Great review of the paper regarding brain bleeding and blood pressure goals but I have to disagree with the conclusion regarding the significance of the study. Unfortunately the authors' endpoint was too vague for my tastes. It would be akin to looking at mortality in STEMI patients but not paying attention to their ejection fraction, incidence of heart failure, an overall quality of life if they survived. Since stroke patients can have such a wide range of long-term disabilities and severities of disabilities, the paper would have been more useful clinically had they trended the NIHSS or a similar functional outcome rather than morality or "serious disability".
Thank you for starting the conversation about our loss of meaning in emergency medicine. There is no doubt that we have loss our direction and the reason for doing the difficult work that we do. But the cure for fatigue is whole heartedness. Restoring meaning one patient at a time by knowing that what do matters is one of the ways forward from a place of disengagement and burnout. Another tool is three good things. It's worth a look to counteract our human nature of holding on to the negative by remembering the positive and has similar outcomes to Prozac in the short term.
I just wanted to thank you for the Intro section on accepting praise. I got to be honest. When I first started hearing it, I had the inner monolog of "I'm mentally tough. I don't need to take time out of my shift to pat myself on the back by listening to positive patient feedback. That isn't going to make me a faster/better ED resident."
Then on my next shift on a long string where I am feeling a little taxed as a end-of-the-2nd-year resident, I had a really mentally and physically taxing case of a 6 year old with a crush injury by cow with a tracheal laceration in a small rural Oregon hospital. The patient was stabilized and airlifted and the distraught parents said a quick thank you with tears in their eyes as they were rushed to the awaiting helicopter. The patient and his family ended up going to my home institution and thinking of this segment as well as wanting to see how he was doing I went to visit them the following day. The parents then opened up to me on how terrified they were and appreciative of what we did the previous night.
This has left me with an afterglow for over a month now and re-invigorated me. Thank you for putting a breath of fresh air into my practice and I hope this will encourage others to have these interactions with their patients.
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Bad Bleeds in the Brain and PelvisFull episode audio for MD edition243:12 min - 339 MB - M4AEM:RAP 2017 February Australian EditionAustralian17:35 min - 24 MB - MP3EM:RAP 2017 February Canadian EditionCanadian18:09 min - 25 MB - MP3EM:RAP 2017 February Spanish EditionEspañol81:17 min - 112 MB - MP3EM:RAP 2017 February German EditionDeutsche68:14 min - 78 MB - MP3EM:RAP 2017 February French EditionFrançais28:00 min - 39 MB - MP3EM:RAP 2017 February Board Review Answers191 KB - PDFEM:RAP 2017 February Board Review Questions184 KB - PDFEM:RAP 2017 February Separate MP3 Files323 MB - ZIPEM:RAP 2017 February Spanish Written Summary1 MB - PDFEM:RAP 2017 February Written Summary971 KB - PDF
Emily J. - February 7, 2017 8:58 AM
You mentioned an RN RAP, where can I find this for my RN friends?
Tracy G. - February 8, 2017 3:14 PM
Hi Emily! Here is a link to our YouTube channel where your friends can watch a video explaining how to subscribe to the EM:RAP RN Edition.
https://youtu.be/NwenIpCyzuI
James C. - February 24, 2017 8:20 AM
Great review of the paper regarding brain bleeding and blood pressure goals but I have to disagree with the conclusion regarding the significance of the study. Unfortunately the authors' endpoint was too vague for my tastes. It would be akin to looking at mortality in STEMI patients but not paying attention to their ejection fraction, incidence of heart failure, an overall quality of life if they survived. Since stroke patients can have such a wide range of long-term disabilities and severities of disabilities, the paper would have been more useful clinically had they trended the NIHSS or a similar functional outcome rather than morality or "serious disability".
Robert L. - March 17, 2017 10:06 AM
Thank you for starting the conversation about our loss of meaning in emergency medicine. There is no doubt that we have loss our direction and the reason for doing the difficult work that we do. But the cure for fatigue is whole heartedness. Restoring meaning one patient at a time by knowing that what do matters is one of the ways forward from a place of disengagement and burnout. Another tool is three good things. It's worth a look to counteract our human nature of holding on to the negative by remembering the positive and has similar outcomes to Prozac in the short term.
Jeff - March 29, 2017 5:26 AM
Thanks for covering that article on likelihood ratios. That is the best description I've ever heard!
Alex S. - April 15, 2017 12:04 PM
Rob and Swami,
I just wanted to thank you for the Intro section on accepting praise. I got to be honest. When I first started hearing it, I had the inner monolog of "I'm mentally tough. I don't need to take time out of my shift to pat myself on the back by listening to positive patient feedback. That isn't going to make me a faster/better ED resident."
Then on my next shift on a long string where I am feeling a little taxed as a end-of-the-2nd-year resident, I had a really mentally and physically taxing case of a 6 year old with a crush injury by cow with a tracheal laceration in a small rural Oregon hospital. The patient was stabilized and airlifted and the distraught parents said a quick thank you with tears in their eyes as they were rushed to the awaiting helicopter. The patient and his family ended up going to my home institution and thinking of this segment as well as wanting to see how he was doing I went to visit them the following day. The parents then opened up to me on how terrified they were and appreciative of what we did the previous night.
This has left me with an afterglow for over a month now and re-invigorated me. Thank you for putting a breath of fresh air into my practice and I hope this will encourage others to have these interactions with their patients.