It’s winter. The waiting room has had to bring in extra chairs to handle the overflow, and you are likely working your way through your 3rd or 4th URI of the season. The new staffing model for extra help during the busy season worked the first day but has since devolved into an extra doc following up on respiratory panels from last week. People are wearing their emotions as the next patient with a cough/congestion chief complaint gets checked in.
Physician wellness and its counterpart, burnout, are two of the buzzwords that have captured the medical zeitgeist of the past decade. Although they may be a little overused, their importance cannot be overstated—especially in these overworked, sun setting at 2pm, cold days. It has become so important that there is now a physician wellness fellowship at Stanford. Multiple research papers and physician groups have identified the issues that seem to affect us all: EMRs, documentation, patient loads, insurance nightmares, emotional exhaustion, and depersonalization. Some ways to combat burnout and promote wellness are obvious but may not feasible—cutting patient loads, taking a walk during lunch, or outsourcing your more nominal daily activities. But we are emergency medicine physicians, we do not have a say in patient loads, and I feel lucky when I can eat a sandwich at my computer on wheels in between patients (don’t take away our food in the ED…).read more
The New Year of 2020 has commenced and with it will come new challenges, new opportunities and an abundance of new information. The sheer volume of new literature published and presented in 2019 will virtually make it impossible to keep up for most practicing PEM physicians. This is an attempt to wade through the published literature in order to identify the most impactful articles published in 2019. Compiled here are arguably the top five manuscripts that have potential impact on our day-to-day practice. Surely, there may be other articles that readers find to be more relevant and more impactful to the field, and these should be discussed on our list serve and the website. Here is the list:read more
Chumpitazi, CE, Camp, EA, Bhamidipati, DR, et al. “Shortened Preprocedural Fasting in the Pediatric Emergency Department.” The American Journal of Emergency Medicine, vol. 36, no. 9, 2018, pp. 1577–1580.
Carmen D. Sulton, MD
The relationship between pre-procedural fasting times and aspiration and/or pulmonary complications are often a topic in anesthesia and sedation literature. In particular, fasting or nil per os (NPO) guidelines for urgent procedures outside of the operating room continue to be vague. Prolonged fasting times can often be difficult for both emergency providers and families to manage. The American Society of Anesthesiologists (ASA) guidelines focus on 2 hours of fasting for clear liquids and up to 8 hours for full fatty meals. The American College of Emergency Physicians (ACEP) states that procedures in the emergency department (ED) setting should not be delayed based on fasting times alone. Many studies looking specifically at fasting times and adverse events often are under-powered, or may not focus specifically on patients in the ED setting. read more
Jakelin Caal Maquin. That is the name of the 7 year old girl who died in the custody of US officials soon after arriving at our border. More details about her death may follow, but, as of now, we know that she reportedly died from dehydration after a long journey from Guatemala. Apparently she was in US custody for 90 minutes before receiving any medical attention. Finger pointing will now ensue and the death of this little girl may serve as a political football for advocates on different sides of the issues.read more
Intro by Chair-Elect Taryn Taylor, MD, FAAP, FACEP
ACEP in San Diego was an enriching experience. We had an opportunity to learn new techniques, see old friends and reinforce critical concepts that are essential to our practice. We opened the ACEP PEM section meeting with a dynamic presentation from Dr. Christopher Amato, who provided guidance on being an effective speaker. November’s microsite highlights education, and the editor’s thought it a timely opportunity to showcase a portion of Dr. Amato’s presentation. Enjoy!read more