Always On EM - Mayo Clinic Emergency Medicine

Chapter 16 - Sorry Taylor, there is no bad blood - a discussion on transfusions

Dr. Justin Kreuter, Transfusion Medicine attending at Mayo Clinic, joins Alex and Venk on the podcast to talk about transfusion in its many dimensions. We talk through a model of evaluation for patients with life threatening bleeding, how to interpret tests, the science behind the 1:1:1 ratio of trauma transfusion practice and much much more!

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda; @KreuterMD

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @KreuterMD

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

1. Lab medicine rounds podcast link: https://news.mayocliniclabs.com/homepage/podcasts-2/lab-medicine-rounds/
2. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, plaeteles, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma – the PROPPR Randomized Clinical Trial. JAMA. 2015; 313(5):471-482
3. Holcomb JB, Del Junco DJ, Fox EE, et al. The prospective observational multicenter major trauma transfusion (PROMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013 Feb;148(2):127-136
4. J-Y Borg et al. FEIBA in the treatment of acquired hemophilia A: results from the prospective multicentre French ‘FEIBA dans l’hemophilie A acquise’ (FEIBHAC) registry. Haemophilia. 2015 May;21(3):330-337
5. Sharp G, Young CJ. Point of care viscoelastic assay devices (rotational thromboelastometry and thromboelastography): a primer or surgeons. Anz J Surg. 2019 Apr;89(4):291-295
6. Hospital Liaison Committee for Jehovah’s Witnesses: https://www.jw.org/en/medical-library/strategies-downloads/hospital-liaison-committees-jehovahs-witnesses/

Grand Rounds - Dr. Amy Zeidan - Health and health rights of immigrants in the US

In this episode, Alex and Venk give the virtual stage to Dr. Amy Zeidan from Emory University. She is an experienced and passionate advocate for helping those most in need - particularly immigrants to the United States. She gave Grand Rounds to our department January 24, 2023 and we share that with you here.

 

Summary

The United States immigration system is exceedingly complex and results in barriers to care for structurally vulnerable immigrant populations. Immigration status alone is a social determinant of health with historical, economic, social and political implications related to healthcare 'access'. As a result, the emergency department may be one of the most reliable and safe points of entry into the health system for immigrant populations, as 'access' to routine care may seem unattainable. EM physicians are well positioned to provide high
quality and structurally competent care to immigrant populations seeking care in the ED, as well as facilitating community-academic partnerships to address external barriers to care. Doctor Zeidan will provide an overview of the US immigration system, how it impacts health seeking behaviors, and discuss strategies and considerations for care delivery for immigrant populations.

 

Objectives:
1) Explore the structure and context of the US immigration system and how this impacts the health of immigrants
2) Discuss the barriers to care faced by immigrants that impact health seeking behaviors (both inside and outside of the hospital)
3) Consider the role of EM physicians in supporting the health rights of immigrants on shift and beyond the hospital

 

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @Amyjwal

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

 

Chapter 15 - Don’t Stop Me Now! - Preexcitation and WPW

Dr. Abhishek Deshmukh, Cardiologist specializing in electrophysiology at Mayo Clinic, joins Alex and Venk on the podcast to talk about Wolff Parkinson White Syndrome and other supraventricular tachycardias. We will review the underlying pathophysiology, and how the specific electrical conduction pathway should determine how you treat your patient. He brings a pragmatic approach to this complex topic that you will be able to implement on your very next shift.

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @Abhishek_mbbs

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

Grand Rounds - Dr. Liz Goldberg - Five Traits of Exceptional People

Exceptional individuals display five common traits according to former FBI agent, Joe Navarro, an expert in non-verbal communication. These include: self-mastery, observation, communication, action, and psychological comfort. Most clinicians would agree that the therapeutic effect we have on patients has little to do with the medication we provide, but more what is communicated verbally and nonverbally during the interaction. But, how do we hone these skills? And importantly, how do we become masters of the art of medicine, so we can provide comfort and healing in the most complex of encounters - to the geriatric patient in acute crisis. Join Dr. Liz Goldberg in this Mayo Clinic Emergency Medicine Grand Rounds, titled, The 5 Traits of Exceptional People & How to Use Them to Master the Geriatric Patient Encounter, to learn how to adopt and further develop these five traits through case studies in geriatric emergency medicine.

 

Upon conclusion of this activity participants should be able to:

- List the five traits of exceptional individuals

- Discuss strategies to improve care for geriatric patients in the ED

- Recognize ways to grow your impact through scholarship

 

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @LizGoldbergMD

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @LizGoldbergMD

EMAIL - AlwaysOnEM@gmail.com

Chapter 14 - Urine the know - Dialysis, Renal Failure and more

Alex and Venk sit down with Dr. Jim Gregoire, Mayo Clinic Nephrology, to talk through a variety of emergency nephrology topics. We talk through dialysis related issues including the different types of peritoneal dialysis and their complications. Following that we talk through acute kidney injury with a focus on how we should approach this as emergency practitioners. Finally, we talk through some electrolyte issues that are not commonly discussed in our specialty.

Grand Rounds - Dr. Sergey Motov - Acute Pain Management in the ED

Dr. Sergey Motov, gave this presentation on acute pain management to the Mayo EM Grand Rounds audience in the fall of 2022.

Pain is the most common reason for people to seek care in the Emergency Department. The current laws and regulations have significantly affected ED Clinician’s ability to provide effective, efficient and safe pain relief by worsening opiophobia, by repurposing non-analgesic medications for pain control and by proliferation of dangerous drug-drug combinations. This talks is set to discuss the current state of ED analgesia when it comes to acute pain management with a primary focus on what works and what does not.

 

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @PainFreeED

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

Chapter 13 - Can’t Breathe Without You - Angioedema and Awake Tracheal Intubation

Dr. Ben Sandefur, Emergency Medicine attending at Mayo Clinic, joins Alex and Venk on the podcast to talk about angioedema and awake tracheal intubation. He reviews the different types of angioedema in a format designed to assist the emergency department practitioner with decision making and prognostication. This is followed by a description of how to prepare for and lead a team and patient through awake tracheal intubation using fiberoptic and video laryngoscopy techniques.

 

Contacts

TWITTER - @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

References

1. Rosenbaum S, Wilkerson RG, Winters ME, Vilke GM, Wu MYC. Clinical Practice Statement: What is the Emergency Department Management of Patients with Angioedema Secondary to an ACE-Inhibitor? J Emerg Med. 2021 Jul;61(1):105-112 [from the American Academy of Emergency Medicine] https://pubmed.ncbi.nlm.nih.gov/34006418/
2. Moellman JJ, Bernstein JA, et al. A consensus parameter for the evaluation and management of angioedema in the emergency department. Acad Emerg Med. 2014 Apr;21(4):469-84 [from the American College of Allergy, Asthma & Immunology (ACAAI) and the Society for Academic Emergency Medicine (SAEM)] https://pubmed.ncbi.nlm.nih.gov/24730413/
3. Carrillo-Martin I, Gonzalez-Estrada A, Funni SA, Sandefur BJ, Jeffery MM, Campbell RL. Angioedema - related emergency department visits in the United States: Epidemiology and time trends, 2006-2015. J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2442-2444. https://pubmed.ncbi.nlm.nih.gov/32302784/
4. Ishoo E, Shah UK, Grillone GA, Stram JR, Fuleihan NS. Predicting airway risk in angioedema: staging system based on presentation. Otolaryngol Head Neck Surg. 1999 Sep;121(3):263-8 https://pubmed.ncbi.nlm.nih.gov/10471868/
5. Arthur J, Caro D, Topp S, Chadwick S, Driver B, Henson M, Norse A, Spencer H, Godwin SA, Guirgis F. Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema. Am J Emerg Med. 2022 Oct 19;63:44-49 https://pubmed.ncbi.nlm.nih.gov/36327748/
6. Sandefur BJ, Liu XW, Kaji AH, Campbell RL, Driver BE, Walls RM, Carlson JN, Brown CA. Emergency Department Intubations in Patients with Angioedema: A Report from the National Emergency Airway Registry. J Emerg Med. 2021 Nov;61(5):481-488 https://pubmed.ncbi.nlm.nih.gov/34479750/
7. Sandefur BJ, Oliveira Silva L, Lohse CM, Goyal KA, Barbara DW, Castaneda-Guarderas A, Liu XW, Campbell RL. Clinical features and outcomes associated with angioedema in the emergency department. West J Emerg Med. 2019 Aug 6;20(5):760-769 https://pubmed.ncbi.nlm.nih.gov/31539333/

Additional Resources

1. Wilkerson RG, Moellman JJ. Hereditary Angioedema. Emerg Med Clin North Am. 2022 Feb;40(1):99-118 https://pubmed.ncbi.nlm.nih.gov/34782094/
2. Wilkerson RG, Winters ME. Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema. Emerg Med Clin North Am. 2022 Feb;40(1):79-98 https://pubmed.ncbi.nlm.nih.gov/34782093/

 

Grand Rounds - Dr. Victor Montori - On Care

This is a recording of Dr. Victor Montori's grand rounds presentation to Mayo Clinic Emergency Medicine challenging us to rethink the care we provide to our patients and the community as a whole. 

 

He will be discussing the movement toward careful and kind care he calls the Patient Revolution. This movement seeks to turn away from industrialized healthcare – a form of healthcare in which the care of patients is a means to an end, in which patients are processed, and in which cruelty happens routinely and care by happy accident. He challenges us to turn toward careful and kind care. Careful care is unhurried, evidence-based, safe, and sensible. It is responsive to the needs and situation of this patient rather than patients like this. Careful care, as he describes, requires that clinicians see patients in high definition, notice their problems in their biology and biography, and respond with compassion and competence by co-creating plans of care that make intellectual, emotional and practical sense to each patient. Kind care recognizes each patient as a fellow human, one of us rather than one of them. It calls for minimizing the demands healthcare makes on patients’ scarce time, energy, and attention which patients rather use to fulfill their obligations, pursue their loves, and flourish. Based on solidarity and love, health care must support the work of people who come together to give and receive care. Beyond healthcare, we need to advocate for common care and for the care of our environment. He is challenging us to create a movement for care.

 

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @VMontori

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

 

References:

1. Why we revolt, authored by Dr. Victor Montori, published October 2017

2. www.PatientRevolution.org, organization cofounded by Dr. Victor Montori

 

Chapter 12 - A lion, a House, and the mystery - Lupus and the ED

Dr. Uma Thanarajasingam, Rheumatology attending at Mayo Clinic, joins Alex and Venk on the podcast to talk about how to approach patients with symptoms that span multiple organ systems and we are considering Lupus or when the patient has known Lupus when they present. We talk about Catastrophic Antiphospholipid antibody syndrome, immunochemistry and much more!

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

Grand Rounds - Dr. Brian Patterson - Predictive analytics to prevent falls after ED visits

SPEAKER: Brian Patterson, MD, University of Wisconsin

He discusses the experience at UW conceiving, designing, and implementing a program, which incorporates a machine-learning algorithm for real-time calculation of fall risk for all older adults who visit the ED. The talk will include the rationale for using automation to improve public health referrals from the ED, techniques used to create the intervention, and issues surrounding the design and governance of similar interventions.

 

TWITTER @BPatterson; @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM @AlwaysOnEM

EMAIL AlwaysOnEM@Gmail.com