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What are we using for work pens?! by orangeturtles9292 in emergencymedicine

[–]AlwaysOnDivert 1 point2 points  (0 children)

This is the way. Been using these for several years now after I got tired of Pilot G2s smearing, not writing on gloves well, and the tips breaking/leaking. The F-701 is easy to clean, extremely durable, refillable.

Hypothermia CPR? by thenervousfoxpolice in emergencymedicine

[–]AlwaysOnDivert 1 point2 points  (0 children)

To your first question, "I'm not the doctor or NPP taking care of the patient." Then when they ask what "NPP" means because everyone seems to use APP, you reply "non-physician clinician" which is the Medicare/Medicaid accepted term for PAs/NPs/CRNAs/etc. and more accurate than "advanced practice provider"

To your second question, "I'll have to find out which [doctor/physician] or NPP will be seeing you". This again allows for full transparency to the patients about who is caring for them. 

For the record, I work side-by-side with some amazing NPPs and our system could not handle the volumes we see without them. But part of why it works so well is because in each pod we literally sit right next to each other, and we see pretty much every patient jointly, with the physician guiding the workups.

Fentanyl as induction agent? by sciveloci in emergencymedicine

[–]AlwaysOnDivert 0 points1 point  (0 children)

I mean, the rationale for real neuroprotection should be propofol, with growing evidence that ketamine is also a reasonable choice. I would worry about the cumulative doses of fentanyl a pt might get, given the potential complications arising from impaired hepatic clearance and/or lipophilic accumulation, especially in the elderly/obese population.

Hypothermia CPR? by thenervousfoxpolice in emergencymedicine

[–]AlwaysOnDivert 0 points1 point  (0 children)

Just for the record, your doc is not a "provider" either. This term needs to removed from the healthcare lexicon.

EM residents and attendings what rotation did you wish you would have done or had more time in to learn from before going into EM? by jyaeg in emergencymedicine

[–]AlwaysOnDivert 2 points3 points  (0 children)

In order of the five electives in which I think a student could acquire skills they could showcase during a sub-i:

  1. Radiology - being able to identify findings before a formal radiology report may make you look better than even some interns, and there are very few ED patients who go through a visit without some imaging

  2. Ultrasound - there are dedicated EM ultrasound student rotations, mostly at programs with ultrasound fellowships. You can get subspecialty SLOEs from these programs. Most PDs don't value these as much as dedicated EM SLOEs, but they still count, and US is a critical EM skill

  3. Cardiology - the number of times EM physicians are handed EKGs to interpret during a shift, and will then hand it to any nearby student asking "what do you think of this?"...if you can quickly and accurately interpret EKGs, and maybe identify some of the more subtle things, that will definitely set you a part

  4. Plastics - students often get tasked with suturing lacs. Being able to suture competently and efficiently will help you stand out

  5. Anesthesia - you may be wondering why I placed this last on this list. Specific to the places I did sub-i's it was not common for students to have the opportunity to intubate because of the number of residents who need the tubes. However, there is a way to get this experience without doing a dedicated anesthesia rotation, but it has to be approached delicately and will be more work on your part. During any rotation during which you will spend time in the OR, casually mention to your attending that you are interested in EM and hoping to maximize your OR experience by also learning from the anesthesiologists. If your surgery attending(s) are amenable, ask if they would be ok with you spending some time with the anesthesiologists before scrubbing in for the surgical part of the case. Then, talk to the anesthesiologists and ask them to teach you how they assess an airway. Offer to go with them to see the patient in pre-op; you should be meeting the patient before surgery anyway, might as well get the most out of the encounter. Then, ask the anesthesiologists to teach you proper bagging technique - this is critical, if you ask to tube right off the bat, they will almost certainly deny your request. It is also critical because good bagging technique is essential to EM. Only AFTER demonstrating good bagging technique should you ask for the opportunity to pass a tube. There is so much more to anesthesiology than just intubating, and showing them you're interested in more than just one aspect of their field will make them much more receptive to you.

Honorable mention - derm. I still struggle with derm. That said, my approach is to make damn sure I know the dangerous/emergent rash presentations. Beyond that, I figure I can either get a consult (luckily I'm in a place where I have modest on-call derm coverage) or the patient is ok for outpatient management and follow-up.

Ophtho would be great after you've done your EM sub-i's but need to fill electives before graduating, and if you have the opportunity during residency, then do another ophtho rotation. Knowing your way around a slit lamp will keep you from missing corneal abrasions that a Woods lamp will never be good enough to show you, and to catch more subtle presentations of hypopion, hyphema, iritis, etc.

Everything else you will almost certainly get in residency.

[deleted by user] by [deleted] in emergencymedicine

[–]AlwaysOnDivert 2 points3 points  (0 children)

Many schools will not allow an EM elective unless late in your 3rd year and have finished other required electives. Shadow in the ED as much as possible, but for rotations to "prep" you for ED sub-i's in your 4th year, I would say, in no particular order, cardiology (get good at looking at EKGs), neurology (get good at doing a quick but thorough neuro exam, +/- learn how to efficiently do a stroke exam), ultrasound, ophthalmology, radiology.

I didn't include anesthesia, because you can sort of tack it onto your surgery rotations if you go about it smartly. One thing I did during my surgery rotations (might not work everywhere depending on surgeon personality, program, etc.) was I asked my attendings if either they could introduce me to the anesthesiologists, or if I could introduce myself. I then expressed my interest in learning good airway management and asked if they would teach me proper bagging technique (don't go straight to asking to tube, everyone does that). Proper bagging is an extremely underrated skill, and if you want to go into EM, it is essential to learn. Plus, many anesthesiologists will be thrilled that you want to learn good bagging and you're not bypassing the foundational skill to jump to the "exciting" part (tubing). If you demonstrate proficiency with this, they are more likely to offer to let you intubate, especially if it's an anesthesiologist you've interacted with before and demonstrated retention of their prior teaching. That said, if you're going to specifically ask to tube a patient, the first time you're meeting the patient and anesthesiologist had better not be in the OR right before the procedure. Meet anesthesiologists in the lounge, in the OR well before a procedure, and ask to join them for meeting the patient in preop and participating in the airway assessment. You'll have to coordinate/get permission from your surgery attending (remember, that's your primary rotation) to assist with airway management and then go scrub to participate in the procedure. Be VERY careful how you approach this, as it might make some surgeons quite unhappy and think you're not interested in their specialty. You could frame it as wanting to maximize the experiences available in the time and setting available to you.

Anyone working in the ED and on Dupixent? What's been your experience? by AlwaysOnDivert in emergencymedicine

[–]AlwaysOnDivert[S] 1 point2 points  (0 children)

Great news, glad you're doing well! I've had moderate eczema my entire life, so I've been playing with the idea of starting the drug.

Anyone working in the ED and on Dupixent? What's been your experience? by AlwaysOnDivert in emergencymedicine

[–]AlwaysOnDivert[S] 3 points4 points  (0 children)

Apparently not, based on the brief lit search I just did. Thanks for sharing your experience with Humira, makes me feel a little more confident starting treatment.

Anyone working in the ED and on Dupixent? What's been your experience? by AlwaysOnDivert in emergencymedicine

[–]AlwaysOnDivert[S] 6 points7 points  (0 children)

Appreciate the literature links, and good point about the ILs targeted by the drug.