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This is Spinal Tap.

  This was a 3-week old otherwise healthy full-term boy who was brought in by his parents for a fever of 100.8F rectally at home. Parents are extremely concerned because their firstborn baby is dehydrated because he has not been drinking very well all day with 1 wet diaper. Parents deny any cough, rhinorrhea, vomiting, diarrhea or rash.   You explain to them that you will need to do a full septic work-up, which will include blood, urine and CSF studies. They are extremely anxious about the lumbar puncture, and ask if there is anything you can do to ensure a more successful Read more [...]
Frozen (2013)Olaf (voiced by Josh Gad)

Brr it is frreeezzing out there… (are you really not dead until your warm and dead?)

A five year old patient comes into the ED after falling through the ice on their pond playing hockey.  He  had on scene CPR for 10 minutes and you have now continued CPR for 20 minutes. The classic pediatric teaching is-- the patient is not dead until they are warm and dead.  We are trained to continue CPR because of case reports of "miracle" neurologic outcomes in pediatric cold water drowning patients with prolonged submersion (> 60 minutes).  The "Guinness" book of records reports survival in children with temperatures as low as 15C and CPR for up to 6.5 hours.  Rewarming these Read more [...]
good-choice-bad-choice

Doctor Cents–There is NO price too LOW for BAD advice!

In the last post we talked about the importance of making a financial plan. This concept rightfully scared some of you. Hopefully this post will help ease some anxiety regarding your personal financial plan by helping you determine how you are going to make your personal financial plan. As a PEM fellow or PEM attending you will be approached by many different individuals who want to “help” you do financial planning (if you haven’t been approached already). Financial advisors usually come in one of four flavors: commission based employee of a brokerage firm or insurance company fee Read more [...]

Are We Aware That We Are Burnt Out?

By: Virteeka Sinha* and Ameer Hassoun Four years of medical school, three years of residency, and additional years of fellowship, countless hours of service and night work, tired minds, exhausted bodies and a whole lot of fatigue is what we have gotten ourselves into. The concept of burnout is not new. Medicine, more than many other similar paying professions, is very demanding and exhausting. There is a constant demand and stress on body and mind to do better at work and at home. The prevalence of burnout in health care workers is estimated to be as high as 25%. Out of over a 1000 emergency Read more [...]

Promotions and Academic Scholarship, Part I

For many of us who went through medical school, perhaps graduate school, and landed an academic faculty position, there has always been pressure to succeed academically.  Some of us are now happy with good jobs and careers that center only on direct patient care, whereas there are others who still wanted something a little more.  Particularly for those folks who complete PEM fellowships, the allure of going forward academically is always there, shining like a light at the end of the tunnel.  And boy, it's a long tunnel. Once fellowship graduation is over, it is a difficult landscape to navigate. Read more [...]

Winning the lottery is NOT a financial plan

One of the first decisions with regards to financial planning a PEM fellow/attending must make is what to do with their finances. This means you need a financial plan. Aaack!! You say—I don’t know the first thing about making a financial plan. That is OKAY. Your second thought after your heart rate returns to normal is, “what is a financial plan?” Many people/books exist to help you formulate a financial plan*. A financial plan is a roadmap of your financial goals and how you hope to accomplish them. (Winning the lottery shouldn’t be the foundation of your financial plan!) In a Read more [...]
Dr GoPro

Doctor GoPro and Nurse Microsoft Hololens meet Patient Google Glass: How are we still not videotaping PED care?

Will the day come that a patient coming in with Googleglass is cared for by a doctor wearing a GoPros and a nurse with a Microsoft Hololens? How are we still not videotaping PED care? There has been a great deal of attention on the potential applications of these new wearable video based technologies in medicine.  It is exciting to engage in discussions about these devices and see research/news stories in the mainstream media. With all of this excitement why is it that existing methods of video are currently being used on such a limited basis? Is your center using video as an Read more [...]