cardiologist specializing in electrophysiology at Mayo Clinic, joins Alex and Venk on the podcast to talk about Wolff Parkinson White Syndrome and other supraventricular tachycardias. We will review the underlying pathophysiology, and how the specific electrical conduction pathway should determine how you treat your patient. He brings a pragmatic approach to this complex topic that you will be able to implement on your very next shift.

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @Abhishek_mbbs

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

Grand Rounds - Dr. Liz Goldberg - Five Traits of Exceptional People14 Jan 202301:00:01

Exceptional individuals display five common traits according to former FBI agent, Joe Navarro, an expert in non-verbal communication. These include: self-mastery, observation, communication, action, and psychological comfort. Most clinicians would agree that the therapeutic effect we have on patients has little to do with the medication we provide, but more what is communicated verbally and nonverbally during the interaction. But, how do we hone these skills? And importantly, how do we become masters of the art of medicine, so we can provide comfort and healing in the most complex of encounters - to the geriatric patient in acute crisis. Join Dr. Liz Goldberg in this Mayo Clinic Emergency Medicine Grand Rounds, titled, The 5 Traits of Exceptional People & How to Use Them to Master the Geriatric Patient Encounter, to learn how to adopt and further develop these five traits through case studies in geriatric emergency medicine.

 

Upon conclusion of this activity participants should be able to:

- List the five traits of exceptional individuals

- Discuss strategies to improve care for geriatric patients in the ED

- Recognize ways to grow your impact through scholarship

 

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @LizGoldbergMD

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @LizGoldbergMD

EMAIL - AlwaysOnEM@gmail.com

Chapter 14 - Urine the know - Dialysis, Renal Failure and more01 Jan 202301:34:04

Alex and Venk sit down with Dr. Jim Gregoire, Mayo Clinic Nephrology, to talk through a variety of emergency nephrology topics. We talk through dialysis related issues including the different types of peritoneal dialysis and their complications. Following that we talk through acute kidney injury with a focus on how we should approach this as emergency practitioners. Finally, we talk through some electrolyte issues that are not commonly discussed in our specialty.

Grand Rounds - Dr. Sergey Motov - Acute Pain Management in the ED14 Dec 202201:09:04

Dr. Sergey Motov, gave this presentation on acute pain management to the Mayo EM Grand Rounds audience in the fall of 2022.

Pain is the most common reason for people to seek care in the Emergency Department. The current laws and regulations have significantly affected ED Clinician’s ability to provide effective, efficient and safe pain relief by worsening opiophobia, by repurposing non-analgesic medications for pain control and by proliferation of dangerous drug-drug combinations. This talks is set to discuss the current state of ED analgesia when it comes to acute pain management with a primary focus on what works and what does not.

 

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @PainFreeED

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

Chapter 13 - Can’t Breathe Without You - Angioedema and Awake Tracheal Intubation01 Dec 202201:09:41

Dr. Ben Sandefur, Emergency Medicine attending at Mayo Clinic, joins Alex and Venk on the podcast to talk about angioedema and awake tracheal intubation. He reviews the different types of angioedema in a format designed to assist the emergency department practitioner with decision making and prognostication. This is followed by a description of how to prepare for and lead a team and patient through awake tracheal intubation using fiberoptic and video laryngoscopy techniques.

 

Contacts

TWITTER - @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

References

  1. Rosenbaum S, Wilkerson RG, Winters ME, Vilke GM, Wu MYC. Clinical Practice Statement: What is the Emergency Department Management of Patients with Angioedema Secondary to an ACE-Inhibitor? J Emerg Med. 2021 Jul;61(1):105-112 [from the American Academy of Emergency Medicine] https://pubmed.ncbi.nlm.nih.gov/34006418/
  2. Moellman JJ, Bernstein JA, et al. A consensus parameter for the evaluation and management of angioedema in the emergency department. Acad Emerg Med. 2014 Apr;21(4):469-84 [from the American College of Allergy, Asthma & Immunology (ACAAI) and the Society for Academic Emergency Medicine (SAEM)] https://pubmed.ncbi.nlm.nih.gov/24730413/
  3. Carrillo-Martin I, Gonzalez-Estrada A, Funni SA, Sandefur BJ, Jeffery MM, Campbell RL. Angioedema - related emergency department visits in the United States: Epidemiology and time trends, 2006-2015. J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2442-2444. https://pubmed.ncbi.nlm.nih.gov/32302784/
  4. Ishoo E, Shah UK, Grillone GA, Stram JR, Fuleihan NS. Predicting airway risk in angioedema: staging system based on presentation. Otolaryngol Head Neck Surg. 1999 Sep;121(3):263-8 https://pubmed.ncbi.nlm.nih.gov/10471868/
  5. Arthur J, Caro D, Topp S, Chadwick S, Driver B, Henson M, Norse A, Spencer H, Godwin SA, Guirgis F. Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema. Am J Emerg Med. 2022 Oct 19;63:44-49 https://pubmed.ncbi.nlm.nih.gov/36327748/
  6. Sandefur BJ, Liu XW, Kaji AH, Campbell RL, Driver BE, Walls RM, Carlson JN, Brown CA. Emergency Department Intubations in Patients with Angioedema: A Report from the National Emergency Airway Registry. J Emerg Med. 2021 Nov;61(5):481-488 https://pubmed.ncbi.nlm.nih.gov/34479750/
  7. Sandefur BJ, Oliveira Silva L, Lohse CM, Goyal KA, Barbara DW, Castaneda-Guarderas A, Liu XW, Campbell RL. Clinical features and outcomes associated with angioedema in the emergency department. West J Emerg Med. 2019 Aug 6;20(5):760-769 https://pubmed.ncbi.nlm.nih.gov/31539333/

Additional Resources

  1. Wilkerson RG, Moellman JJ. Hereditary Angioedema. Emerg Med Clin North Am. 2022 Feb;40(1):99-118 https://pubmed.ncbi.nlm.nih.gov/34782094/
  2. Wilkerson RG, Winters ME. Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema. Emerg Med Clin North Am. 2022 Feb;40(1):79-98 https://pubmed.ncbi.nlm.nih.gov/34782093/

 

Grand Rounds - Dr. Victor Montori - On Care14 Nov 202200:57:11

This is a recording of Dr. Victor Montori's grand rounds presentation to Mayo Clinic Emergency Medicine challenging us to rethink the care we provide to our patients and the community as a whole. 

 

He will be discussing the movement toward careful and kind care he calls the Patient Revolution. This movement seeks to turn away from industrialized healthcare – a form of healthcare in which the care of patients is a means to an end, in which patients are processed, and in which cruelty happens routinely and care by happy accident. He challenges us to turn toward careful and kind care. Careful care is unhurried, evidence-based, safe, and sensible. It is responsive to the needs and situation of this patient rather than patients like this. Careful care, as he describes, requires that clinicians see patients in high definition, notice their problems in their biology and biography, and respond with compassion and competence by co-creating plans of care that make intellectual, emotional and practical sense to each patient. Kind care recognizes each patient as a fellow human, one of us rather than one of them. It calls for minimizing the demands healthcare makes on patients’ scarce time, energy, and attention which patients rather use to fulfill their obligations, pursue their loves, and flourish. Based on solidarity and love, health care must support the work of people who come together to give and receive care. Beyond healthcare, we need to advocate for common care and for the care of our environment. He is challenging us to create a movement for care.

 

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @VMontori

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

 

References:

1. Why we revolt, authored by Dr. Victor Montori, published October 2017

2. www.PatientRevolution.org, organization cofounded by Dr. Victor Montori

 

Grand Rounds - Dr. Samit Shah - Seeing the invisible: Angina and Nonobstructive Coronary Arteries (ANOCA)14 Sep 202401:06:47

Ischemic heart disease is a leading cause of morbidity and mortality. While atherosclerotic coronary artery disease (CAD) is the focus of most outpatient and inpatient evaluations for cardiovascular symptoms, up to two thirds of patients suffer from myocardial ischemia with non-obstructive coronary arteries (INOCA). Patients with INOCA have unique symptoms and are more likely to have functional limitation and repeat presentations for cardiovascular evaluation. While there has been increasing recognition of INOCA there is no specific functional status measure, limiting our ability to evaluate the course of illness or effectiveness of therapies. In this presentation, Dr. Samit Shah, interventional cardiologist at Yale New Haven Hospital who recently gave grand rounds recently to the Mayo Clinic Department of Emergency Medicine, reviews the causes of ischemic heart disease, challenges with current symptom assessment, and proposes a new path for better diagnosis and treatment of heart disease.

 

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda; @SamitShahMD

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Chapter 12 - A lion, a House, and the mystery - Lupus and the ED01 Nov 202201:20:07

Dr. Uma Thanarajasingam, Rheumatology attending at Mayo Clinic, joins Alex and Venk on the podcast to talk about how to approach patients with symptoms that span multiple organ systems and we are considering Lupus or when the patient has known Lupus when they present. We talk about Catastrophic Antiphospholipid antibody syndrome, immunochemistry and much more!

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

Grand Rounds - Dr. Brian Patterson - Predictive analytics to prevent falls after ED visits14 Oct 202201:04:19

SPEAKER: Brian Patterson, MD, University of Wisconsin

He discusses the experience at UW conceiving, designing, and implementing a program, which incorporates a machine-learning algorithm for real-time calculation of fall risk for all older adults who visit the ED. The talk will include the rationale for using automation to improve public health referrals from the ED, techniques used to create the intervention, and issues surrounding the design and governance of similar interventions.

 

TWITTER @BPatterson; @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM @AlwaysOnEM

EMAIL AlwaysOnEM@Gmail.com

Chapter 11 - What’s cooler than being cool? Ice Cold! - Hypothermic Cardiac Arrest01 Oct 202201:24:20

Dr. Doug Brown is an emergency physician and expert in wilderness medicine and mountain rescue with a special career focus on hypothermic cardiac arrest. He has been instrumental in building the rescue and resuscitation practices in Vancouver region of Canada and has published his work in the New England Journal of Medicine. Dr. Brown talks with Alex and Venk about a bunch of very COOL topics!

 

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

 

References:

1. Brown DJ, Brugger H, Boyd J, Paal P. Accidental Hypothermia. N Engl J Med. 2012 Nov 15, 367(20):1930-8

2. Paal P, Brown DJ, Brugger H, Boyd J. In hypothermic major trauma patients the appropriate hospital for damage control and rewarming may be life saving. Injury. 2013 Nov;44(11):1665

3. Wanscher M, et al. Outcome of accidental hypothermia with or without circulatory arrest experience from the Danish Praesto Fjord boating accident. Resuscitation. 2012 Sep;83(9):1078-84

Grand Rounds - Dr. Sara Crager - Reframing Shock12 Sep 202201:06:37

SPEAKER: Sara Crager, MD, UCLA Emergency Medicine

When it comes to shock, we have developed a blood pressure addiction. Our propensity for a laser-like focus on blood pressure frequently hobbles our ability to promptly diagnose and optimally manage shock patients. This lecture aims to facilitate a more naunced approach to shock through an expanded mental model of shock pathophysiology combined with an iterative hypothesis testing strategy for clinical problem solving

 

TWITTER @SaraCrager; @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM @AlwaysOnEM

EMAIL AlwaysOnEM@Gmail.com

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