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Controversies in Pulmonary Embolism Imaging and Treatment of Subsegmental Thromboembolic Disease

5 Comments / FOAMED, In the Literature, practice updates /

Pulmonary embolism (PE) is classically a life-threatening diagnosis, often considered in the work-up of patients with chest pain or dyspnea. Initial mortality rates of missed, untreated PE has been quoted as high as 26%, based on a 1960 study. This disease is common, with 400,000 patients affected with nonfatal PE and another 200,000 patients in the U.S. dying each year from this disease. PE is the third most common cause of death in cardiovascular disease after myocardial infarction and stroke.

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Clinical Decision Rules Series Part 2: CDR Implementation

Leave a Comment / FOAMED, practice updates /

There are often multiple roadblocks to incorporating a CDR into clinical practice. These can be broken into the 1) individual provider and 2) the institution.

1. Emergency physicians are a rare breed, and many of us do not appreciate suggestions on how to practice. Individual providers vary in many regards: training, knowledge, experience, and gestalt. Workups and treatments can significantly differ among providers. With CDRs, physicians may be hesitant to apply these rules to their own practice. They may feel the rules are too complex, too difficult to remember, or detract valuable time from patient care. Providers often feel that gestalt or experience is better than rules.

2. Institutions may have habits or a culture for particular conditions that may make it difficult to apply a rule. Tradition or consultant availability may color the use of CDRs. Unfortunately, the medico-legal environment or funding can also play a large role in the use, or lack thereof, for CDRs.

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Alcohol Withdrawal: Pearls and Pitfalls

4 Comments / EM Cases, FOAMED /

Alcohol use is extremely widespread throughout developed countries. It is estimated that 8 million people in the US are alcohol dependent. Approximately 20% of men and 10% of women will at some point in their lives have an alcohol-use disorder. About half of people with alcohol-use disorders will have symptoms of withdrawal when they cut down or stop their alcohol consumption. Extreme complications, including seizures and/or delirium tremens, will occur in 3-5% of these people.

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One Physician’s Advice to the New Grad

2 Comments / EM MINDSET, FOAMED /

To the Class of 2016 – Congratulations!! You’ve made it. After at least 11 years of post-high school education, you have finally reached that proverbial finish line and are ready to transition from resident to attending. What I would like to share with you is some advice about what life is like on the other side. Now that you have finished residency, it’s safe to say that you know the medicine really well. But, I have come to find that your learning about life as a professional is just beginning.

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Reflections on Leadership and Resilience in Emergency Medicine

4 Comments / EM MINDSET, FOAMED /

Who are the people you consider the biggest leaders and influencers of change in our profession? What traits do they have that seem to make them a natural for their role? How did they get there? Perhaps even better questions to ask – what makes some people more engaged in their job? Why do some people bounce back from the stress of our jobs better than others do? Are there common traits that overlap leadership and resilience?

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Cognitive Load and the Emergency Physician

11 Comments / EM MINDSET, FOAMED /

You may not know what cognitive load is, but if you work in an Emergency Department (ED) you are probably carrying a ton of it. Cognitive load refers to the total amount of mental effort burdening your working memory at any given time. Working in an ED can involve extremely high cognitive load, and learning to understand and manage it can make you more efficient and less stressed on shift. In the field of ED management, the ED bed is often described as the ‘Million Dollar resource’. If that is true, then the cognitive machinery of the Emergency Physician has to be the ‘Billion Dollar resource’.

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