LITFL Review 332

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

LITFL review

Welcome to the 332nd LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.

Readers can subscribe to LITFL review RSS or LITFL review EMAIL subscription

The Most Fair Dinkum Ripper Beauts of the Week

Nick CumminsPulmonary embolism risk stratification is a must when working up your patients. FOAMCast goes over the current guidelines, while the latest SGEM episode discusses the PROPER trial with guest skeptic Jeff Kline. [MMS]

The Best of #FOAMed Emergency Medicine

  • In this post from ALIEM, the case is made regarding ketamine for ethanol withdrawal. There is a review of the pathophysiology of ethanol withdrawal and how ketamine works in the CNS. Three studies are detailed and their results would indicate there is a potential benefit of ketamine in select ethanol withdrawal patients. [TCN]
  • Rory Spiegel dives into a hot off the press publication on bougie first intubation. It may be time for a paradigm shift of bougie as a rescue device. [SR]
  • Clay Smith reviews a recent paper on atraumatic needles for lumbar puncture. Why are we still using the standard LP needles that come in the kits? [SR]
  • Justin Morgenstern is at it again reviewing some papers of the month for May 2018. If you want to hear the audio version checkout his podcast with Casey Parker over at broome docs. [SR]
  • Which abscess needs antibiotics? Which need to be drained? How should they be drained? Rob Bryant gives a fantastic literature review of these questions in the ever-changing evolution of abscess management. [MMS]
  • Here’s EMCrit’s podcast on Part II of TTP and DIC, which features Tom DeLoughery’s treatment recommendations. [SN]

The Best of #FOAMcc Critical Care and #FOAMres Resuscitation

The Best of #FOAMtox Toxicology

  • The Tox and the Hound blog reviews a common but often mis/underdiagnosed entity: alcoholic ketoacidosis (AKA). [AS]

The Best of #FOAMus Ultrasound

The Best of #MedEdFOAM and #FOAMsim

  • Nervous about your next presentation? Check out these top seven tips on rehearsing your presentation on the first Medutopia blog post. [MMS]
  • Mike Gisondi discusses strategic planning to foster critical changes in your educational leadership teams to become harder, better, faster, stronger. [MMS]

Reference Sources and Reading List

Brought to you by:

LITFL Review 332 Marjorie Lazoff, MD

Article source here:Life in the Fast Lane


Funtabulously Frivolous Friday Five 237

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 237.

Readers can subscribe to FFFF RSS or subscribe to the FFFF weekly EMAIL

Question 1:


  • Charles Heber McBurney (1845 – 1913)
  • The seat of greatest pain, determined by the pressure of one finger, has been very exactly between an inch and a half and two two inches from the anterior spinous process of the ilium on a straight line drawn from that process to the umbilicus” – McBurney 1889 [Reference]

Question 2

Which anaesthetist published a neonatal scoring system commonly used today in 1953?


  • Virginia Apgar (1909 – 1974)
  • APGAR is the (b)acronym for the eponym
  • The APGAR scoring system is a comprehensive screening tool which should be used to assess newborns at birth and can assist in identifying the need for any immediate attention/ intervention that baby needs.
  • The original work published by Apgar in 1953 described the five variables as heart rate, respiratory effort, reflex irritability, muscle tone and colour. In 1961 Apgar received a letter from Dr Joseph Butterfield a professor at the Colorado University in Denver which informed her that one of his residents had devised an acronym connecting the five letters of her surname to the five evaluations of the newborn…APGAR. [Reference]


Question 3

A son of an innkeeper described the effectiveness of chest percussion for diagnosing certain respiratory ailments. Who was he? 


  • Josef Leopold Auenbrugger von Auenbrugger (1722 – 1809)
  • Auenbrugger is said to have tapped wine barrels in his father’s cellar as a boy to find out how full they were.
  • Auenbrugger validated his clinical observations on the use of diagnostic percussion by:
    • comparing clinical assessments with post-mortem findings
    • injecting fluid into the pleural cavity of cadavers to demonstrate that percussion could accurately define the physical limits of any fluid present.
  • Unfortunately his work was largely unheralded at the time. His teacher (Van Swieten) in 1764 and 1772 major treatises on ‘pulmonary chills and chest water’ failed to mention Auenbrugger. Similarly De Haen, who was the head of the medical clinic in Vienna from 1754-1776 makes no comment on percussion in “Ratio Medendi In Nosocomio Practico Vol I to VIII” ironically complaining “how dark and difficult is the diagnosis of the thoracic water, the pleuritic and pericardian exudates.
  • It was not until a French translation by Jean-Nicolas Corvisart des Marest, personal physician to Napoleon, appeared in 1808 that the diagnostic method gained worldwide acceptance. Corvisart taught the method of percussion to his students and in 1808 translated and published the book with annotations a year before Auenbrugger’s death. [Reference]

Question 4

Which heavy metal accumulates in the lenses of the eyes of smokers?


  • Cadmium.
  • The accumulation of copper, lead, and cadmium occurs in cataract.
  • The probable source of cadmium in humans is cigarettes.
  • Lenticular cadmium accumulation also increases copper and lead precipitation in the lens. Cigarette smoking might be cataractogenic. [Reference]

Question 5

Do identical twins have identical fingerprints?


  • No
  • To a standard DNA test, they are indistinguishable. But any forensics expert will tell you that there is at least one surefire way to tell them apart: identical twins do not have matching fingerprints.
  • Genetics helps determine the general patterns on a fingertip, which appear as arches, loops and whorls. While a foetus is developing, the ridges along these patterns are influenced by a number of factors, including bone growth, pressures within the womb and contact with amniotic fluid. [Reference]

…and finally

Choose Wisely

Funtabulously Frivolous Friday Five 237 Neil Long

Article source here:Life in the Fast Lane

Baked Buffalo Chicken Fingers + I’M GETTING MARRIED!

For a delicious adult version on a kids classic whip up these easy and healthy baked buffalo chicken fingers!

Celebrate your inner child with these Baked Buffalo Chicken Fingers. Made with almond meal, egg and hot sauce, this is a simple recipe that you can serve for weeknight dinners or for a healthy kids meal.

Celebrate your inner child with these Baked Buffalo Chicken Fingers. Made with almond meal, egg and hot sauce, this is a simple recipe that you can serve for weeknight dinners or for a healthy kids meal.

This is the last post on the blog before I GET MARRIED.

Okay let’s all just take a second to let that soak in.

Deep breaths.

Somehow it felt fitting to post a recipe for baked buffalo chicken fingers before my wedding. 1) because we are most definitely serving them at our wedding (to be fair it’s the kids menu, but still…) and 2) because I feel like a child bride who eats still eats chicken fingers at least once a week and is deeply confused about who gave me permission to get married.

Late 20s are such a weird time. Some people are married and have babies and others are still trying to commit to a relationship with their hairdresser. Your age doesn’t seem to match your maturity…in either direction.

I digress…Is marriage brain a thing?

Baked Buffalo Chicken Tenders made from all-natural ingredients like almond meal, organic chicken and ghee!

To be honest, the last year of my life (since getting engaged) has been one hell of a season! Some incredible ups and some deeply deep downs. We celebrated our engagement in the most perfect way possible and I’m still so grateful to have had both sets of our parents there. But we also experienced overwhelming loss and some stressful health problems. Note to all brides: try NOT to get shingles, okay?

We celebrated birthdays and travelled to destinations near and far. I become a yoga teacher, C deepened his roots with The Sierra Club and Bodhi perfected the art of the snuggle. I’m not going to lie, I’m looking forward to this time next week when we’ll officially be married and moving onto the next chapter of our lives but even though this year has been a challenge, I wouldn’t have changed any of it.

I get to marry my best friend, surrounded by our closest family and friends. I’ve had many moments where I just wanted to give up or shed wayyyy too many tears over invites/flowers/welcome bags/caterers, but it’s this piece I’m holding on to. I can only imagine how incredible it will feel to look around and see my family interacting with my high school friends, talking with Curt’s camp friends, sitting next to my blogging friends. There are few opportunities in life to bring together all the people you love in one room. I can’t believe this opportunity will be my life in a few short days!

Healthy Baked Buffalo Chicken Fingers for an easy weeknight dinner or kid-friendly favorite!

So what’s going to be happening around here? As of Wednesday I will be off for 10 days, prepping, getting married and then mooning so hard (#moonsohard <– let’s get this trending!). THM will not be shutting down though. I’m taking this little break as an opportunity to introduce you to Team Maven and the incredible women who keep THM afloat. Tanya and Georgia will be introducing themselves next week and then sharing some amazing pieces of wisdom and yummy recipes with you. I will be very sporadic on social media as well. My #1 priority is to be present in this huge life milestone, not worry about whether or not I’ve posted on Instagram.

I will of course be sharing the details with you after the fact, but I’d like to believe I’m only going through this experience once and I’d like to cherish every minute of it.

So with that, I leave you with this delicious recipe for Baked Buffalo Chicken Fingers and bid you adieu until I return as DAVIDA LEDERLE. WOAH. See you soon!


.tasty-recipes-image { float: right; } .tasty-recipes-print-button { background-color: #666677; display: inline-block; padding-left: 1em; padding-right: 1em; padding-top: 0.5em; padding-bottom: 0.5em; text-decoration: none; } a.tasty-recipes-print-button { color: #FFF; } a.tasty-recipes-print-button:hover { color: #FFF; } .tasty-recipes-rating.tasty-recipes-clip-10 { -webkit-clip-path: polygon(0 0, 10% 0%, 10% 100%, 0% 100%); clip-path: polygon(0 0, 10% 0%, 10% 100%, 0% 100%); } .tasty-recipes-rating.tasty-recipes-clip-20 { -webkit-clip-path: polygon(0 0, 20% 0%, 20% 100%, 0% 100%); clip-path: polygon(0 0, 20% 0%, 20% 100%, 0% 100%); } .tasty-recipes-rating.tasty-recipes-clip-30 { -webkit-clip-path: polygon(0 0, 30% 0%, 30% 100%, 0% 100%); clip-path: polygon(0 0, 30% 0%, 30% 100%, 0% 100%); } .tasty-recipes-rating.tasty-recipes-clip-40 { -webkit-clip-path: polygon(0 0, 40% 0%, 40% 100%, 0% 100%); clip-path: polygon(0 0, 40% 0%, 40% 100%, 0% 100%); } .tasty-recipes-rating.tasty-recipes-clip-50 { -webkit-clip-path: polygon(0 0, 50% 0%, 50% 100%, 0% 100%); clip-path: polygon(0 0, 50% 0%, 50% 100%, 0% 100%); } .tasty-recipes-rating.tasty-recipes-clip-60 { -webkit-clip-path: polygon(0 0, 60% 0%, 60% 100%, 0% 100%); clip-path: polygon(0 0, 60% 0%, 60% 100%, 0% 100%); } .tasty-recipes-rating.tasty-recipes-clip-70 { -webkit-clip-path: polygon(0 0, 70% 0%, 70% 100%, 0% 100%); clip-path: polygon(0 0, 70% 0%, 70% 100%, 0% 100%); } .tasty-recipes-rating.tasty-recipes-clip-80 { -webkit-clip-path: polygon(0 0, 80% 0%, 80% 100%, 0% 100%); clip-path: polygon(0 0, 80% 0%, 80% 100%, 0% 100%); } .tasty-recipes-rating.tasty-recipes-clip-90 { -webkit-clip-path: polygon(0 0, 90% 0%, 90% 100%, 0% 100%); clip-path: polygon(0 0, 90% 0%, 90% 100%, 0% 100%); } .tasty-recipes-nutrition ul { list-style-type: none; margin: 0; padding: 0; } .tasty-recipes-nutrition ul:after { display: block; content: ‘ ‘; clear: both; } .tasty-recipes-nutrition li { float: left; margin-right: 1em; } @media print { .tasty-recipes-no-print, .tasty-recipes-no-print * { display: none !important; } } /* Tasty Recipes Elegant recipe card styles */ .tasty-recipes-display { border: 0.15em solid; border-color: #fff; padding: 1.5em; outline: .5em solid #f9f9f9; background: #f9f9f9; margin-bottom: 1em; } .tasty-recipes-display h2 { font-weight: 400; text-transform: uppercase; } .tasty-recipes-print-button { margin-top: 0.5em; margin-right: 0.5em; padding: 0.5em 1em !important; float: right; font-size: .8em; font-weight: 400; border: none; } .tasty-recipes-image { border-left: 1.5em solid; border-color: #f9f9f9; } .tasty-recipes-rating .rating-label { font-size: 0.8em; font-style: italic; } .tasty-recipes-rating p { margin-bottom: 1rem; margin-right: 0.8rem; display: inline-block; } .tasty-recipes-details { font-size: 0.8em; } .tasty-recipes-details ul li { list-style-type: none; display: inline-block; width: 30%; } .tasty-recipes-description p { font-size: .8em; font-style: italic; } .tasty-recipe-ingredients h3, .tasty-recipes-ingredients h3, .tasty-recipe-instructions h3, .tasty-recipes-instructions h3, .tasty-recipes-notes h3 { font-weight: normal; margin-top: 0.6em; margin-bottom: 1.2em; text-transform: uppercase; } .tasty-recipes-notes { margin-bottom: 1rem; } .tasty-recipes-notes h3 { font-size: 1.2em; } .tasty-recipes-notes p, .tasty-recipes-notes ul { font-size: 0.8em; } .tasty-recipes-nutrition h3 { font-size: 1em; text-align: center; margin-top: 1em; } .tasty-recipes-nutrition { padding: 0.5em; border-top: .15em solid #fff; } .tasty-recipes-nutrition ul { text-align: center; } .tasty-recipes-nutrition ul li { list-style-type: none; font-size: 0.8em; margin-left: 0; width: 30%; } .tasty-recipes-entry-footer { text-align: center; padding-top: 1rem; } .tasty-recipes-entry-footer p { margin-bottom: 0; } .tasty-recipes-print-view { font-size: 11px; }

Baked Buffalo Chicken Fingers

For a delicious adult version on a kids classic whip up these easy and healthy baked buffalo chicken fingers!
  • Author: The Healthy Maven


  • 1 1/2 lbs boneless, skinless chicken breasts
  • 1 large egg
  • 4 1/2 tbsp hot sauce of choice (reserve 3 tbsp for sauce)
  • 2/3 cup almond meal (NOT almond flour)
  • 1 tsp garlic powder
  • 1/2 tsp chili powder
  • 1/4 tsp cumin
  • 1/2 tsp sea salt
  • 1 1/2 tbsp ghee (or butter)


  1. Preheat oven to 400 degrees F.
  2. Slice chicken breasts into strips.
  3. Beat egg in a large bowl and combine with 1 1/2 tbsp hot sauce
  4. In a separate bowl combine almond meal and spices.
  5. Dip 1 strip into egg mixture with left hand and place into almond-spice mixture and mix to coat with right hand.
  6. Place onto a a parchment or silicone-lined baking sheet.
  7. Repeat with remaining strips.
  8. Bake for 20 minutes.
  9. Let cool on tray for 20 minutes
  10. In a large shallow pan, combine ghee and remained 3 tbsp of hot sauce until melted and combined.
  11. Using tongs or a fork, dip each chicken finger into sauce and flip to coat on both sides.
  12. Place back into tray to let soak in mixture for 10 minutes

These Baked Buffalo Chicken Fingers are a lightened up version on classic chicken tenders with a spicy kick. A perfect weeknight dinner for adults and kids alike.

Any words of wisdom for our upcoming nuptials? What did you serve at your wedding?

The post Baked Buffalo Chicken Fingers + I’M GETTING MARRIED! appeared first on The Healthy Maven.

Article source here:The Healthy Maven

The Art of Saying No

It's hard to say no in a world of saying yes. But truthfully, the art of saying no, really is the art of saying yes. This article breaks down some tips and tricks on deciding when to say no and best practices for how.

There is such mixed messaging out there when it comes to saying no. Shonda Rhimes tells us to embrace YES and dedicate an entire year to it, while others have declared vehemently that life is truly about saying no.

I’d like to believe my philosophy sits somewhere in the middle. I think we all far too often say “no” to the things that scare us and “yes” to the things that don’t serve us. It’s also hard to differentiate between the two.

It's either a HELL YES or a HELL NO. Anything else isn't worth your time. Learn more about the art of saying no, here.

This is why I truly believe that saying no is an art. It’s not something that is mastered overnight, but with practice you definitely get better at it. It’s something I’ve been practicing for the last few years and while it still isn’t easy, I’ve certainly improved. It’s an art I’ve been working on in both my personal and professional life. Through discipline and setting boundaries, I’ve been able to find a much better work-life balance. It’s required me saying “no” to work opportunities so that I can actually have a life, and saying “yes” to hiring a team to help me in making THM the best it can be. P.S. You’ll be meeting Team Maven soon!

I’ve said “no” to more money than I ever thought imaginable because the brand was not the right fit and “yes” to brands who had zero budget but whose values aligned. I’ve said “no” to countless meetings and “yes” to spending time with loved ones. I stumbled a lot along the way, but I’m getting there.

What I’ve learned is that saying no really means saying yes. It means saying yes to you, and your values. It means saying yes to the people you love and your responsibility to be a kind, compassionate human.

It doesn’t get you out of paying your taxes or showing up to the things you hate doing (we all have those things), but instead asking yourself if you have the choice between saying yes and no, is yes really the answer?

I find there are a couple questions and tips that have helped me learn the art of saying no and knowing when it might be time to say yes. I thought I’d dedicate this post to sharing those tips with you:

1. Is Fear the Root?

This question goes both ways. Are you saying yes because you’re scared the opportunity will never come again? The answer in this case is to say no. Are you saying no because you don’t think you’ll perform well enough or do the job perfectly? Challenge yourself and say yes!

2. Will you Feel Resentful?

Oh mannnn this is a hard one! The number of times I’ve said yes to something only to feel resentful or angry in return. It was oftentimes because I agreed to do something for way less value than I felt I deserved. If you’re going to be angry, resentful or avoidant of something because you don’t feel you are being valued or compensated appropriately, WALK AWAY. Fast! It took me learning this lesson 10 times over to finally realize that my time was not worth being wasted on things that did not serve me or my business.

3. How Much Time Do You Have?

Realistically look at how much time you have. Set boundaries! Are you willing to work on weekends? Weeknights? What does your work schedule look like? How much time are you spending with your loved ones? Do they feel they are being acknowledged? If no, it’s time to reassess how you spend your time and if you are prioritizing it well. Which brings me to…

4. What Are Your Priorities?

When was the last time you sat down and looked at your priorities? We oftentimes move through life in auto-pilot without actually taking the time to see if we’re living life according to our values and passions. I suggest setting aside some time to write down your passions and then numbering them according to what you want to prioritize in your life. If an opportunity comes along that isn’t in your top 5 priorities, say no. It can oftentimes be a map to navigating those challenging situations where you’re not sure if it’s the right opportunity or not.

5. Can You Provide An Alternative Offering?

This is probably the easiest way to say no and a good practice if you’re just getting started. Maybe you can’t offer what is being asked of you, but you can bring some kind of alternative solution? I do this a lot for work where I turn down an opportunity but suggest people who might be a better fit. I also do this frequently for blog consulting. While I’d love to sit down and talk with every person who wants to start a blog, it’s not realistic for me. Instead I send them over to The Blogger Project which offers tons of resources on starting a blog. My suggestion is to create a couple canned responses for those situations that may frequently pop up that don’t align with your time or priorities but perhaps you can offer help in another way.

6. Practice Practice Practice

Saying “no” is uncomfortable (as is saying “yes”) occasionally. But it gets easier with practice! I’m a lot more comfortable saying no now that I’ve done it many many times. It also helps to know how. Providing an alternative offering is always a good idea, but if you don’t have time for that, know that’s it’s okay to just say no. If you say it with compassion and understanding, people will respect you. If they don’t, that’s on them, not you. It’s probably a practice that they still aren’t comfortable with.

* * * * *

I’m not here to tell you that you need to say no to everything. I do think there’s value in saying yes. But I also think you should be saying no far more often than you are saying yes. If you are overwhelmed with work or maybe are oversaturated with play (it happens!) consider what you’re saying yes to and what you might want to consider saying no to. I also think it helps to have people say no to you because it teaches you to get a lot more comfortable with rejection and understanding that rejection does not be you are unworthy. Rejection is bad timing or the wrong fit. It has nothing to do with you. Once you experience a lot more of that you’ll then get much more comfortable giving it in return.

But as I said, it takes a ton of practice! It’s an art, not a science.

Saying no isn't always easy, but it's one of the most powerful tools you can use. This is the art of saying no and what it takes to get to a place where you can finally say HELL YES instead.

Are you comfortable with saying no? Share an experience where you said no to something even though it made you uncomfortable!

The post The Art of Saying No appeared first on The Healthy Maven.

Article source here:The Healthy Maven

Medmastery: AC/SIMV modes

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

The team at Medmastery are providing LITFL readers with a series of FOAMed courses from across their website.

Checking out the Mechanical Ventilation Essentials course today with a video exploring assist control (AC) and synchronized intermittent mandatory ventilation (SIMV) modes on a ventilator.

Further reading:

Guest post: Josh Cosa, MA, RRT-ACCS, RRT-NPS, RCP. Registered respiratory therapist and respiratory care practitioner, Clinical Education Manager at Philips.

I received my license to practice in 2003 and I have been teaching, managing, monitoring, and modifying ventilator settings ever since. I live in Southern California and have learned from and worked with some of the best teachers anyone could meet.” –Josh Cosa

Medmastery: AC/SIMV modes sabrine

Article source here:Life in the Fast Lane

Episode #62: Q&A: Wedding Planning, Yoga Teacher Training and What’s Coming up for The Healthy Maven

Hey guys! Welcome back to another episode of the podcast and the final episode before I get married! Fear not, there are still a few posts I have to share with you but since podcast episodes come out once a week, it just worked out that this will be the last one before we’re married. Next podcast episode I’ll officially be Davida Lederle. WOAH.

On episode #62 of That's So Maven, I'm hosting a Q&A episode and answering all your burning questions. From Wedding planning to yoga teacher training to have I have a healthy relationship with my body, no question is off limits in today's episode!

I thought since we’re rounding things out for a little while that I’d do a solo Q&A episode for you and answer some of your most pressing questions as well as share some wedding planning details, a more personal take at my experience in yoga teacher training and some insider info on what’s coming up next for The Healthy Maven.

Here are a few other things we cover in today’s episode:

  • Wedding planning and some challenges along the way
  • Why I haven’t shared that much about the wedding and what I plan to share afterwards
  • Yoga Teacher Training and why I chose my specific program
  • Doing yoga teacher training at the same time as wedding planning
  • Do I plan to teach or how I plan to incorporate yoga content on The Healthy Maven
  • Anxiety and how it’s manifested in various ways in my life
  • My best tips for growing a blog
  • How to change and evolve when you have a digital platform without alienating your audience
  • What advice I would have for a college student trying to figure their life out

LISTEN HERE:  iTunes | Stitcher | Google Play | Player.FM | Podbean | Spotify

Did I miss any of your questions? Happy to answer them here!

The post Episode #62: Q&A: Wedding Planning, Yoga Teacher Training and What’s Coming up for The Healthy Maven appeared first on The Healthy Maven.

Article source here:The Healthy Maven

How to be The Shop Floor Clinician

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

Once in a while we don’t have to be Epic. We can be a plain worker bee, low ranking, mission brown, a serf. We are permitted to hitch up our strides like peasants, and get on with the business of hoeing through the garden of the unwell.

Such freedom, you say. None of the high-level responsibility of being in charge of the department. No duty phone. No behaving like an epileptic desperado when asked to go to a flow meeting. Just good, honest toil.

I’ve been doing this job for a while now, and I’d like to share with you some of the wisdom I’ve attained over the years. I believe I may have something to offer – the wealth from my experience. We are now all schooled in wellness and life-balance, and I have taken this gentle, lapping mindfulness to heart. I usually start rostered days by rising at five a.m, meditating for twenty minutes, then fixing an oaty berry bowl of deliciousness, after which I write down a list of things that I craft into an acrostic poem; things about gratitude, goals for the day, things I can teach my juniors, things, other things, aphorisms. And I absolutely would do these things, except that I don’t. Ever. Most days I drive in, late and flustered, already slightly rageful at the insolence of traffic cones, unbreakfasted, in mismatched scrubs, and the most mindful thing I do is try and compose a humorous but slightly pathetic tweet whilst stuck at traffic lights, so that by the time I get into the heaving department, this place bursting at the seams with Very Unhappy People, I will have two, maybe three replies by kind people saying, there, there, it will all be alright. I hope to God they mean it.

I stride in fortified. I have four likes and a retweet. A record. Somebody cares for me.

Faced with a handover, and a to-do list that would make a self-help author blanch (shock this person, drain the CSF from another, placate this patient, find out what’s wrong with this one – please – and maybe this one too), I focus on the main apothegm that will get me through the day. Smile, be kind, and work on being only a minor train wreck. It mostly works.

I fire up the plough. I dive into the innards of people. On the whole my job consists of figuring out what is not wrong with people. I have become an expert in recognising the dark matter of the emergency pathology universe – once I know what is not, I can work out where to deal with what is. This should be simple, except my day is now less ploughing, more running in a blindfolded steeplechase, and not on horses, but cows with a particularly dementing strain of bovine spongiform encephalitis. There are barriers and pitfalls and lava pits and sink-holes. It is not pretty.

As a responsible leader, I do not look at social media while at work. Although perhaps I should reward myself with a little glance every now and then. This means pulling out my phone every two to three minutes to refresh twitter. I tell myself it’s to keep up with the erudite critical care information on this forum. I check my status. One more like. Because I am surreptitious about doing this, and also highly trained (and certified) in hand hygiene, I have taken to wiping down my phone with alcohol gel so many times, the skin on my hands is brittle and cracked, my pockets have an unsettling greasy feel to them, and the phone, while not quite tipsy, is almost unreadable.

I am very keen to teach the interns something. Five minute teaching, bed-side pearls, teaching on the run, that sort of thing. But thus far the potential clinical encounters have been a large-bodied nudist who is currently in dispute with God, several patients with hazy chest pain, a scandal involving a nursing home where one inmate swallowed another one’s tablets, and an extremely briefly run cardiac arrest. I offer nothing. When I do haul an intern aside, me sternly demanding this be a teachable moment, he presents his latest patient to me. I go in to see the patient. This is not the same patient he presented. Different story, different examination features, perhaps even different gender. I kindly confront him about this. He assures me it is the same patient. We sigh.

I, in the meantime, have a patient load all of my own. Decisions decisions. Much of my time is spent trying to work out which specialty team to speak to. Specialties are a broody taxonomy round these parts. I have become accomplished in defusing cantankerously answered consults. An ophthalmology registrar walks past. I know this because he is wheeling luggage, as though he’s navigating the duty-free stores at Heathrow, and he looks scared. I ask if I can help him. Turns out he is scared, and was trying to find the seminar room. Other specialties come and go. Most of them don’t really like us, often for no other reason than we add to their already over-burdened workload. It took me a long time to realise this. Most of them secretly think we’re quite competent, but are afraid to say so, as if this might somehow open the floodgates.

I see more patients. I listen to the shadows and the echoes of the stories in these brushes with humanity. I pull my notebook from my scrubs pocket, and jot things down. After all, I like to write, and these details are the lifeblood of novels. Unfortunately, when I take my notebook out on wash day, I realise I cannot read a single word of what I’ve written. Not one. I also have, on rotation, a set of books that I keep in the other pocket. Virginia Woolf, Keats, other small anthologies of poems. Like my extreme commitment to mindfulness, I read and reflect on these often. Which, actually, is also an Instagram-grade falsehood. Mostly they simply offer succour by being close to me throughout the long day, even if I never read them. I am a poor excuse for a novelist, I realise, and go back to focusing on being a doctor.

For an hour I look after the unbuckled body of a boy in a motorbike crash. I think he might die, and for the duration I have a nameless ache in my entrails, part nausea, part fear, that despite all I know and all I can do, it might not be enough. I might not be enough. He hangs on long enough to get to ICU. A minor success. Cases like this, however, feed on your adrenaline, leaving you tired and depleted. I wish, for the millionth time, that we had little rest-pods; white, comfortable, softly lit refuges, where nobody could reach you for twenty minutes. We don’t. Instead I buy another coffee.

I return to it. The training registrars with whom I work are quite brilliant. I learn bucket-loads from them, and I am sustained by their commitment and energy. We have this quaint setup where they assure me they are learning from me, and are grateful for the on and off floor teaching. They say this sincerely, and we all smile.

Emergency medicine evolves faster than Monsanto canola. It’s hard to keep up with all the latest and greatest (oops, better check twitter again), but, funnily enough, it’s the doing of the basics well that seems to be the most effective tool for the best patient outcomes. Perhaps there’s something to be said for us plodders, turning up again and again, year after year, just trying to do the best for the single patient in front of us. No system or institution is perfect. Ours certainly isn’t. But I honestly believe we do a very good job for most of the people that have the misfortune to hurtle through our doors on their bad days. Their days are our days. We’re in it together, we, the proletariat of medicine. I clock off, joining the queue shuffling out the doors in our overalls.

‘How to be’ series. An Instruction manual for those in Critical Care

How to be The Shop Floor Clinician Michelle Johnston

Article source here:Life in the Fast Lane

Jellybean 94 with Salim Rezaie – Teaching teachers about teaching

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

Teaching teachers about teaching; lets get super-meta.

The Teaching Co-Op. (The event formerly known as The Teaching Course.) It’s in Alcatraz, Brisbane and Copenhagen. It’s in Melbourne, Manchester and Manila. I’d be exhausted just thinking about it if it didn’t sound like so much fun.

Salim Rezaie is a softly spoken, erudite, talented attention avoider. He wants to credit someone else, he wants you to be happy, he wants to perfect the next slide for his next talk. He doesn’t want to give his next talk quite as much as he wants to make the slides but we, the consumers of his inimitable style, are not complaining. Instead we are signed up subscribers, following and forwarding his work because it’s good, very good.

Salim is a bit of a pro. He started out on ALIEM. He started RebelEM as a blog and then he got a podcast up and running. He got into this whole education #FOAMed thing, and from his involvement he became increasingly interested in the processes of the whole teaching/training/learning/simulating/feedback thing. So much so that he realised that there was an appetite, a need, for a resource that helps teachers get better at teaching. We are educators, we are motivated, we know some stuff, but we are often isolated within our various institutions as the education woman or man. We don’t have our own little cadre of education enthusiasts close by to ask for help, to compare notes, to share techniques.

So Salim set one up. He formed a team. He formed a cooperative. He is the leader but the is an incredibly modern type of super-collaborative empathic leader. He is soaking up ideas from all sources. He has gathered a group of super-impressive women and men that help him out. Let’s think for a second about the Teaching Course Faculty. To shed light on this lets bring in my resident philosophical conundrum machine; Cormac.

My son Cormac asks me some very important questions. Last week he asked me a good zombie apocalypse question; “Come the Zombie Apocalypse which of your friends would you want with you to help you survive?” That is an interesting question, it is a thought experiment in utilitarian ethics.

I’d suggest there are a few candidates in the Teaching Coop faculty.

Of course one would have to get into the whole #MetaMoments thing that The Teaching Course is embracing, that means feedback, lots of feedback. The imagined “Flipping MedEd Zombie Apocalypse Survival Team” would be giving and receiving lots of feedback. There would be lots of eye contact and hugs. Hopefully not too much to distract them from the zombies which would give the wrong sort of feed back altogether.

“Whats that noise? Feedback! I hate feedback. No, wait, hang on, I love feedback.”  Neil Young.

Feedback is a love hate thing for many of us, but then have you ever been taught how to take feedback? Give it, maybe, but take it? We can tease ourselves for being a bit meta about all this stuff but there is a reason we are talking about it. If we are mentoring young nurses and doctors, if we are running simulation sessions, (and we are), then we do need to think about all this and more.

The Teaching Course is a constantly evolving set of distinct and imaginative units. There’s presenting skills and simulations skills, there’s mindfulness stuff and an awful lot more. If you are an educator then this course is definitely worth a look. It is so good you may wish to go more than once.

I would. I’d go just to get more down-to-earth wisdom from probably my favourite Texan. (Apologies to Cordell Walker.)

Accidental, old fashioned, sage and reluctant FOAMed star, it’s Salim Rezaie @srrezaie

Check out these Jellybean Podcasts with other Teaching Course Faculty;

It’s like a Jellybean Playlist. I might go and build that Playlist on SoundCloud.

Thanks to Salim for coming along on the podcast. I asked Salim for a piece of music that was from where he was from. He came back with Thunder by Imagine Dragons. I came back with the world famous instrumental version of that song by the legendary Molotov Cocktail Piano and just in case that wasn’t huge enough for you our outro comes from the 8-Bit Misfits and their own misinterpretation of the classic. All of those available on iTunes and so many other places.

Further Listening

JellyBean Large

Jellybean 94 with Salim Rezaie – Teaching teachers about teaching Doug Lynch

Article source here:Life in the Fast Lane

ANZICS Safety & Quality Conference 2018 and Feedback in the Workplace

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

The next ANZICS Safety & Quality Conference is coming…

This year’s ANZICS Safety & Quality Conference will take place from 30 – 31 July 2018 in Melbourne. Australia and New Zealand have been world leaders in the conception and promulgation of the Rapid Response System (RRS) model of care. An impressive scientific program has been developed which will explore Rapid Response Team Training, Rapid Response Teams in specific areas and explore strategies to improve the quality and safety of care delivered to deteriorating ward patients.  Theoretically grounded but practically orientated, the program will be presented through active discussions and free papers to develop new safety and outcome initiatives. A number of dynamic speakers from various disciplines will present. The Conference focuses on multidisciplinary team activities and is suitable for critical care nurses, allied health staff and physicians. The topics presented have implications for patient monitoring and the recognition, response and treatment of deteriorating hospitalised patients.

A/ Prof Daryl Jones
Conference Convenor

This conference continues to mature and, with a dual emphasis on Rapid Response Teams and ICU Safety & Quality in general, is particularly interesting for its cross-disciplinary inter-professional relevance. The organisers have embraced that and have created an event that will appeal to trainees, nurses, and consultants, with patient care front-and-centre.

I’m lucky to be involved in what promise to be two dynamic and interactive sessions on “feedback in the workplace”. Most learning happens in the workplace and we need to maximise the opportunities. We even have Prof Elizabeth Molloy coming as one of the world leading experts on work integrated learning. The sessions are a great opportunity for all clinicians, whether trainees or trainers, to immerse themselves in mastering “the philosopher’s stone” of improved performance, feedback.

I hope to see you there.

Abstract submissions are closing soon… The deadline is 5:00 pm AEST Friday 25 May 2018.
Register for the conference soon as Early Bird registrations close at 5.00 pm AEST Friday 8 June 2018.

ANZICS Safety & Quality Conference 2018 and Feedback in the Workplace Chris Nickson

Article source here:Life in the Fast Lane

LITFL Review 331

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

LITFL review

Welcome to the 331st LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.

Readers can subscribe to LITFL review RSS or LITFL review EMAIL subscription

The Most Fair Dinkum Ripper Beauts of the Week

Nick CumminsOne of the most challenging blog posts I have ever read is this one on codependency and the (emergency) physician from St Emlyn’s. Food for thought. [SO]

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care and #FOAMres Resuscitation

  • Josh Farkas discusses a simple airway algorithm to deal with intubating a patient who is actively vomiting: The Drowned Airway Algorithm. [SR, MG]
  • David Carr recently presented at dasSMACC with the attention-getting title, “Endocarditis will also f&*k you up.” Easy to remember “fever plus…” criteria for identifying suspected endocarditis and current management practices are presented as a means to avoid missing this critical diagnosis. [TCN]
  • The EDECMO podcast hosts Dr. Heidi Dalton to discuss her approach to ECMO for sepsis. An important discussion, as sepsis was once considered a contraindication for ECMO. Dr. Dalton describes which septic patients to consider ECMO for and when to initiate extra-corporeal support. [TCN]
  • The classic teaching for LVAD patients in cardiac arrest is to withhold chest compression, but the NAEMSP blog has an important literature update. [MG]
  • The Bottom Line review a recent NEJM paper on Thrombectomy 6-24 hours after stroke. Nice work Anthony! [SO]
  • ICU is all about “sweating the small stuff”- routine things like VTE prophylaxis and feeding are incredibly important. Deranged Physiology discusses the merits of routine ICU care mnemonics (such as FAST HUGS) in a really detailed post. Not to be missed. [SO]

The Best of #FOAMtox Toxicology

  • David Juurlink makes a case for why we should not be prescribing Tramadol. It should be called Tramdont as it can cause seizures, serotonin syndrome, drug-drug interactions, hypoglycemia, dependence, addiction, and death. [SR]

The Best of #FOAMus Ultrasound

The Best of #MedEdFOAM and #FOAMsim

Reference Sources and Reading List

Brought to you by:

LITFL Review 331 Marjorie Lazoff, MD

Article source here:Life in the Fast Lane