Emra*cast

OverviewNew to emergency medicine residency and trying to take that first step toward building your knowledge base? Maybe you're trying to optimize your study strategy? Look no further! The great thing about EM is that we LOVE medical education. Today we take a look at a variety of educational resources to help build a solid foundation of your medical/clinical knowledge. Key PointsTopics we cover include: EM gear to bring to shift Podcasts to listen to on the way to shift The most valuable on-shift mobile apps Pocket guides for every clinician Textbooks that won't collect dust Question banks that will be the work-horse of your study plan The best way to keep up with current medical literature How to solidify your knowledge Resources and References Best EM Podcasts: https://www.emra.org/emresident/article/best-podcasts-for-the-student-em-nerd/ Textbook suggestions by Scott Weingart: https://emcrit.org/recommended-reading/ EMRA's on-shift guides: https://www.emra.org/apps  https://www.emra.org/amazon  htt

The emergency medicine job market has been tight this year, there's no doubt. COVID has caused some groups and hospitals to cut back or even lay off EM physicians. So what's a resident or fellow to do? In this episode, host Kate Joyce, MD, MPH, gets a few perspectives on the job landscape from Washington Post reporter Ben Guarino, US Acute Care Solutions chief clinical recruiting officer Travis Ulmer, MD, FACEP, and NYU/Bellevue chief resident Michelle Romeo, MD. Learn some tips on navigating the job market this year and in the years to come. Key Points COVID has added stress to the EM job market, making finding jobs more difficult. Applicants are encouraged to apply broadly in terms of setting and geography. Recruiters can be especially helpful in the job hunt. Talk to your attendings to learn their experience and to find networking opportunities. Collaborating with fellow residents can help everyone find work. Reaching out to departments directly may reveal jobs not posted on hospital websites. Your first

Let's discuss a few hot topics: How do rising temperatures affect emergency medicine and the health of your patients? In this episode we sit down with Dr. Caitlin Rublee to discuss bugs, drugs, plants, and people. We connect the dots to show how climate change relates to social emergency medicine and what we can do as leaders to engage in health policy and take action to protect our patients! Key Points Climate change affects bugs, drugs, plants, and people! Rising temperatures mean increased vector-borne/zoonotic infections,  decreased efficacy of medications and patient access to medications, as well as increased potency of plant-borne illness and decreased biodiversity. Most important, it means poor health outcomes for our patients. Addressing health care equity is crucial when it comes to climate change. Vulnerable populations are disproportionately affected, and social determinants of health are front and center.  Start a conversation about climate change in your program or medical school Incorporate h

Guest: Jess Mason, MD, FACEP, director of the Medical Education Fellowship at UCSF-Fresno and deputy editor of EM:RAP, EM:RAP HD videos, and creator of EM:RAP’s C3 Hosts: Ranjita Raghavan, MD, of The Mount Sinai Hospital EM Residency, and Shreyans Sanghvi, DO, of Northwell Zucker School of Medicine (North Shore/LIJ)  OverviewEmergency medicine offers an exciting yet staggering number of career paths. In this episode, we explore what it takes to find your niche in the specialty. Get the inside track from Jessica Mason, MD, FACEP, who knew early on what motivates her and has established herself as a leader in FOAMed. Key Points If you are looking for inspiration for what niche to pursue, ask yourself, "What bothers you?" The answer to this question usually will lead to something you are passionate about. You do not need to be at a residency that directly fits your passions; you can find mentors and pursue opportunities anywhere you go. You just need to reach out to people; they will generally be willing to hel

EMRA*Cast host Dr. Shreyans Sanghvi takes a deep dive on the history, current practice, and future direction of cardiac arrest management and advanced resuscitation medicine with research pioneers Dr. Lance Becker and Dr. Sam Parnia. OverviewEach year hundreds of thousands of Americans suffer from cardiac arrest out of the hospital. CPR has been a core tenet in the rescue algorithm for patients in cardiac arrest, but how do we transform this age-old treatment with today's advances in technology, and to where do we turn when CPR alone is ineffective? Dr. Lance Becker, chair of Emergency Medicine at Northwell Health North Shore - LIJ, and Dr. Sam Parnia, director of Critical Care Research at NYU Langone Medical Center, discuss lessons they've learned along the way dedicating their lives to the research and treatment of patients in cardiac arrest.   Key Points CPR is the single most-effective measure in the resuscitation of patients in cardiac arrest. CPR when used in tandem with real-time biomarkers such as en

OverviewDo you ever get overwhelmed with all the ED analgesic options? In part 2 on ED Pain Management, Dr. Sergey Motov helps break things down, reviewing a few cases and finishing with Sergey’s 10 Commandments of ED Pain Management. Key PointsSergey's 10 Commandments of ED Pain Management Titrate opioids regardless of initial dosing regimen: weight-based, fixed, or nurse-initiated. Use alternatives (to IV) routes of analgesic administration: PO, PR, IN, SubQ, nebulized, topical. Utilize sub-dissociative dose ketamine for selected acute and chronic painful conditions. Educate patients about appropriate expectations of pain course and management. Embrace a concept of channels/enzymes/receptors targeted analgesia. Use NSAIDs based on their analgesic ceiling dose. Attempt to use non-opioid analgesics whenever possible. Promote nerve blocks for a variety of acute painful conditions (trauma, infection, inflammation). DO NOT prescribe long-acting opioids, SR/ER opioids, or fentanyl patches in the ED or at dischar

Do you ever get overwhelmed with all the ED analgesic options? Dr. Sergey Motov from Maimonides Medical Center in Brooklyn helps breaks down ED pain management. We cover everything from topical NSAIDs to ketamine infusions. Curious which opioid to go with or what dosing? Look no further. Key Points: Remember to set appropriate pain management expectations. The goal is to make the pain tolerable, not to eliminate it. The more you include your patient in your decision making, the more in control they will feel. NSAIDs are a go-to first option. If a patient doesn’t respond to one class, try another. And don’t forget about topical NSAIDs like diclofenac! Reasons to avoid this class would be history of GI bleed or CAD. Ketamine is a great option for acute pain. 0.3mg/kg in a bolus over 30 minutes followed by 0.1mg/kg/hr during their ED stay. Use these slow infusions to avoid dysphoric reactions. Don’t be afraid to use ketamine in combination with other analgesics for optimal pain management. Neuropathic pain is d

Do you ever feel like a fake, a fraud? Imposter syndrome can make you feel a pervasive sense of intellectual fraudulence, despite all the evidence to the contrary. In this episode, Dr. Kim Bambach discusses imposter syndrome with Dr. Jamie Hope including strategies that you can use to combat it. Host:Kim Bambach, MD Ohio State University, PGY3 @kimbambachhttps://twitter.com/kimbambach Guest: Jaime Hope, MD Assistant Professor Beaumont Hospital, Royal Oak @DrHopeHealth Key Points: Watch out for the typical signs and symptoms: These include devaluing your accomplishments, attributing your accomplishments to external causes, constantly comparing yourself to others, and a negative inner “bully” monologue.  Go first: Be the first to speak up about imposter syndrome, because acknowledging those feelings gives others a chance to feel understood and helps you recognize that you are not alone.  Put your name in the hat: Don’t let imposter syndrome hold you back when it comes to professional development. Apply for t

Overview: With an upcoming election, social unrest and a global pandemic - there’s a lot to get fired up about.  But what’s our role as residents? PGY2 Kate Joyce talks with Dr. Mariana Del Rios, Dr. Dara Kass and Dr. Alister Martin about a program that registers patients to vote in the ED, social emergency medicine, policy and advocacy.  We’ll round things out by talking about how to get involved - without putting your career in jeopardy. Key Points: Social Emergency Medicine recognizes the importance of addressing the social determinants of health in the Emergency Department through direct practice, community engagement, advocacy and research. Many of our patients have not been introduced to the political process.  For others, it may not be safe for them to go to the polls.  VotER is a nonpartisan project that allows patients to register to vote or request absentee ballots while they wait, without adding to the work burden of providers.     Drs Del Rios, Kass and Martin lay out a few examples and suggest wa

Host: Dr. Isaac Agboola, MD, MS Guest: Dr. Sheryl Heron, MD, MDP, FACEP Assistant Dean of Medical Education and Student Affairs at Emory University School of Medicine  Vice Chair of Administrative Affairs Professor of Emergency Medicine Overview: On today’s episode, Drs. Agboola and Heron discuss the intricacies of cognitive bias and cultural competency and the roles it plays in the emergency department. They discuss ways that individuals and residency programs alike can approach ensuring that they are rendering more culturally competent care. Additionally, they spend time addressing communities that are at risk for such biases such as undomiciled populations, individuals from lower socioeconomic status, and racial minorities.   Key Resources:   EMRA Diversity and Inclusion Committee    Key Points:   Cognitive bias, microaggressions and cultural humility should compel us to think more deeply on how we can deconstruct the “-isms”. It is important to create and nurture an environment that allows for open

Guest hosts: RJ Sontag, MDPresident-Elect, EMRA Residency: UT Health San Antonio Medical School: Wright State University EM Resident Articles Twitter: @RJSontagMD Andrew Meltzer, MD, MS Associate Professor of Emergency Medicine, George Washington University Director, Urgent Matters Fellowship: Clinical Research, University of Maryland Shock Trauma Center Residency: University of Maryland Shock Trauma Center Medical School: SUNY Downstate School of Medicine Twitter: @ACMeltzer Guest: Raul Ruiz, MD, MPH, MPP United States Congressman (CA-36) Fellowship: International Emergency Medicine, Brigham and Women’s Hospital Residency: University of Pittsburgh Medical School: Harvard University Twitter: @CongressmanRuiz In this episode, guest hosts Drs. RJ Sontag and Andrew Meltzer interview a sitting Congressman, Dr. Raul Ruiz, to explore how students, residents, and recent grads can become advocates for their patients and their profession outside the emergency department. As EMRA’s 2019 Congressional Health Policy Fell

Host:   Alex Kaminsky, MD PGY-3 UCSF-Fresno (@Alex_KamskyEM) Guest: Stephanie Benjamin, MD (@StephBenjaminMD)EMS/Disaster Fellow, UC-DavisAuthor: “Love, Sanity, or Medical School”- https://www.thirdyear.org/ Overview:  In this episode Dr. Kaminsky sits down with veteran journal writer, award winning author, lecturer and current EMS/disaster fellow Dr. Stephanie Benjamin to discuss tangible ways to combat burnout: beyond the buzzwords and by actively building resiliency via personal or medical journaling. Dr. Benjamin discusses the strong medical origins to journaling, her own path and experiences into writing, the evidence-based physical and mental benefits of writing and how residents can delve into combating burn-out in a meaningful and realistic way. What we do is HARD. What we see is difficult. We need outlets to cognitively offload and unpack. Journaling is one way to actively (or passively) practice mindfulness outside of meditation and yoga. Key Points:  Journaling has deep roots in medicine. From Que

Dr. Berberian joins EMRA*Cast with Alex Kaminsky to delve deeper into the pathophysiology and electrical findings associated with diagnoses such as WPW, Brugada and ARVD in part 1 of this series. Lumps and Bumps: Can’t-Miss Diagnoses in Syncope (Part 1) Host: Alex Kaminsky Guest: Jeremy Berberian, MD Associate Director of Resident Education: Christiana Health System Editor-in-chief: EMRA EKG Guide Author EM Resident Monthly ECG Challenge. Overview: Residents are well programmed to recognize cardiovascular emergencies such as STEMIs at a glance. However, during a busy shift it can be easy to overlook dysrhythmias and other electrophysiologic urgencies and emergencies. Syncope is a prime example of a chief complaint that may be uncovered with an EKG alone -- however syncopal emergencies are often subtle and nuanced. Dr. Berberian joins EMRA*Cast with Alex Kaminsky to delve deeper into the pathophysiology and electrical findings associated with diagnoses such as WPW, Brugada and ARVD in part 1 of this series. K

In part 2 of her interview with Dr. Haney Mallemat, Dr. Jessie Werner finds out how to manage the ventilator in the ED and reviews some real-life cases with Haney! Overview: As Emergency Medicine physicians we’re tasked with taking care of the sickest of the sick, often before we even have a diagnosis to clarify the clinical picture. Stabilizing critically ill patients may require placing a definitive airway and providing hemodynamic support with pressors. When faced with these challenging situations, what do you do? So you decide to intubate. Now what? What are the different ventilator modes and how do we choose? What does it mean when the vent is alarming? Find out how to select vent settings and troubleshoot problems in Part 2 on becoming a critical care beast in the ED!  Key Points There’s no difference between pressure and volume control If you’re giving a certain pressure, you monitor the volume, and vice-versa Remember 6-8cc/kg of volume (using ideal body weight) for lung protective strategy Peak p

In part 1 of her interview with Dr. Haney Mallemat, Dr. Jessie Werner discusses using pressors in the ED. Stay tuned for part 2 on managing the ventilator! Overview: As Emergency Medicine physicians we’re tasked with taking care of the sickest of the sick, often before we even have a diagnosis to clarify the clinical picture. Stabilizing critically ill patients may require placing a definitive airway and providing hemodynamic support with pressors. When faced with these challenging situations, how do you choose the right pressor? What’s the dose? When do you add another agent? What about fluids? We answer all these questions and more in this episode of EMRA CAST. Also, stay tuned for the follow-up to this episode which covers vent management in ED.  We’ve got you covered with all the tips you need to become a critical care beast in the ED! Key Resources: The RUSH protocol (which includes the HI-MAP technique Dr. Mallemat mentions) – Rapid Ultrasound for Shock and Hypotension.  Key Points Perfusion is compo

In this episode, Dr. Tiffany Proffitt talks with Dr. Esther Choo about tangible ways to view and address gender disparities in emergency medicine. Description: Recorded at ACEP 2018 on the Expo floor. A discussion with Dr. Esther Choo on overcoming gender disparities in medicine as well as advice to residents and core faculty for implementation of techniques to encourage change and advancement. Introduction to Dr. Choo’s new start up Equity Quotient. Content of Show Notes: Dr. Choo’s Top 3 for Overcoming Gender Disparities in Medicine: Find your support network - there are local and national groups! You are NOT alone! Continue to work to improve the problem as you move up. Just a Few Support Networks: Your own hospital’s women’s group – if it doesn’t exist, reach out to your faculty and start one! EMRA Academy for Women in Academic Emergency Medicine  American Association of Women Emergency Physicians FemInEM:  Dr. Choo Citations for Any Relevant Articles Anna S. Mueller, Tania M. Jenkins, Melissa Osbor