Emergency Care BC

In this episode of End of Shift, Eric and Joe continue their discussion with Dr. Shannon Jackson, talking about blood types and donation as well as sickle cell disorders. ONCE AGAIN, call 604-682-2344 (St. Paul’s Hospital) and you can reach a hematologist 24/7. Most hospitals carry: pRBC, FFP, platelets and cryo. The Canadian Blood Services knows where all the products are, and the central transfusion registry in BC circulates products to areas of need and does so with minimal wastage. FFP is made from plasma which is separated from donor blood and frozen to minus 35°C to preserve it. Cryoprecipitate (cryo) is made from FFP which is frozen and repeatedly thawed in a laboratory to produce a source of concentrated clotting factors including Factor VIII, Factor XIII, von Willebrand factor and fibrinogen. FFP can reverse the effect of warfarin because it contains substantial levels of vitamin K dependent clotting factors (II, VII, IX, X and protein C/S). FFP is indicated when a patient has MULTIPLE factor deficiencies and is BLEEDING. Cryoprecipitate is indicated for the treatment of acquired fibrinogen deficiency or dysfibrinogenaemia, due to critical bleeding, an invasive procedure, trauma or disseminated intravascular coagulation (DIC). It’s not ideal for specific factor replacement. If you have no factor available, you can use FFP/cryo. DONATE DONATE DONATE! There is never too much blood – donated blood can also be used for non-clinical research. You can donate every 8 weeks! There are very few exclusions to donating. Go to Canadian Blood Services - www.blood.ca - to book your donation. Dr. Shannon Jackson is a clinical hematologist and the medical director of the Provincial Adult Bleeding Disorder program based out of St. Paul’s Hospital in Vancouver. Related Clinical Resource: Treatment of Persons with Inherited Bleeding Disorders (PwIBD) in the Emergency Room by Dr. Shannon Jackson, Michelle Bech

The older ED crowd will remember this classic Supertramp track from the 1974 album, Crime of the Century. It's our springboard to talk about bleeding disorders. Dr Shannon Jackson is a clinical hematologist and the medical director of the Provincial Adult Bleeding Disorder program based out of St. Paul’s Hospital in Vancouver. The program deals primarily with inherited bleeding disorders: Factor (VIII and IX) deficiencies, von Willebrand disorder, platelet disorders and undefined bleeding disorders. This is episode 1 of 2 with Dr. Shannon Jackson. Factor VIII or IX deficiency: Von Willebrand disorder: FEARED bleeds are intracranial, GIB, iliopsoas, vaginal, medial forearm, anterior calf Patients are usually very well informed - perhaps more than you. They carry Factor First cards, identifying their disease, appropriate doses of factor for treatment and thankfully – the contact information for the on-call hematologist. Steps in the ED? Reverse order! Tranexamic acid also a useful adjunct – UNLESS gross hematuria (can trigger renal and ureteric concretions) Related Clinical Resource: Treatment of Persons with Inherited Bleeding Disorders (PwIBD) in the Emergency Room

Conventional medical school and residency curricula glossed over nutrition for patients and certainly made no mention of how to look after oneself on shift. Eric and Karine discuss the roles that caffeine, hydration and nutrition play when working in emergency medicine. They look at some good and not-so-great strategies and provide some advice for shift performance enhancement. Coffee: Caffeine is the most widely consumed CNS stimulant, and coffee is the world's 3rd most popular beverage. If you drink coffee, you can probably do stupid things faster and with more energy but ... Seriously, caffeine has beneficial effects on reaction time, vigilance, and attention, but there is less to suggest that it improves decision making and problem solving. coffee nap: Hydration: Nutrition:

End of Shift went on the road in late 2021 to catch up with Dr. David Pledger. David practiced in both Las Vegas and Vancouver before settling in Nevada. He fills us in on the interesting differences between US and Canadian emergency care and comments about how COVID impacted his adopted state and British Columbia.

In this episode of End of Shift, Eric and Joe talk with Dr. Carolyn Kelly-Smith about the practice of medicine (and sometimes not) in austere environments. Dr. Kelly-Smith is an FRCP trained attending ED physician at the Royal Columbian and Eagle Ridge Hospitals. She is an Advanced Medical Provider for North Shore Rescue, a faculty member of the Canadian Society of Mountain Medicine and a ski patroller at Whistler/Blackcomb. Why should you care about wilderness medicine? There are many reasons – from going where the action is (increasingly outdoors) to expanding your clinical horizons by stretching your comfort zone. We examine the utility of having a physician involved in outdoor settings, be it reasonably controlled settings like a ski resort, or a complicated rescue operation with failing daylight and minimal clinical details. It’s not all Mission: Impossible style heroics – sometimes the most useful clinical actions and decisions are simpler than you might think. How to get involved? We’ll tell you. You’ll learn about the North Shore Rescue Society and the Canadian Society of Mountain Medicine – and maybe get fired up to get out there! Resources: Search and Rescue: North ShoreCanadian Society of Mountain Medicine

Management of ED trauma cases has transformed over the past 20 years. Our guest, Dr. Hazel Park, discusses new and emerging pearls, trauma systems, training, and virtual support for BC trauma management. Dr. Hazel Park Dr. Hazel Park is an attending emergency physician and Trauma Team Leader at Lions Gate Hospital, Medical Director of the Regional Trauma Program for Vancouver Coastal Health and Providence Health Care. She is a Clinical Associate Professor at UBC. Dr. Park completed her training and family practice residency at the University of Toronto and worked at the emergency department of the Wellesley Hospital in Toronto. She currently volunteers as a ski patrol physician and is an advanced medical provider for the Vancouver North Shore Rescue. Resources BC Emergency Medicine Network - Trauma Management Clinical ResourcesReal-Time Virtual Support in BCInformation on Trauma CoursesEnd of Shift Hosts Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His nonmedical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

In this quick review, Dr. Julian Marsden and Dr. Rob Stenstrom discuss updates in sepsis management, research, and the latest diagnostic guidelines for the emergency department (ED). Dr. Stenstrom shares up-to-date guidance on the use of steroids, fluids, vasopressors, and antibiotics to treat sepsis in the ED. Dr. Rob Stenstrom Rob Stenstrom is an emergency physician and senior researcher at St. Paul's Hospital in Vancouver, BC. He also holds a Ph.D. in Epidemiology and Biostatistics from McGill University. He is the Sepsis and Soft Tissue Infections Research Lead for the BC Emergency Medicine Network. Resources World Sepsis Day Events & WebinarsBC Emergency Medicine Network Sepsis ResourcesEmergency Department Surviving Sepsis GuidelinesBC COVID-19 Therapeutics Committee GuidelinesRob StenstromSepsis and Soft Tissue InfectionsDavid Sweet, Clinical Supports RUDiROSeBC Bedline Host Dr. Julian Marsden Julian Marsden leads the development of the Clinical Resource Program for the BC Emergency Medicine Network. He has been an emergency physician for 27 years and currently works in the emergency departments of St Paul’s, Mount Saint Joseph’s, and Vancouver General Hospital. Julian has a strong interest in knowledge translation and quality improvement. Disclaimer: The views and opinions expressed in this podcast are those of the authors and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network. Learn more at bcemn.ca

In this in-depth review, Dr. Julian Marsden talks to EM Network member Dr. David Barbic, who gives an overview of his recently published article, Rapid Agitation Control with Ketamine in the Emergency Department: A Blinded, Randomized Controlled Trial. The study was published in the Annals of Emergency Medicine online, on Aug. 2nd, 2021. David walks through an in-depth look at the study setup and limitations, key take-home points, how the findings can be interpreted in rural EDs, and implications for emergency nurses and pre-hospital settings. Dr. David Barbic Dr. David Barbic is an emergency physician at St. Paul’s Hospital in Vancouver, BC. He is also a Clinician Scientist at the Centre for Health Evaluation & Outcome Sciences (CHÉOS). David’s particular clinical interest is in patients presenting to the ED with mental health and substances issues and traditionally underserved patient populations. Dr. Julian Marsden Julian Marsden leads the development of the Clinical Resource Program for the BC Emergency Medicine Network. He has been an emergency physician for 27 years and currently works in the emergency departments of St Paul’s, Mount Saint Joseph’s, and Vancouver General Hospital. Julian has a strong interest in knowledge translation and quality improvement. Disclaimer: The views and opinions expressed in this podcast are those of the authors and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

In this quick review, Dr. Julian Marsden talks to EM Network member Dr. David Barbic, who gives an overview of his recently published article, Rapid Agitation Control with Ketamine in the Emergency Department: A Blinded, Randomized Controlled Trial. The study was published in the Annals of Emergency Medicine online, on Aug. 2nd, 2021. David walks through his motivation for the research, the study set up, key take-home points, and how the findings can be interpreted in rural EDs. Listen to the extended version (26 mins): A more in-depth look at the study. Dr. David BarbicDr. David Barbic is an emergency physician at St. Paul’s Hospital in Vancouver, BC. He is also a Clinician Scientist at the Centre for Health Evaluation & Outcome Sciences (CHÉOS). David’s particular clinical interest is in patients presenting to the ED with mental health and substances issues and traditionally underserved patient populations. Dr. Julian MarsdenJulian Marsden leads the development of the Clinical Resource Program for the BC Emergency Medicine Network. He has been an emergency physician for 27 years and currently works in the emergency departments of St Paul’s, Mount Saint Joseph’s, and Vancouver General Hospital. Julian has a strong interest in knowledge translation and quality improvement. Learn more at bcemn.ca Disclaimer: The views and opinions expressed in this podcast are those of the authors and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

Guest Jeanne MacLeod guides us through the history, process, tips and downfalls of practicing emergency medicine simulation. Listen for some strategies to improve your next SIM! We delve into why it took emergency medicine so long to adopt SIM training, process and teamwork, why some resuscitations go awry, SIM-related anxiety, rural leadership, and available BC simulation resources. Jeanne MacLeod Jeanne is the Simulation Co-Lead for the BC Emergency Medicine Network. She’s an Emergency Physician at St. Paul’s and Mt. St. Joseph’s Hospital and the North Shore Urgent Primary Care Clinic in Vancouver, BC. She is a Clinical Associate Professor at the University of British Columbia. Resources BC EM Network Emergency SIM CasesBC Simulation NetworkEM SIM casesReal-Time Virtual Support in BCUBC CPD Real-Time Virtual Support Education (RTVS)End of Shift Hosts Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His non-medical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer End of Shift podcast discussions may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

What are the most common disciplinary issues among physicians who practice emergency care? How are these issues handled, and how can YOU avoid getting into trouble? Bruce Campana walks us through the art of disciplining physicians. Bruce is currently the Medical Director of Enhanced Medical Staff Support (EMSS) at Vancouver Island Health Authority. EMSS supports medical leaders who are asked to attend to issues of medical staff professionalism. Bruce also describes his early career experience working under legends in emergency medicine, like the Dr. Rosen. From there, his career path led him to Saudi Arabia, where he was the Saudi King’s private physician and hacked into a plane’s oxygen supply to treat the Amir of Kuwait while in the air. His storied career led him to his current position at EMSS, where he emphasizes an empathic approach to bullying, challenging relationships, and mental health issues, among other disciplinary problems faced by emergency physicians. Bruce is an attending emergency physician at Victoria General Hospital, Clinical Associate Professor at the UBC Dept of Emergency Medicine, Medical Director for Enhanced Medical Staff Support for the Vancouver Island Health Authority. He also practices hyperbaric medicine at Vancouver General Hospital. Bruce complete medical school training at McGill University, came out west to intern at St. Pauls’ Hospital in Vancouver and completed his medical residency in Denver, Colorado. He is a frequent keynote speaker at emergency medicine conferences. Resources Enhanced Medical Staff Support (EMSS), Vancouver Island Health Authority End of Shift Hosts Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His non-medical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer End of Shift podcast discussions may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

In this episode, we cover all things POCUS (point-of-care-ultrasound) in emergency care. Guest Karine Badra-Quirion, an emergency physician at Lions Gate and St. Paul's Hospital, imparts her POCUS prowess. We discuss BC's POCUS pioneers and the best studies for patient-oriented outcomes and ED flow. Karine shares image generation techniques, common errors, and her top POCUS tips. We explore ultrasounds VS CT scan and potential diagnoses, POCUS for trauma, and rural practitioner support. Plus, Karine takes the reappointment quiz! Karine Badra-Quirion Karine Badra-Quirion is an emergency physician at Lions Gate Hospital in North Vancouver and St. Paul’s Hospital in Vancouver, Related Resources PoCUS Resources on BC Emergency Medicine Network Real-Time Virtual Support in BCLearn more End of Shift Hosts Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His nonmedical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

Show Notes In this episode we talk to Louise Pick, an emergency bedside and charge nurse at Lions Gate Hospital in North Vancouver. We explore the dynamic between emergency physicians and nurses, and reflect on the unique challenges ED nurses face. Plus, Louise shares a harrowing story of being buried alive by an avalanche, and how her ED team mate saved her. Louise Pick Louise Pick is an emergency nurse with over a decade of experience in busy EDs. She skied competitively early on but stepped away from the podium to train in nursing at McGill University. She started practising at Montreal General Hospital, then moved out west to chase the mountains. She has worked at Lions Gate Hospital in North Vancouver ever since and recently became a Patient Care Coordinator. Related Resources Understanding the factors which promote registered nurses’ intent to stay in emergency and critical care areasMary Van OschEM Network Patient Information SheetsEnd of Shift Hosts Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His nonmedical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network, or the Vancouver Coastal Health Authority.

In this episode, Eric and Joe speak to Dr. David Haughton, a life-long artist and leader in his field. David practiced pediatric emergency medicine at BC Children’s Hospital until 2017 and has been painting prolifically for over 40 years. David shares the lessons learned from his storied career, including navigating medical politics and how to balance occupation, obligations, and the pursuit of happiness. He has now retired to pursue painting full time, but would Eric and Joe welcome him back into the fold? Find out if he passes the End of Shift locum quiz. David Haughton David Haughton received his undergraduate degree at Harvard University. He trained at Cornell Medical College in NYC, and Children’s Hospital of Los Angeles before moving to BC in 1991. He worked at the BC Children’s Hospital for 25 years and headed the BC Section of Emergency Medicine for 11 years. In October 2017, David worked his last night shift and gave up his medical licensure to pursue painting full time. David has been an artist for nearly all his life. He has been sketching and drawing, painting and scumbling for over 40 years. His home studio is in New Westminster, but he has travelled to Tuscany and Tofino to find inspiration for his creations. Visit https://www.haughton-art.ca to find out more about his work. The BC Emergency Medicine Network is a community of physicians who practice emergency care in British Columbia, Canada. Visit http://bcemn.ca for clinical resources, real-time virtual support, continuing professional training, and EM innovation. Podcast Hosts The End of Shift Podcast is hosted by EM Network members Eric Angus and Joe Haegert. Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His non-medical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

In the emergency department, we see many injured and infected hands and need to be comfortable with initial diagnosis and treatment before considering downstream follow up with a hand surgeon. Hosts Eric and Joe discuss common hand presentations, workup, and treatment with Dr. James Saunders, Head of Plastic Surgery for the Sea to Sky Corridor. They review fractures, dislocations, amputations, infections, and injuries in the ED. James advises on the best finger to get chopped off in a hostage-taking scenario, and Joe has two practice-changing, “a-ha” moments. Plus, three ways hand injuries are mismanaged in the ED. End of Shift Hosts Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His nonmedical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

In this episode, Eric and Joe do a deep dive on sepsis with Dr. Rob Stenstrom, Sepsis and Infections Lead for the EM Network. They discuss the most practical definition of sepsis in the ED and which diagnostic score to use. They find the bottom line on serum lactate, fluid treatment, and blood cultures and antibiotic timing. Rob answers questions on which pressor to use, central access timing, and the status of novel therapies. Plus, is there a genetic predisposition to developing sepsis? Sepsis Stats Related links Sepsis and Septic Shock – DiagnosisSepsis with Hypotension and Septic Shock – TreatmentSepsis without Hypotension – TreatmentPediatric Septic Shock ManagementEM Network Sepsis and Soft Tissue Infections Research ProgramEnd of Shift Hosts Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His nonmedical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

Daniel Kalla - danielkalla.com Additional reading Daniel Kalla PandemicResistanceBlood LiesWe All Fall DownThe Last HighStephen King On Writing: A Memoir of the CraftMichael Crichton michaelcrichton.com Resources for Emergency Care Practitioners Oral Opioid Analgesic Conversion TableBuprenorphine (Suboxone) Initiation for Opioid Use Disorder Patients Opioid Overdoses – ManagementSuboxone Take Home (Buprenorphine-Naloxone) Patient Information SheetConflict of Interest Statements Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

In this episode of the End of Shift podcast, recorded on Jan. 7, 2020, Eric and Joe talk to Jim Christenson, Executive Lead of the BC Emergency Medicine Network. They discuss highlights from Jim's 40-year career practicing emergency medicine and talk about why he started the BC Emergency Medicine Network. Jim shares his lessons on how to stay well and avoid burn out. Plus, find out whether Eric would hire him as locum! Jim Christenson Jim is an emergency physician, and professor and head of the Academic Department of Emergency Medicine at UBC. Jim’s primary research interest is in resuscitation. He is a co-principal investigator for the Canadian Resuscitation Outcomes Consortium (CanROC) and has been involved in various aspects of cardiac arrest and trauma research for 25 years. Currently, he is leading a groundbreaking prehospital stroke study. Committed to improving emergency care across BC, Jim is proud to provide leadership to the BC Emergency Medicine Network that is solely focused on supporting physicians in emergency departments. Two EM Network projects mentioned in the interview have progressed significantly since the date of the recording on Jan. 7, 2020. Find out more by clicking the links below: Kwiis hen nep: project to improve emergency care for remote Indigenous communities in BC View the December 2019 UBC Emergency Medicine Rounds.The project continues despite the challenges posed by the COVID-19 pandemic.Real-Time Virtual Support Project Real-Time Virtual SupportEnd of Shift Hosts Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His nonmedical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

The warrior philosophy addresses doubts and fears EM caregivers experience day-to-day as they work on the front lines. Hosts Eric Angus and Joe Haegert discuss the five concepts of warriorship: observation, acceptance, focus, intention, and commitment. They explore how this philosophy can help you mentally prepare for your shift, focusing on competence, confidence, courtesy, calm, and compassion. They also discuss how to close your shift, focusing on mental wellness (including the After Shift Martini Protocol). They also touch on the profound fears, physical risk, and emotional impact front-line healthcare workers are experiencing in the midst of the COVID-19 pandemic. Additional reading Dan Millman - Way of the Peaceful Warrior, 1980Arno Ilgner - The Rock Warrior's Way, 2003Additional listening EM Cases Ep 134 - Shift Preparation: Pre-gamingEnd of Shift Hosts Eric Angus Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His nonmedical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies. Joe Haegert Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables. Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

In the inaugural episode of the End of Shift podcast, Dr. Brian Yang, Head of Urology for the Fraser Health Authority, answers burning questions about managing renal colic in the ED. What cases does he want a call about in the middle of the night? Does the presentation of proximal stones differ from the presentation of distal stones? What's the recommended imaging and management for renal colic? What does he recommend in cases of urinary retention? What are the best practices for difficult catheterization? Disclaimer The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.