Always On EM - Mayo Clinic Emergency Medicine

Whether or not emergency physicians believe that patients with thoughts of self-harm belong in the ED, they are coming to your ED anyway. According to the Centers for Disease Control, ED visit rates for nonfatal self-harm increased 42% among persons 10 years or older, and visits for suicidal ideation, self-directed violence, or both increased 25.5% from 2017-2018. That’s an increase of more than 1% per month pre-COVID. This solutions-oriented talk will discuss some of the science behind suicide prevention in the ED, and will present techniques that you can use to reduce risk in your ED. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com

Dr. Suraj Yalamuri, Mayo Clinic Anesthesiology Critical Care and Cardiovascular Medicine Consultant, joins Alex and Finch to talk about the fundamentals of ECMO and ECPR. This is a great way to get caught up on this emerging science so that you'll be ready to provide the best resuscitative care for your patients when your system is ready too.

Dr. Leff shares, in her senior resident capstone presentation, a primer on humanitarian efforts, what are basic principles of aid, how to identify the key health needs of populations affected by crises and how EM clinicians can respond to those needs with the greatest impact. She will discuss how to engage responsibly and to anticipate how humanitarianism will develop and adapt in the future to improve responsiveness.

Dr. Mike Olson, former EM PA and now ENT attending sits down to talk about epistaxis with Alex and Venk. We go through a pragmatic approach to epistaxis, discuss some nuance cases including telangiectasia, hypertension, and anticoagulation. interventions are key, what patients are most likely to suffer a bad outcome and more. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS

Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. This is the second part of the two part series. Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. We review the PROCESS, PROMISE, and ARISE trials and provide pragmatic approach to your septic patients. So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Intravascular volume assessment Chest radiography paper referenced Albumin Unbundling studies Vitamin C

Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS SOFA Score: qSOFA score Comparing Prognostic scores IDSA concern About Barcelona Declaration 1- hour surviving sepsis bundle guidance Early Goal Directed Therapy SEP - 1 Quality Measure https://www.qualityforum.org/Projects/i-m/Infectious_Disease_Endorsement_Maintenance_2012/0500.aspxhttps://www.qualityforum.org/NQF_Revises_Sepsis_Measure.aspx Affordable care act https://www.govinfo.gov/app/details/STATUTE-124/STATUTE-124-Pg119/summary Fluids for sepsis in concerning populations WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

In this chapter, Dr. Dougie Moss, final year EM resident presents his Capstone presentation on best charting practices to match reimbursement to the care we deliver. Take a listen to better understand the new billing expectations of our documentation. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com

Alex and Venk talk through a previous case where they care for a young person with meningococcemia on a night shift. We review the disease, what to watch for, how to treat it, and go over some of the residue after being part of a case like this. We also review some of the considerations regarding ECMO for severe sepsis. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

It is no surprise that outcomes are poor for patients who already meet one definition for 'death' even before the point of their first medical contact. But for nearly half of certain patients with out-of-hospital cardiac arrest, good neurologic outcomes can be achieved. And while patients with in-hospital cardiac arrest are also very likely to suffer a poor outcome, there is some reason to believe that some out-of-hospital cardiac arrest patients might have a better chance of survival. During this discussion, we will discuss why this might be, while also challenging assumptions about topics including epinephrine, airway management, and the risks and benefits of transporting patients in cardiac arrest. We will also look to future directions in cardiac arrest management. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com

This chapter we talk with Dr. Henry Schiller, trauma surgeon and professor of surgery at Mayo Clinic, about a variety of hematomas including Morel Lavellee lesions, retroperitoneal hematomas, rectus sheath and more! Alex even gets to ask a question about REBOA that he has been hoping to do for a long time. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS

In this episode, Dr. Heather Murray, from Queen's University Department of Emergency Medicine presents the landscape of diagnostic errors in emergency medicine from the perspective of why they might occur, what can be done when they happen, and how we might minimize them in the future. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES ARHQ report and responses: https://effectivehealthcare.ahrq.gov/sites/default/files/related_files/cer-258-diagnostic-errors.pdfMulti-Organizational Letter Regarding AHRQ Report on Diagnostic Errors in the Emergency Department December 14, 2022https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121120/pdf/ms120_p0114.pdfMisdiagnosis in the Emergency Department: Time for a System Solution | Health Care Safety | JAMA Recovering from error: Second Victims: Support for Clinicians Involved in Errors and Adverse Events | PSNetHow Do Providers Recover From Errors? | PSNetSupporting Clinicians after Adverse Events: Development of a Clinician Peer Support Program - PMCCaring for our own: deploying a systemwide second victim rapid response team General resources on Diagnostic Error: Characteristics of Disease-Specific and Generic Diagnostic Pitfalls: A Qualitative Study | Health Policy | JAMA Network Openhttps://asmepublications.onlinelibrary.wiley.com/doi/full/10.1111/medu.13872The Path to Improve Diagnosis and Reduce Diagnostic Error Cognitive biases: Cognitive Bias and Diagnostic Errors among Physicians in Japan: A Self-Reflection SurveyAnchoring Bias With Critical Implications | PSNet"Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance"Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance | PLOS ONE Better teams in EM: Psychological safety and emergency department team performance: A mixed‐methods study - PurdyEnhancing the Quality of Morbidity and Mortality Rounds: The Ottawa M&M Model - Calder - 2014 - Academic Emergency Medicine - Wiley Online Library Selected references for artificial intelligence in medicine: Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum | Health Informatics | JAMA Internal MedicineIs Medicine Ready for AI? — ITT Episode 6 | NEJMArtificial Intelligence for the Prediction of In-Hospital Clinical Deterioration: A Systematic Review - PMCBenefits, Limits, and Risks of GPT-4 as an AI Chatbot for Medicine | NEJM

Neonatal fever can raise the temperature of the entire clinical pod along with the baby, but it doesnt have to. Join as Dr. Meghan Cain, chair of the division of pediatric and adolescent emergency medicine at Mayo Clinic, talks through the nuances of evaluating fever concerns in neonates of different ages and risk profiles and empowers you to be cool as a cucumber in these situations. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS

So many people come to emergency departments with unexplained recurrent pains, fatigues, gastrointestinal symptoms and more - when there seems like no way we can help them, Dr. Mohabbat offers us some insight into what might be happening and how we can help be a positive experience in these patient's and family's lives. Listen to this grand rounds on Central Sensitization and be a better doctor for this large segment of the population. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com

Dr. Katie Young, co-director of the cardioobstetrics clinic here at Mayo Clinic sits down to talk about peripartum cardiomyopathy. This is something we will likely consider many times in our careers for patients with shortness of breath in and around late pregnancy. Find out what interventions are key, what patients are most likely to suffer a bad outcome and more. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS

In this chapter, Dr. Alex Niven, renowned critical care physician and educator, provides a mirror for us to see our current state of emergency airway management - for its opportunities for improvement, innovations and best practices. This evidence fueled presentation is a must-listen for any emergency healthcare physician or provider. CONTACTS Youtube -https://www.youtube.com/@AlwaysonEM X - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com

Dr. Nayantara Coelho-Prabhu, Mayo Clinic gastroenterologist specializing in the care of patients with gastrointestinal bleeding and endoscopy, talks through many aspects of acute GI bleeding. She helps to clarify the prioritization of medications, when to incorporate imaging, broadens our differentials for upper and lower GI bleeding, gives mindblowing advice on stool guiac testing and SO much more in this over-stuffed (or should we say constipated) chapter of Always on EM. There is also a special cameo from Dr. Luke Wood going over how to insert a Minnesota tube (esophageal balloon tamponade device)! CONTACTS X - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com RECOMMENDATION: https://youtu.be/tzJQDen1nug?si=zOmywZ1VN3VvA004 REFERENCES:

Is healthcare more like an airplane, a flock of birds, or a mayonnaise? Why does it matter? In this talk, Dr. McNamara, emergency physician and patient safety champion, explores the question through the story of how she found herself at the intersection of complexity theory, safety science, and emergency medicine. She will discuss multiple perspectives on safety science, including specific strategies for clinicians to apply in their daily practice to survive amidst the complexity. CONTACTS X (formerly Twitter) - @AlwaysOnEM; @VenkBellamkonda; @ShannonOMac Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com

Drs. Alex Finch and Venk Bellamkonda talk through tick related infectious diseases including Lyme Disease, Rocky Mountain Spotted Fever, Ehrlichiosis, Babesiosis and more! Tick related illnesses are prevalent this time of year, so take a moment to brush up on how to manage them. CONTACTS Twitter - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Society guidelines:

Dr. Kharmene Sunga, Mayo Clinic emergency medicine consultant physician, specializing in simulation, diversity equity and inclusion, and education shares a guide for how to communicate (both through listening and speaking) most effectively when it counts. TEASER There's no place like the Emergency Department. Patients are in pain, scared, and anxious. Staff are distracted, fatigued, frustrated - and sometimes, well, also scared and anxious. How can Emergency Physicians speak to rise above the fray, to best care for patients, lead a team, and ensure that everyone feels heard? Join Dr. Kharmene Sunga as she discusses insights from sources ranging from medicine to business and even child psychology to cut through the proverbial noise. CONTACTS Twitter - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com

Ms Lisa Beck, assistant professor of nursing and a clinical nurse specialist in the department of physical medicine and rehabilitation, shares her experiences over a career in caring for persons with intrathecal baclofen pumps for managing spinal cord injury related spasticity. Baclofen related complications such as withdrawal and overdose can both be fatal and pump specific complications as well require timely expertise from the emergency care team – but not often discussed in emergency medicine. Check out the episode to learn more! CONTACTS Twitter - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS