PEMNetwork changes (July 15, 2014)

Dear PEMNetwork users We recently had a breach within the main PEMFellows.com site as of July 14, 2014.  The breach caused all of the files to be deleted from the server, and it took 24 hours for the recovery of the entire site.  We believe that the breach took place because of the infrastructure of the main PEMFellows.com site, which - for those of you who are techy - was based on a content management system Joomla! 1.5, an aging system prone to hack attacks.  As of July 15, we have the rest of the PEMNetwork sites (podcast, moodle, blog) up and running. We do not believe any information Read more [...]

Unintended Consequences

Everything we do can have unintended consequences. Accepting transfer of a sick cardiac transplant patient- when your PICU census is full is just one more decisional ingredient in cooking up a spicy “perfect storm” soup.  And while we can’t always predict which straw will break the proverbial camel’s back, they are further amplified by system changes that dictate decisions to multiple providers and may propagate errors, unless there is a concurrent commitment to 1) pre-testing 2) post-assessment 3) ongoing reassessment both for improvement in intended outcomes, but also Read more [...]
Screen Shot 2014-04-30 at 10.57.52 AM

Answer: “I Saw The Spine, And It Opened Up My Eyes, I Saw The Spine”

This post is in response to the July Ultrasound Image of the Month: "I Saw The Spine, And It Opened Up My Eyes, I Saw The Spine" To summarize, we had a 6-year-old female with a history of nephrotic syndrome who presented with abdominal distention, vomiting and diarrhea and orthopnea.  The following images that were obtained on point-of-care ultrasound demonstrate the presence of bilateral pleural effusions. Thank you to all of you who took the quiz! Here are your results below:     Mirror Imaging In normal RUQ and LUQ images, there is a 'mirror imaging’ Read more [...]
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I Saw The Spine, And It Opened Up My Eyes, I Saw The Spine

  A 6-year-old female with a history of nephrotic syndrome is brought to your ED with worsening swelling, vomiting and diarrhea. Her abdomen is distended and you notice she has difficulty breathing whenever she lays down. She hasn’t had any fever, cough or congestion but the parents are concerned that her breathing has changed over the past few days. A point-of-care ultrasound of her abdomen was performed and the following images of the right and left upper quadrant were obtained. Images courtesy of Drs. Selin Sagalowsky and Sharon Pan. http://lng801.polldaddy.com/s/i-saw-spine   Thank Read more [...]
237365

24-7-365: The evolution of emergency medicine

This is an amazing video created by a Yale Emergency Medicine Resident as part of a collaboration with EMRA and "goose" (anthony edwards). Please check it out and share with friends colleagues. While it relates to EM and not PEM it provides an outstanding overview of the history of our field: "Emergency medicine is one of the youngest medical specialties in the U.S., accepted into the house of medicine in 1979. Born out of the public’s growing need for emergency care, ours is the only specialty that serves anyone, anyplace, anytime – 24/7/365. There is no better time for this documentary Read more [...]
application

Applicant’s Corner 1: Overview & the Personal Statement

Congratulations, everyone, as the new Fellows start now, we open up yet another Applicant Season for the upcoming July 2015 start for U.S. and Canadian fellowships.  The deadlines are much later than in previous years: 07.15.2014 - MyERAS opens 08.27.2014 - Match opens 10.22.2014 - Ranking opens 12.03.2014 - Rank Order list deadline 12.17.2014 - Match Day One of the hardest questions we get asked is, "what should I write in my Personal Statement"?  I'll invite other fellowship directors and former applicants to chime in and comment, but the answer is relatively straightforward. Read more [...]
Decision

Making Hard Choices and Good Doctors

For me, the hardest cases in pediatric emergency medicine are not necessarily the critically ill patients. In most of those cases, the choices are relatively clear. If they are hypotensive, consider fluids or inotropes. If they are having respiratory distress, consider interventions such as oxygen and ventilatory support. If they are bleeding, stop the bleeding. The patients that often make me uneasy and my shifts challenging are the ones in which the choices are grey. Whether the grey is clinical (“I can’t figure out what’s going on with this patient”), social (“this injury seems Read more [...]

Welcome newbies! DOB 7.1.2014

The start of summer is an exciting time of year. The sun is shining, the beaches are packed and our Children’s Hospitals welcome a different type of newbie. These new arrivals are extremely intelligent, well trained and want to do the best they can to care for the injured infants and children in our EDs.   I was impressed with the knowledge and skills of our new interns this week at PALS. It was exciting to see the impact of inter-professional education efforts in the undergraduate medical curriculum with most of the interns reporting they had participated in team training during medical school. This Read more [...]