Author: Ibrahim Sarbay, Turkey

I am an Emergency Medicine Resident living in İstanbul, Turkey. Writing online since 2002, and co-founded "Opereyşın," one of the most notable community blogs of Turkey. Currently, I write for a favorite Turkish FOAMed blog, acilci.net, and share my journey of learning through social media. I like researching, web programming, and making infographics. I believe in Free Open Access to medical education by heart.

Autism in the Emergency Department

~ Ibrahim Sarbay, Turkey ~ Leave a comment

An Emergency Department (ED) is undoubtedly one of the most complex and chaotic places on earth where every individual can visit, regardless of age, gender, socioeconomic status, and existing conditions. Patients with autism may also visit EDs with any medical complaints. So, as Emergency Medicine physicians, what can we do to provide them the best health care possible? Of course, there is no limit to what we can individually do to help them, but it may be a good start to think about our EDs’ conditions and find the ways to improve them to serve ALL patients best.

About Autism

The Word “Autism” is derived from Greek autos (“self”) and  -ισμός (-ismós) (“-ism”) and was used for the first time by psychiatrist Eugen Bleuler in 1908. He used it to describe a schizophrenic patient who had withdrawn into his own world. Until the 1970s, many scientists confused autism with mental retardation and psychosis and blamed the parents for their lack of parental skills. “A morbid self-admiration and withdrawal within the self” was the definition of Autism in this time period. In the 1970s Autism correctly described at last as “conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication” and autism and schizophrenia were recognized as completely different conditions. Treatment modalities in autism have undergone a dramatic shift with the help of this level of awareness – from pain and punishment to behavioral therapies.

In 2013, the American Psychiatric Association merged four distinct autism diagnoses (autistic disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger syndrome) into one diagnosis: Autism spectrum disorder (ASD). (1)

Society’s Perspective

The fact that individuals with autism experience various difficulties in communication may cause them and their relatives to be “labeled” and encounter many problems throughout their lives, from education to transportation, from neighborhood relations to social life. It has been shown in various studies that families of individuals with autism are exposed to high levels of stress.

The general view and attitude of society are included in a wide spectrum of negative behaviors such as pitying, excluding, avoiding, and harming the individual with autism.

Why It’s Important to Be Cautious?

The average number of ED visits is nearly 30 percent higher for children with ASD, and their experience is generally far from good. In a comprehensive literature review, it was found that young patients (aged 0-17 years) with ASD were up to 30 times more likely to present to the ED, were likely to have repeat visits, and more likely to be admitted to the hospital. (2)

Caregivers of children with ASD are more likely to report “difficulty utilizing services, lack of shared decision making and care coordination, and adverse family impact”. (3)

Because of language and learning problems, children with ASD may have difficulty understanding hospital procedures and medical tests, which can increase their already high-stress levels. In addition, ED personnel often do not have enough knowledge about the special needs of patients with ASD. (4)

Early mortality is markedly increased in ASD due to a multitude of medical conditions. This is particularly important in ASD as it may indicate insufficient awareness of comorbid diseases, misdiagnosis, and mistreatment in the health system, in addition to the increased susceptibility to various diseases.

In a population-based cohort study, it was shown that the risk of death due to all diseases examined increased compared to the normal population. (5) In another study, all major psychiatric disorders, immune system disorders, nearly all medical conditions (including epilepsy, obesity, dyslipidemia, hypertension, and diabetes), suicide attempt and rarer conditions such as stroke and Parkinson’s was found to be significantly more common among adults with autism. (6)

These results indicate that physicians working in all medical specialties should have a better level of knowledge about ASD.

Remember These Words: See – Hear – Feel – Speak

There are many recommendations in various sources regarding the clinical approach to patients with ASD in the ED (7-10). In this article, I will be content with introducing a highly memorable 4-step system, which was developed by Samet and Luterman in order to facilitate patient-centered encounters with pediatric patients with ASD: (11)

Before examining a patient with ASD presenting to your ED, immediately think of these words: See – Hear – Feel – Speak.

Step 1: See – Remove non-essential visual stimuli. Dim the lights if possible, or try to place the patient in a dimmer room in the ED. Eliminate flickering lights like old fluorescents and avoid fluorescent lighting altogether if possible. Move active flashing lights or monitors out of the patient’s direct visual field.

Step 2: Hear- Remove excessive auditory stimuli before interacting. Turn off any unnecessary alarms or beeps from devices in the room, mute the TV, and move the patient to the least noisy room in the ED, if possible.

Step 3: Feel- Ask both the patient and care providers if they have any textures, which they find calming or agitating. Patients with ASD may have specific tactile stimuli they find soothing or aggravating.

Step 4: Speak – Say aloud in simple language to the patient everything you are doing before and as you are doing it. Ideally, speak directly in front of the patient’s plain view, because they may have difficulty with localizing the sounds.

Conclusion

It is possible to provide better healthcare to individuals with ASD through better training of health workers and structural changes to the EDs.

In this long journey to perfection, the first step could be increasing our awareness.

Because they deserve the best.

References

  1. Autism Speaks, What Is Autism?, Accessed June 4, 2021,  https://www.autismspeaks.org/what-autism
  2. Lytle S, Hunt A, Moratschek S, Hall-Mennes M, Sajatovic M. Youth With Autism Spectrum Disorder in the Emergency Department. J Clin Psychiatry. Published online June 27, 2018. doi:10.4088/jcp.17r11506
  3. IBCCES . Autism and the Emergency Department (ED): Why it’s Important. IBCCES. Published June 5, 2020. Accessed April 4, 2021. https://ibcces.org/blog/2020/06/05/autism-and-the-emergency-department-ed-why-its-important/
  4. When a Psychiatric Crisis Hits: Children with Autism in the Emergency Room. SPARK. Accessed April 4, 2021. https://sparkforautism.org/discover_article/when-a-psychiatric-crisis-hits-children-with-autism-in-the-emergency-room/
  5. Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, Bölte S. Premature mortality in autism spectrum disorder. Br J Psychiatry. Published online March 2016:232-238. doi:10.1192/bjp.bp.114.160192
  6. Croen LA, Zerbo O, Qian Y, et al. The health status of adults on the autism spectrum. Autism. Published online April 24, 2015:814-823. doi:10.1177/1362361315577517
  7. Taylor K, Cadman E, Burkitt S, Langseth A. G338(P) Improving the emergency department experience for children with autism, and their families. In: Association of Paediatric Emergency Medicine. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health; 2018. doi:10.1136/archdischild-2018-rcpch.328
  8. Kirsch SF, Meryash DL, González-Arévalo B. Determinants of Parent Satisfaction with Emergency or Urgent Care When the Patient Has Autism. J Dev Behav Pediatr. Published online June 2018:365-375. doi:10.1097/dbp.0000000000000573
  9. Giarelli E, Nocera R, Turchi R, Hardie TL, Pagano R, Yuan C. Sensory Stimuli as Obstacles to Emergency Care for Children With Autism Spectrum Disorder. Advanced Emergency Nursing Journal. Published online April 2014:145-163. doi:10.1097/tme.0000000000000013
  10. Nicholas DB, Muskat B, Zwaigenbaum L, et al. Patient- and Family-Centered Care in the Emergency Department for Children With Autism. Pediatrics. Published online April 2020:S93-S98. doi:10.1542/peds.2019-1895l
  11. Samet D, Luterman S. See-Hear-Feel-Speak. Pediatric Emergency Care. Published online February 2019:157-159. doi:10.1097/pec.0000000000001734
Cite this article as: Ibrahim Sarbay, Turkey, "Autism in the Emergency Department," in International Emergency Medicine Education Project, July 19, 2021, https://iem-student.org/2021/07/19/autism-in-the-emergency-department/, date accessed: September 27, 2023

Social Media Ethics for Medical Professionals

ethics
~ Ibrahim Sarbay, Turkey ~ Leave a comment

From Twitter to LinkedIn, every single one of us use social media every day. While using social media is not an obligation (obviously), imagine how you would be surprised by someone who has no social media account. Our posts on social media are meant to be there forever, carefully protected from deletion by Terms and Conditions of the social media site we used. Once you shared a post, it takes its place in the digital world as our footprint. “Who cares?”, you might ask. Well, the answer is EVERYBODY. Employers routinely check social media accounts of the individuals to grasp an opportunity to “reveal” their identities and and use this data in recruitment processes. Advertising companies are using our “share/like” data to select  “suitable” ad contents for us. States constantly monitor the soical media contents of their citizens.

In one sense, social media profiles are like the diaries of the past. However, there is a fundamental difference: While diaries are meant to be a confidante of the individual, social media “diaries” are notoriously verbose speakers ready to ruin us.

Statements

American Medical Association’s (AMA)  “Professionalism in the Use of Social Media” webpage emphasizes some basic (yet vital) rules. They can be summarized as follows:

  1. Physicians should be aware of patient privacy standards at all times, and must refrain from posting identifiable patient information online.
  2. When using social media for educational purposes or to exchange information professionally with other physicians, follow ethics guidance regarding confidentiality, privacy and informed consent.
  3. Physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that once on the internet, content is likely there permanently. Thus, physicians should routinely monitor their own internet presence to ensure that the personal and professional information about them is accurate and appropriate.
  4. If physicians interact with patients on the internet, they must maintain appropriate boundaries of the patient-physician relationship.
  5. Physicians should consider separating personal and professional content online.
  6. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to advise against it. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.
  7. Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students) and can undermine public trust in the medical profession.

World Medical Association (WMA) issued a statement on the professional and ethical use of social media in 2011 which has some additions to the rules mentioned above:

  1. Physicians should study carefully and understand the privacy provisions of social networking sites, bearing in mind their limitations.
  2. Physicians should consider the intended audience and assess whether it is technically feasible to restrict access to the content to pre-defined individuals or groups.
  3. Physicians should adopt a conservative approach when disclosing personal information as patients can access the profile. The professional boundaries that should exist between the physician and the patient can thereby be blurred. Physicians should acknowledge the potential associated risks of social media and accept them, and carefully select the recipients and privacy settings.
  4. Physicians should provide factual and concise information, declare any conflicts of interest and adopt a sober tone when discussing professional matters.
  5. Physicians should draw the attention of medical students and physicians to the fact that online posting may contribute also to the public perception of the profession.
  6. Physicians should consider the inclusion of educational programs with relevant case studies and appropriate guidelines in medical curricula and continuing medical education.

British Medical Association’s (BMA) “Ethics of Social Media Use” page has detailed information on both benefits and risks of social media. Its “Social Media, Ethics and Professionalism Guidance” emphasizes the arguably most important reminder: “You are still a doctor or medical student on social media”. Touché!

Tips from Experts

The rules and codes are of course very important in theory. However, experts in this field will know best how to apply them in practice. For this article, we asked the leading names of the #FOAMed World the following question: “What is your FIRST RULE while using social media?”

Here are their answers:

Skin in The Game

“If you haven’t somehow got skin in the game, your opinion is probably worthless and/or unwanted.”

– Karim Brohi [*]

Stick to the Science

“Dr. Sapna Kudchadkar’s basic Twitter rules applies to all social media.

Always remember “a tweet is forever” it does not disappear.

Stick to the science and be collegial are my rules.”

-Yonca Bulut [*]

Dr. Sapna Kudchadkar’s Basic Twitter Rules

“Don’t ever give specific medical advice or try to diagnose online.

Don’t write about actual patients or cases.

Don’t ever sacrifice collegiality due to a difference of opinion.

Don’t forget to cite the source.

Don’t tweet slides of unpublished data.”

-Dr. Sapna Kudchadkar

No regrets!

“I never post anything I might regret in the future.”

-Shanta W. [*]

Vice Versa

“Don’t just try to project the best version of yourself on social media. Try to become more like the better version of yourself that you want to project on social media.”

-Elias Jaffa [*]

THINK

“One word: THINK. T: Is it true? H: Is it helpful? I: Is it inspiring? N: Is it necessary? K: Is it kind?”

-Manrique Umana McDermott [*]

Know the Rules

“So many important things to consider….one of the bigger ones is know your institution’s rules and guidelines… Most have them—some are strict and some aren’t. But know the rules. Many institutions literally have someone assigned to watch social media output among employees.”

-Rob Rogers [*]

A Force for Good

“Be a force for good in the world. Don’t say anything you wouldnt say in front of my mother & chair.”

-Seth Trueger [*]

Once You Write…

“Every single letter is a long lasting prey of the web.”

-Nicolas Peschanski [*]

Not an Online Hospital

“1- Patient privacy rules are also valid here.

2- Social media is not an online hospital.

3- Social media is not a scientific journal.

4- Social media is not a suitable platform to debate with colleagues.”

-Fatih Beşer

Think Before You Speak

“The best tweets are the ones you don’t ever send. You should consider not sending the vast majority of tweets.”

-Bruce Lambert [*]

Conclusion

“What should I be known for?” A social media account that you have shaped around this simple question will undoubtedly lead to incredible opportunities. In any case, there is no escape from using social media.

By carefully reading and implementing the rules mentioned in this post, you can prevent social media from doing you more harm than good.

Cite this article as: Ibrahim Sarbay, Turkey, "Social Media Ethics for Medical Professionals," in International Emergency Medicine Education Project, April 26, 2021, https://iem-student.org/2021/04/26/social-media-ethics-for-medical-professionals/, date accessed: September 27, 2023

Which Emergency Medicine Textbook Should You Read First?

emergency medicine books
~ Ibrahim Sarbay, Turkey ~ Leave a comment
As Dan Sanberg once said; “Emergency Medicine is the most interesting 15 minutes of all specialties”. Indeed, if we were to recommend one textbook to a newly graduated physician, it would probably make the most sense for it to be an Emergency Medicine textbook. So which one? I asked this question in Turkish and English to the Twitterverse recently. The responses showed once again the diversity of emergency medicine resources and the importance of basic textbooks. https://twitter.com/ibrahimsarbay/status/1305952482414206977 Justin Hensley reminded the fallacy of the sentence “I’ll read it just on the Internet” and the importance of keeping up-to-date as follows: “I’m not sure there’s a right answer to this. Honestly, I would say the one that has the most recent new addition, because it will be the least out of date. The fundamentals need to come out of a text and not #FOAMed though. Can’t build a pyramid without a base.“ Shehni Nadeem said: “It’s hard to pick ONE. Here’s why: 1) Textbooks are critical to forming that foundation of knowledge but must be kept current 2) Ea textbook has a slightly different read to it. I would encourage the learner to try out each one and see which fits the best (did this as an intern)” Isn’t it a great idea to leave the preference to the reader by giving general information about the books rather than ranking the best for “me” or “person x”? Let’s do it like this. We will discuss the books included in this article in two groups according to book sizes.

Hand and Pocket Size Textbooks

You cannot see a doctor standing at the bedside with a large reference book in his/her hands. In fact, most textbooks are not even suitable to keep in your bag and take it wherever you go (Hello, back pains, hello!). Hand and pocket books have been prepared to solve this problem. TL; DR (Too long, didn’t read), the small ones of these books are called “pocket books” and the bigger ones are called “handbooks”. Isn’t that great? Yes, but please remember that “only” studying handbooks may not be enough if you haven’t read the topics from a broader source before. It is best to move on to these books after doing the basic reading. Or, as we all did when we first turned the pages of Tarascon, you’ll stare at the pages for a long time and try to understand whether it is English or Klingon.

1- Oxford Handbook of Emergency Medicine

The Oxford Handbook of Emergency Medicine, whose 5th edition has been released recently, is a starter book prepared for medical students, paramedics and physicians. The manual-sized work is still 800 pages long and contains basic information on many subjects from life-threatening emergencies to ENT, analgesia to toxicology. The fourth edition of the book was released in 2012. Emergency Medicine professor Richard Body also recommends this book to our readers as a starter book.

2- Emergency Medicine Secrets

Unlike many resource books, Emergency Medicine Secrets deals with questions and answers on every subject. For example, when you look at the Pneumonia section, you can find various questions (and answers, of course) such as, “Why should I learn about Pneumonia?”, “How does pulmonary infection develop?”, “What are the differences between the presentations of typical and atypical pneumonia?”. The book that can really benefit to the reader in this respect is 768 pages long.

3- Avoiding Common Errors in the Emergency Department

This work by Amal Mattu et al., One of the well-known names in FOAMed world, discusses 365 common mistakes in emergency medicine practice in a chatty, easy-to-read style, and offers practical, easy-to-remember tips to avoid these pitfalls. The fact that the chapters are short and understandable allows easy reading even when you are working. The second edition published in 2017 has a total of 1080 pages.

4- EM Fundamentals: The Essential Handbook for Emergency Medicine Residents

This pocket guide, prepared by EMRA (Emergency Medicine Residents Association) for Emergency Medicine residents, is one of the ideal books you can take with you during your emergency department shifts. On 366 pages, it summarizes common situations that may be encountered in the emergency room, in clear language and without missing the necessary emphasis.

5- Tarascon Adult Emergency Pocketbook

I do not think there is an emergency medicine physician unfamiliar with Tarascon (at least in Turkey). We know that on many Emergency Medicine Clinics those who do not have Tarascon in their pockets at bedside visits are condemned. As someone who is always amazed at how many things fit into this 240-page pocket book, I say, “If you haven’t found what you are looking for in basic emergency medicine in this book, look again, there is for sure.” Tarascon published books in a series style from Pediatric Emergency to Orthopedics. I recommend especially Adult Emergency and Medical Procedures pocket books. Character sizes may spoil the taste of those who like to read books written in big fonts and large line spacings. But the goal here is to be as small as possible, so it is understandable.

6- Tintinalli’s Emergency Medicine Manual

Would there be an Emergency Medicine list without Tintinalli? Tintinalli book appears with large-small-median dimensions. The last version of this book, which is easy to read and will not let the reader down with its structure containing plenty of pictures, tables and graphics, is the 8th edition published in 2017. It covers every subject an Emergency physician may need, and Palliative Care is no exception. The preface to the latest edition is also giving a glimpse of Emergency Medicine’s history.

Large Textbooks

Large textbooks that might be expected not to leave “anything missing” in their field often have a serious volume and a long list of authors. These works that will have a dedicated spot in your library to grab and read from time to time over the years may be too much for a medical student or a newly graduated physician. But if it is necessary to prepare a presentation or learn a subject in depth, the address is clear.

1- Adams Emergency Medicine: Clinical Essentials

This 1888-page “tome”, which weighs nearly 5 kilograms, provides extensive information on any subject you may need in a visually rich and easily understandable language. The disadvantage is that the second original edition is dated 2012. So it may be partly outdated. Elsevier is sharing the book online (for a fee) under the title Adams Emergency Medicine Review. However, even that was published in 2015.

2- Clinical Emergency Medicine

Clinical Emergency Medicine contains information on the diagnosis and treatment of 98 changes and condition in 400 pages. Each chapter starts with the Key Points. It also continues with Introduction, Clinical Presentation (History and Physical Examination), Diagnostic Studies, Medical Decision Making, Treatment and Discharge, and Reading Recommendations. The printing date is a bit old. The last edition was published in 2014.

3- Diagnosis And Management Emergency Medicine

The 556-page work by Mike Cadogan is not only practical, but also includes a very comprehensive content. The eighth edition has been completely revised and updated. the book covers all emergencies as well as procedures and administrative and legal issues.

4- First Aid For The Emergency Medicine Boards

Published for those who want to prepare for the Emergency Medicine Boards exams organized by the American Board of Emergency Medicine, this book offers a great option for those who want concise summaries with reminder boxes, notes, mnemonics and clinical pearls. Each subject is briefly described in subheadings such as Symptoms, Diagnosis, and Treatment in this approximately 1000-page book.

5- CURRENT Medical Diagnosis And Treatment

This book can be considered as an Internal Medicine textbook. However, in addition to Internal Medicine subspecialties such as geriatrics, preventive medicine and palliative care; it offers detailed reviews of all internal medicine disciplines such as gynecology and obstetrics, dermatology, ophthalmology, neurology, psychiatry, and infectious diseases. The book includes the diagnosis and treatment of more than 1000 diseases and is about 2000 pages. It is ALWAYS up-to-date due to its yearly updates.

6- Rosen & Barkin’s 5-Minute Emergency Medicine Consult

In this textbook, each subject is summarized in 2 pages divided into three sections. The last edition of the chapter, in which every subject is explained systematically in Introduction, Diagnosis, Treatment, Follow-up, Tips, Reading, ICD Codes sections. Its last edition was published in 2019 with a length of 1256 pages.

7- Rosen’s Emergency Medicine: Concepts And Clinical Practice

This book is one of the “brand”s of our field. The original version is 2688 pages long. When you think about it yu will realise that even if you read 10 pages a day, it will be over in 9 months. Due to its size, its suitability for colleagues who do not intend to acquire an Emergency Medicine profession can be discussed, but making a list that Rosen is not included will also upset every Emergency physician.

8- Tintinalli’s Emergency Medicine

I think it would suffice to say that it is the best selling Emergency Medicine book worldwide. Tintinalli’s word is deed, wherever Emergency Medicine is experienced, from in-clinic trainings to certification exams. The 9th edition, published very recently, is 2160 pages long. Pre-hospital care, disaster preparedness and resuscitation techniques… You can find everything you can think of in this book, from all major medical, traumatic and environmental conditions that require urgent treatment in adults, children and neonates.

Conclusion

Suppose you are going to Antarctica as a “team doctor”. You will be completely isolated from the outside world for 3 months. Neither a plane nor a ship will bring aid. Which textbook would you choose to take with you? In my opinion, the answer to this question for every physician is an Emergency Medicine textbook. Due to the nature of our expertise, every textbook will undoubtedly help Emergency in at least one way. If you choose to read a good Dermatology or a good ENT textbook, you will definitely benefit. From another angle, even the most comprehensive Emergency Medicine textbook will not enable you to learn everything, for example, a thorough understanding of all heart rhythms or interventional procedures. You should refer to thousands of pages of books written specifically for these. Therefore, our aim in this article was to present a collection of textbooks that examine Emergency Medicine as a whole. While choosing from hundreds of textbooks, we got the great support of the Twitter #FOAMed world. Most of the photos above were provided by the physicians mentioned below. I thank them very much. If knowledge is a flower garden, textbooks are honeycombs prepared by “master” bees by roaming around those flowers. Rather than visiting thousands of flowers one by one and trying to distinguish between good and bad; it would be most logical to set the foundation on these “honeycombs” and set sail to new gardens. What did Justin Hensley say? “You can’t build a pyramid without a base.” Exactly.   We would like to thank the following names for their contributions to this article (alphabetical order): Ali Kemal Yıldız, Arif Alper Çevik, Ayhan Özhasenekler, Barış Murat Ayvacı, Berika Kavaz Kuru, Bora Çekmen, Burak Özkan, Cem Turam, Ener Çağrı Dinleyici, Fatih Beşer, Gizem Altınsoy, Göksu Afacan Öztürk, Haldun Akoğlu, İbrahim Varol, Justin Hensley, Mehmet Çulha, Mike Cadogan, Nevrez Koylan, Nurettin Özgür Doğan, Oğuzhan Aytepe, Onurcan Kaya, Richard Body, Salahi Engin, Shehni Nadeem, Yonca Bulut, Yusuf Ali Altuncı, Zeynep Kekeç. You can read the Turkish version of this article on Acilci.net: “Hangi Acil Tıp Kitabı?”
Cite this article as: Ibrahim Sarbay, Turkey, "Which Emergency Medicine Textbook Should You Read First?," in International Emergency Medicine Education Project, February 8, 2021, https://iem-student.org/2021/02/08/emergency-medicine-textbooks/, date accessed: September 27, 2023

Recent Blog Posts by Ibrahim Sarbay

Things You Should Know Before Your First ED Shift

Things You Should Know Before Your First ED Shift
~ Ibrahim Sarbay, Turkey ~ Leave a comment

I recently posted a question to the Twitterverse:

“Imagine that an Emergency Medicine intern asked you for advice before his/her FIRST SHIFT. What would be your FIRST ADVICE?”

I also raised the same question in Turkish. In a couple of days, I received nearly 100 answers from reputable names of Emergency Medicine working worldwide. I highly benefited from these advice, and I think that our site’s valuable readers can also benefit. I tried to select the most inspiring ones and divided them into main categories. Under each advice, you can find the name of the tweet owner and the link to the original tweet. Let’s start.

Core

Enjoy being on the frontline by helping patients who are seeking your help in their most difficult time. This is a great privilege and responsibility that we should never forget.

Arif Alper Cevik (@drcevik) Tweet

Never forget what a privilege and responsibility it is that people don’t know you ask for your help on the WORST DAY OF THEIR LIFE.

Amal Mattu (@amalmattu) Tweet

In the Emergency Department, you may be worried about 'why am I here?' one day, but you may think that you are doing the best job in the world another day. Now you have a lifetime which every day and every patient is different. Love your profession EVERY WAY, glorify knowledge and skill, and always be at peace with your job.

Başak Bayram (@basakdr) Tweet

Education

Never be afraid to say, "I don't know." It's why you're here to be taught. If you already knew everything, then you wouldn't need residency.

Justin Hensley, (@EBMgoneWILD) Tweet

Trust yourself as if you know everything, try to learn as if you know nothing.

@cear_slan Tweet

Want to get smart? Do 2 things: 1) Read up on at least 1 patient every shift. 2) Ask lots of questions to residents, attendings and consultants.

Amal Mattu (@amalmattu) Tweet

Feel free to ask me (or another senior) about anything (/everything). When I was at that stage I wish I’d asked more. I suspect some people think asking is a sign of ignorance or weakness. Actually, it helps us to be safe & to appreciate other perspectives.

Rick Body (@richardbody) Tweet

This is the Emergency Room; this is the lion’s den; first, you have to protect yourself, and you will do this with your knowledge. So don't think ‘I'll practice, I'll fill my knowledge gap in 3-5 months', sit down, and read the textbook.

Göksu Afacan Öztürk (@Goksu_Afacan) Tweet

First compel yourself to read at specific points, and gradually you will find your appetite for reading. You are the one primarily responsible for your education!

@ChannelAziz Tweet

Never feel shy to ask or say I don't know. It's your chance to make mistakes and learn, share the knowledge you have and don't keep it to yourself.

Lara Sulaiman (@Dr_Lara) Tweet

Of course, you cannot know everything, but you can start learning.

Ozlem Guneysel (@oguneysel) Tweet

80% of “KNOWLEDGE” is "INTEREST"

Ayhan Özhasenekler (@Aozhasenekler) Tweet
Resilience

Resilience

The Emergency Medicine career is a marathon, not just the first few years of residency. Don't waste your energy inordinately for things you can't fix. Invest in the future self.

Can Özen (@cozenmd) Tweet

When you dance with the bear you can't stop until the bear wants to stop.

Nurettin Özgür Doğan (@DrOzgurDogan) Tweet

Calm down. Every shift eventually ends.

Mustafa Ercan Günel (@mercangu) Tweet

Rest and eat, whenever you get the opportunity. The Emergency Room is like a HIIT, you need to slow down first to speed up.

Burcu Yılmaz (@Burcu_Yilmazzz) Tweet

If you are a parent, sleep when the child sleeps.

@pekinipeklisi Tweet
Empathy

Empathy

Don’t judge patients or consultants without walking a mile in their shoes.

Amal Mattu (@amalmattu) Tweet

Think of every patient as your relative. Balance your professional authority with your kindness.

@damkmiyenses Tweet

Communication is important. Tell the patient and one of his/her relatives what you already did and what you plan to do, and ask if there is anything they want to ask.

Altuğ Kanbakan (@prothemanes) Tweet

Peter Rosen once said, “Nobody woke up this AM decided to ruin your day.” Happiness is YOUR choice. Be happy, stay positive.

Amal Mattu (@amalmattu) Tweet

Remember, when you see a patient in the middle of the night who requests you to apply his/her prescribed topical cream on his/her back because –apparently- he/she can’t, that person is the joy of the night.

@dogu6 Tweet

Follow up on your patients. This will reinforce your learning. Call patients at home to see how they’re doing. They will love it, and it reminds you of why you chose this profession.

Steve Richards (@srichmd) Tweet

Remember to acknowledge that you most likely are a stranger to your patient. It only takes a few minutes to reassure someone that you are there to help them through their ER experience as a team. We tend to forget this in the busy ER.

Anél Pelser (@PelserAnel) Tweet
Values

Values

Nobody expects you to know much (yet). But it is expected you to be 100% reliable. Never EVER EVER EVER lie. If you don’t know something or you don’t do something, be honest.

Amal Mattu (@amalmattu) Tweet

Your attitude to this advice will determine your path through our specialty. The blindingly following advice will bring as much peril as ignoring it all. Emergency Medicine requires you to consider impacts on patients, professionals & the populations - no one approach fits all.

Damian Roland (@Damian_Roland) Tweet

Never EVER EVER EVER be arrogant. You will be wrong many times in your career. Learn humility NOW.

Amal Mattu (@amalmattu) Tweet

What I like most about emergency medicine is how it allows us new perspectives every day. In the pandemic, we are treating the same disease all the time, but each patient and their family brings a different story, and every time I feel more humble in the face of life, the disease, and the future. Being in a LIMC country can be so challenging, so painful to treat and suffer along with inequalities and lack of resources... But we have the opportunity to be our best, as I said yesterday to my residents: we don’t have the best hospital, but we can be our best and give the patient what they may not have in the best hospital: treatment with dignity and respect and love. For me, being able to show my patients that I care, and receiving their gratitude has been undoubtedly the only possible prevention of Burnout. So I would say: Our specialty is beautiful, the opportunity for growth is vast, but it takes humility and perseverance to complete this journey.

Jule Santos (@julesantosER) Tweet

Never allow senior residents of other departments to treat you as if you are their junior.

Dr Erdi Kadir Y. (@DrEKYacil) Tweet

Our fingers are not equal, and so are the attendings whose hands you train on are not the same nature. There is the gentle one who loves you and there are critics who believe that development comes only with criticism and a dose of pain. Your job is not to try to classify them but to do what is required of you and to benefit from everyone.

@ChannelAziz Tweet

We want you to be the brain of a machine in which none of its cogs can work properly. Sometimes, even if you don't know how to swim, you will find yourself in the ocean surrounded by the waves, but most of the time, in the hardest moments, you will find a huge army with you. Welcome...

Barış Murat Ayvacı (@emresuspack) Tweet

If you think a senior is wrong about something, give him evidence, but don’t be obstinate...

Ali Kaan Ataman (@erdrkaan) Tweet

You may be untutored, but never be uninterested. Because knowledge definitely comes to those who have interest.

Mustafa Ipek (@dr_mustafaipek) Tweet

Appear weak when you are strong and strong when you are weak. Look weak when strong; look strong when weak. Also don't forget to look at vital signs 😉

Osman Avşar Gül (@mefisto_avsar) Tweet

Don’t be a d*ck.

Rob Rogers (@EM_Educator) Tweet

Enjoy your junior days, qualify for your senior days.

Agit Akgül (@DrAgitAkgul) Tweet
Patient Records

Patient Records

(Carefully) Fill out the patient records. What will save you from everything are these records.

@dferek Tweet

Spoken words fly away, written words remain. Record everything...

Şervan Gökhan (@servangokhan) Tweet

What is not written is deemed not done. First, protect yourself and then protect the patient. Choose a good role model.

Ozge Duman Atilla (@ozgedumanatilla) Tweet

Workup

No workup can replace a good physical examination.

Erdal Demirtaş (@Erdal_DD) Tweet

Never order a test that you won’t check the results.

Eyupkaraoglu (@drekaraoglu) Tweet

Know your tests! Know their rough sens/spec and when to trust them (and more importantly, when NOT to trust them)!! No test is 100%, and all are context-dependent!

Elias Jaffa MD MS (@jaffa_md) Tweet

Decision Making

Being efficient should never be at the expense of being thorough. You will eventually have to waste more time making things right.

Danya Khoujah (@DanyaKhoujah) Tweet

If someone brings up a concern, go to the bedside.

Sunny Elagandhala (@elegantdolla) Tweet

Think simple, make a quick decision. Determine the senior you will take as a model.

Ayhan Özhasenekler (@Aozhasenekler) Tweet

Once you suspect about a diagnosis, be sure to rule it out.

Ilker Akbaş (@ilkerakbas) Tweet

Do not forget to consider emergencies and other diseases while focusing on frequent diseases of the period, such as COVID. The most important thing that the emergency doctor needs to do is to look at the case from a wide perspective from the very beginning.

Gaziantep Acil Tıp (@AcilGaziantep) Tweet

Watch out for the last patient who came just before your shift ends.

Meltem Şahin (@onlakonusmayin) Tweet

In emergency medicine [and in life :)] the possibilities are 0% or 100% only in limited scenarios. You need to quickly learn managing probabilities, setting priorities, distinguishing acceptable and unacceptable risks. Also you need to learn reading the environment; because it usually gives many signs before the problem emerges.

Elif Dilek Çakal (@DrEDCakal) Tweet

Patient in the Resus is easy. Spotting the patient with a real emergency in minors is the tough one.

@fakuna_matata Tweet

First rule of emergency response is to ensure your own safety!

SALİH KARABULUT (@drskbulut) Tweet

When in doubt or worried about someone, talk to floor senior physicians EARLY.

Rahul Goswami (@Rahul_Goswami_) Tweet

I would say to try your best to remain open-minded and try to be aware of your biases and blindspots. This applies especially to patients with psychiatric illness and substance use disorders. If you're explaining X symptom on Y problem, always ask yourself, "Does this actually make sense?

Elias Jaffa MD MS (@jaffa_md) Tweet

The most frequently overlooked diagnosis in the emergency room is the second diagnosis! Do not limit your perspective to one diagnosis. Most frequently missed fracture in the emergency room? The second one! Remember that the patient may have a second fracture!

Mehmet Ergin (@drmehmetergin) Tweet

While assessing only isolated parts, don’t miss to assess the patient as a whole. Do not evaluate the patient on a single system, single organ basis. Emergency Medicine requires ‘holistic assessment’.

Ayhan Özhasenekler (@Aozhasenekler) Tweet

Discharging

No hospital bed belongs to you. If in doubt, do not discharge the patient.

Haldun Akoglu (@IstanbulEMDoc) Tweet

Do not discharge the patient relying on what someone else is telling you without assessing by yourself!

Emre Salçın (@emresalcin) Tweet

Do not discharge the patient after midnight: You may be tired, you may overlook something, the patient and his relatives may not find a car or money to leave, or they may try to go to the town or another city but have an accident on the road, etc. Those all happened (Not my personal experience, but I have seen them), evidence based...

Ayhan Özhasenekler (@Aozhasenekler) Tweet

Before discharging the patient whose treatment is completed, make sure to think like that: ‘Is there any possibility that this patient will come back with a cardiac arrest before the shift ends?’ If you are hesitant, prolong the process.

@fakuna_matata Tweet

The patient at the hospital is better than the patient at home’. Do not discharge if you are not sure.

Belgin Akilli (@AkilliBelgin) Tweet

Team Play

Emergency Medicine is teamwork. Get along well with your colleagues, your nurse, your intern, your staff and your secretary. Find yourself a role model, try to be a good example for others. And enjoy the Emergency Medicine.

Melih İmamoğlu (@melihimam) Tweet

You may learn a lot of thing from your nurse, act like a teammate.

Yusuf Ali Altuncı (@draltunci) Tweet

That’s all for now. By the way, what would your advice be?

Cite this article as: Ibrahim Sarbay, Turkey, "Things You Should Know Before Your First ED Shift," in International Emergency Medicine Education Project, July 13, 2020, https://iem-student.org/2020/07/13/things-you-should-know-before-your-first-ed-shift/, date accessed: September 27, 2023

3D Video Laryngoscopes

~ Ibrahim Sarbay, Turkey ~ Leave a comment

Laryngoscopy can be described as endoscopy of the larynx, which used to facilitate tracheal intubation during general anesthesia or cardiopulmonary resuscitation. For decades, direct laryngoscopy has been the standard technique for tracheal intubation. But today, there are two main types of laryngoscopy: direct and indirect. Indirect laryngoscopy means the provider visualizes the patient’s vocal cords without having a direct line of sight. Indirect Laryngoscopy includes video laryngoscopes, fiberoptic bronchoscopes, and optically-enhanced laryngoscopes. Video laryngoscopy introduced in recent years and it aims to overcome the limitations of direct laryngoscopy by using a camera attached to the laryngoscope. While it has clear advantages over direct laryngoscopy, video laryngoscopy still has a high cost of investment. It remains a rare commodity for Emergency Medicine clinics, especially in resource-limited settings.

While the COVID-19 pandemic was affecting the world, the people who were under the most significant risk were healthcare workers. We know that the risk of transmission of the disease is quite high, especially when performing high-risk medical procedures such as endotracheal intubation. It is a known fact that personal protective equipment such as masks or face shields are very important in protection. But it is even more important to stay physically away from the patient whenever possible. When intubating a patient, video laryngoscopy has a clear advantage in terms of eliminating the need to approach the patient’s head and trying to have a direct line of sight.

Video laryngoscopy devices are expensive. But, if you think about the essential components of it, you can easily realize that it doesn’t have to be this way. You need a blade, a camera system, a display, and a way to attach the blade and the camera system. While laryngoscopy blades are essential for Emergency clinics anyway, I can safely assume every Emergency clinic has them. A camera system and a display are also both fairly cheap and easy to obtain for most of the places on earth. Find those three and voila! You have a cheap video laryngoscope (In this post, I will not elaborate on the technique of combining a normal blade with a video camera).

For those who want to go to the next level, there are some ways of making your very own prettier video laryngoscopy devices. You just need a 3D printer, but luckily it is possible to find 3D printers in many cities these days.

So here we go.

Umay

The pandemic paved the way for innovation in many ways. Numerous doctors from all over the world rolled up their sleeves to develop new medical devices. Yasemin Özdamar, an Emergency Medicine specialist from Turkey, designed 3D-printable video laryngoscope blades named “Umay” (possibly an allusion to Orkhon inscriptions) in pediatric and adult forms based on normal laryngoscope blades.

The printing files of these blades can be downloaded for free in formats suitable for printing with PLA material, which is frequently used in 3D printers, and PA12, which is preferred for more professional printing. You can download the files here: Pediatric – Adult.

AirAngel

AirAngel is a not-for-profit tutorial center dedicated to making video laryngoscopes accessible in under-resourced nations. You can purchase the blade or video laryngoscopy devices from their website with a fairly low price of US$100-180. You can also get the file of the blade for free and 3D print it yourself. Its design is really similar to a D blade. You can head to AirAngel’s website and grab the printing file now.

Here is an example tutorial for AirAngel:

In our tests (in Turkey), the cost of printing one blade approximately 50 Turkish Liras (roughly equal to US$7 with today’s exchange rates). We also bought a “Borescope USB Camera” with a camera head outer diameter of 5.5mm from our local internet store for approximately US$13 (A similar product from Amazon). So, the cost was US$20 in total, which is cheaper than AirAngel’s offer, and a lot cheaper than a conventional video laryngoscope. We have attached the camera to the blade using special parts on them and connected the camera to a phone. And under a minute, a video laryngoscope was born.

Please note: The intended purpose of these designs is to be used as a training tool. They do not replace any medical-grade video laryngoscope systems. They are not in any way approved medical device designs, nor have they been reviewed by the FDA or any other organization. Be aware that many plastics vary in strength, heat resistance, and chemical resistance. The strength and durability of the blade will vary depending on what you print it with. Harmful and life-threatening complications may occur if pieces break in the airway.

Cite this article as: Ibrahim Sarbay, Turkey, "3D Video Laryngoscopes," in International Emergency Medicine Education Project, May 4, 2020, https://iem-student.org/2020/05/04/3d-video-laryngoscopes/, date accessed: September 27, 2023

5 Ways Technology Drives Medicine to New Horizons

5 ways technology drives medicine
~ Ibrahim Sarbay, Turkey ~ Leave a comment

Recently, I published a Turkish article about my predictions on how emergency medicine will be in 2040 in the well-known Turkish FOAMed blog Acilci.net. In this article, we had the opportunity to brainstorm through a futuristic story about a typical Emergency Department in 2040. We have also conducted an online survey to collect the future projections of more than 40 scientists working on medicine, genetics and engineering fields; and included these predictions in the said article.

As this article was praised, I want to write about 5 ways technology will change Emergency Medicine in the coming years.

Let’s start.

Virtual Reality

VR

Virtual reality is an immersive, three-dimensional, computer-generated environment. While it may seem like technology for gaming and entertainment, it is exceptionally suitable to be used in medicine. One of the most prominent applications of it is in teaching Anatomy, allowing manipulations and dissections on the human body, more precisely than classical cadaveric dissections. Any medical student can access these materials from anywhere in the world. It is also cost-effective and requires less expertise, making it a dream come true for medical faculties(1). Surgical teams started to use 3D printing to build amazingly lifelike reproductions of real patients, and VR will only make it easier and better.

Artificial Intelligence

artificial intelligence

Artificial Intelligence (AI) is a popular term these days. It means “a system’s ability to correctly interpret external data, to learn from such data, and to use those learnings to achieve specific goals and tasks through flexible adaptation.”(2) Scientists all over the world are working determinedly to gain maximum benefit from this technology. AI outperforms a conventional algorithm for emergency department electrocardiogram interpretation. Apparently, it can even diagnose heart arrhythmias with cardiologist-level accuracy. An AI-enabled ECG can detect if a patient has atrial fibrillation even if the patient has a normal sinus rhythm during the test(3). Can we determine the ejection fraction using ECG? For sure. Is it possible to determine age and gender? Of course. If you are tired about ECG, let’s try another one: Can atrial fibrillation be detected just by looking at a patient’s face? Well it turns out deep-learning and a smartphone camera are all you need to do so. AI is capable of surpassing human experts in breast cancer prediction, and it can read X-Rays better than humans. It can diagnose pneumonia better than radiologists. An Israeli company announced that its algorithms were successful in helping to detect the presence of coronary artery disease. Another initiative, Sonde Health Inc., develops a voice-based technology platform for monitoring and diagnosing mental and physical medical conditions. AI will also help to solve doctor shortages: According to MIT Technology Review, Chinese doctors and tech companies are developing tools to automate routine medical tasks and alleviate China’s doctor shortage.

And these are just the baby steps of AI!

Health Wearables

health wearables

When we say «Health wearables,» the first thing that comes into mind might be a smartwatch capable of health features, but it covers an area much broader than that (Can we count pocket-sized ultrasound devices as Health Wearables? Probably.) A tech company Kymira works on a heart monitoring t-shirt that uses a single-lead ECG and movement reducing hardware to offer an accurate reading of heart rate during exercise. Just like Apple Watch, AliveCor’s Kardia measures ECGs and can detect atrial fibrillation with high sensitivity. With the slogan of «Personal ECG for the whole family», Wiwe can detect arrhythmias, help making risk assessment for stroke and sudden cardiac arrest, and also determine blood oxygen levels. The Clinicloud, the EKO Core, the eKuore Pro measure heart and lung sounds as digital stethoscopes. Omron Blood Pressure Smartwatch and the MOCAcare pocket sensor, can monitor blood pressure.

Traditionally EEGs are tests that require hospital settings, but a new device lets you record EEGs in your home. With a noninvasive neural interface that sits on the back of the head, it is possible to control compatible software. Do you want to send a text message with a thought? Say no more!

Great new apps and devices let visually impaired people engage with their environments in ways that were a dream once.

3D Printers

The 3D printing process builds a three-dimensional object from a computer-aided design model. Due to the increasing technological developments, there have been significant improvements in the field of 3D printing in recent years. For example, US-based CELLINK develops bioprinters and bioprinting materials for providing models to enable 3D cell culture, personalized medicine, and enhanced therapeutics. United Therapeutics, managed to bioprint lung tissues. Scientists from Spain have presented a prototype for a 3D bioprinter that can make functional human skin. 3D printed orthopedic casts became an alternative to conventional casting to treating bone fractures.

CRISPR and genomics

genomics

CRISPR is the abbreviation of «clustered regularly interspaced short palindromic repeats,» and it is a family of DNA sequences found within the genomes of prokaryotic organisms. Since the description of it in 1987 by Yoshizumi Ishino and his colleagues’, CRISPR have attracted researchers’ attention due to its great potential. By the end of 2014 more than 1000 research papers had been published that mentioned CRISPR (4). CRISPR associated nucleases have shown to be useful as a tool for molecular testing. Scientists used CRISPR to successfully delete one of the defective genes responsible for hypertrophic cardiomyopathy in human embryos. In 2017, a team of Chinese researchers successfully increased resistance to HIV in mice by replicating a mutation. Researchers managed to treat mice infected with antibiotic-resistant infections using CRISPR-engineered bacteriophages. CRISPR may help grow new and healthier food. It also helps fighting with the disease in Ways we couldn’t even imagine in the past: By targeting female reproduction in the malaria mosquito vector Anopheles gambiae, scientists try to eradicate malaria.

Conclusion

We still have a long way to go. It is not difficult to predict that some of the «magnificent» innovations promoted today will turn up to be phony. Although technology advances; problems such as anti-vaccination, global warming, poverty will open up new fronts. Still, the future will absolutely bring great potentials. We are eagerly looking forward to see.

References and Further Reading

  1. Al-Jibury O. Use of Virtual Reality in Medical Education – Reality or Deception? Med Case Rep. 2017, 3:1. doi: 10.21767/2471-8041.1000039
  2. Kaplan, Andreas; Haenlein, Michael (1 January 2019). “Siri, Siri, in my hand: Who’s the fairest in the land? On the interpretations, illustrations, and implications of artificial intelligence”. Business Horizons. 62 (1): 15–25. doi:10.1016/j.bushor.2018.08.004
  3. Attia ZI, Noseworthy PA, Lopez-Jiminez F, et al. An Artificial Intelligence-Enabled ECG Algorithm for the Identification of Patients With Atrial Fibrillation During Sinus Rhythm: A Retrospective Analysis of Outcome Prediction. Lancet 2019;394:861-867.
  4. Doudna JA, Charpentier E. Genome editing. The new frontier of genome engineering with CRISPR-Cas9. Science 2014. 346 (6213): 1258096. doi:10.1126/science.1258096
Cite this article as: Ibrahim Sarbay, Turkey, "5 Ways Technology Drives Medicine to New Horizons," in International Emergency Medicine Education Project, January 24, 2020, https://iem-student.org/2020/01/24/5-ways-technology-drives-medicine-to-new-horizons/, date accessed: September 27, 2023

Death on the Roads

Death on the Roads
~ Ibrahim Sarbay, Turkey ~ Leave a comment

Save the date: 17th November 2019!

Why? Because road victims will be remembered that day. Starting from 2005, The World Day of Remembrance for Road Traffic Victims is held on the third Sunday of November each year to remember those who died or were injured from road crashes (1).

Road traffic injuries kill more than 1.35 million people every year and they are the number one cause of death among 15–29-year-olds. There are also over 50 million people who are injured in non-fatal crashes every year. These also cause a real economic burden. Total cost of injuries is as high as 5% of GDP in some low- and middle-income countries and cost 3% of gross domestic product (2). It is also important to note that there has been no reduction in the number of road traffic deaths in any low-income country since 2013.

The proportion of population, road traffic deaths, and registered motor vehicles by country income, 2016 (Source: Global Status Report On Road Safety 2018, WHO)

Emergency care for injury has pivotal importance in improving the post-crash response. “Effective care of the injured requires a series of time-sensitive actions, beginning with the activation of the emergency care system, and continuing with care at the scene, transport, and facility-based emergency care” as outlined in detail in World Health Organization’s (WHO) Post-Crash Response Booklet.

As we know, the majority of deaths after road traffic injuries occur in the first hours following the accident. Interventions performed during these “golden hours” are considered to have the most significant impact on mortality and morbidity. Therefore, having an advanced emergency medical response system in order to make emergency care effective is highly essential for countries.

Various health components are used to assess the development of health systems by country. Where a country is placed in these parameters also shows the level of overall development of that country. WHO states that 93% of the world’s fatalities related to road injuries occur in low-income and middle-income countries, even though these countries have approximately 60% of the world’s vehicles. This statistic shows that road traffic injuries may be considered as one of the “barometer”s to assess the development of a country’s health system. If a country has a high rate of road traffic injuries, that may clearly demonstrate the country has deficiencies of health management as well as infrastructure, education and legal deficiencies.

WHO has a rather depressing page showing numbers of deaths related to road injuries. (Source: Death on the Roads, WHO, https://extranet.who.int/roadsafety/death-on-the-roads/ )

WHO is monitoring progress on road safety through global status reports. Its’ global status report on road safety 2018 presents information on road safety from 175 countries (3).

We have studied the statistics presented in the report and made two maps (All countries and High-income countries) illustrating the road accident death rate by country (per 100,000 population). You can view these works below (click on images to view full size).

References and Further Reading

  1. Official website of The World Day of Remembrance, https://worlddayofremembrance.org
  2. WHO. Road traffic injuries – https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
  3. WHO. Global status report on road safety 2018 – https://www.who.int/violence_injury_prevention/road_safety_status/2018/en/
Cite this article as: Ibrahim Sarbay, Turkey, "Death on the Roads," in International Emergency Medicine Education Project, November 1, 2019, https://iem-student.org/2019/11/01/death-on-the-roads/, date accessed: September 27, 2023

Just Some Broken Ribs

Just Some Broken Ribs
~ Ibrahim Sarbay, Turkey ~ Leave a comment

The phone was ringing incessantly. I barely woke up. In my pitch dark bedroom, the ringing phone was the only light source. I slowly grabbed my phone while involuntarily rubbing my eyes. I looked at the caller I.D. It was my father. And what time was it? 1:30 am! In a typical day, this might be an early hour for me, but I was attending a local Emergency Medicine conference that day; so I went to bed early.

I cradled the phone between my ear and shoulder. My father’s voice was fussy. “Someone lies unconscious on the street,” he said hastily. “Can you come and help us?” I asked him to call for an ambulance by that time. He said that he already called. 

While I was preparing in a hurry, my heart started to beat faster and my mind swelled with CPR guidelines, syncope algorithms and my past experiences.

My home is down the block from my parents. I ran there and saw a crowd gathered around a man who was lying on the street. When I passed through I realized someone was doing CPR. I have spotted my parents standing in the crowd and my eyes met with my father. He pointed my younger brother, a trainee surgeon also lives in the same area and was taking his turn on the CPR and checking his pulse. I rushed near them and he filled me in with all they know about the citizen at that point.

The first responder to the cries of the patient’s wife was an ambulance driver with ten years of experience. He said he pulled the patient out of his vehicle. He laid down the man in his 50s suffered from heartburn for the last couple of hours and was about to go to the hospital but lost his consciousness as soon as he started the engine. Since the man wasn’t responding, the former driver started the CPR. About 3 minutes later, my brother showed up along with my father and he took the turn while they kept checking for any response. He said that the rhythm never lasted longer than 10 seconds. So I asked them to keep it up and I took my turn till the ambulance shows up.

It was clear that the patient endured a heart-related condition, probably a myocardial infarction. And I knew by experience that with a proper CPR and early defibrillation, these patients have a high chance of returning of spontaneous circulation, and survival.

The ambulance arrived in a couple of minutes. Paramedics jumped out of the vehicle and rushed to the scene and recognized that I am an Emergency Medicine resident at the State Research and Education Hospital. They let me control the situation. The first rhythm was read on the screen as ventricular fibrillation (VF) and we delivered a shock and started chest compressions again. With the equipment they’ve brought, I intubated the patient while they monitored him with the defibrillator from the ambulance. The nearest hospital was 10 minutes away, and we have shocked-compressed for at least 4 or 5 times in an ambulance moving fast. IT-WAS-HARD!

We have arrived at the hospital. After 10 minutes of additional CPR and proper mediations, spontaneous circulation of the patient returned spontaneous circulation. And a control ECG was consistent with Inferior MI. In a couple of minutes, we were in a different ambulance, headed to the nearest hospital with a coronary angiography unit and ICU.

I took a deep breath after we have delivered the patient to the ICU safe and sound. It was over, for now. One week later, he returned to his home with full recovery, without any neurological sequelae. They were very thankful.

Later on, I’ve heard many funny words people were chattering about this incident. One has particularly given me the giggle. It was coming from an ENT specialist. He said, “So that was no big deal, they probably overreacted and caused him a couple of broken ribs.”

Yeah, there were just some broken ribs… and a life saved.

Further Reading

Cite this article as: Ibrahim Sarbay, Turkey, "Just Some Broken Ribs," in International Emergency Medicine Education Project, August 16, 2019, https://iem-student.org/2019/08/16/just-some-broken-ribs/, date accessed: September 27, 2023

How to Subscribe to iEM Student Podcast

~ Ibrahim Sarbay, Turkey ~ Leave a comment

“A podcast, is an episodic series of digital audio or video files which a user can download in order to listen to.” by Wikipedia’s definition. Listening to podcasts is a useful way of consuming FOAMed materials.

iEM Student audio podcast is one of the components of the project to increase accessibility to the content provided by international contributors. If you like to subscribe and listen to this podcast through your favourite podcast player, here is how: 

1. Just click to your favourite podcast player (We use Overcast app as an example).

2.Click to the plus sign located on the top right.

3. Click to Add URL link.

4. Add below link

http://feeds.soundcloud.com/users/soundcloud:users:443815290/sounds.rss

to the box located below "Podcast URL" text.

5. iEM Student Podcast is now available on the app's main page.

6. Click to the podcast to see the list of available recordings.

That's all! Enjoy!

Cite this article as: Ibrahim Sarbay, Turkey, "How to Subscribe to iEM Student Podcast," in International Emergency Medicine Education Project, June 26, 2019, https://iem-student.org/2019/06/26/how-to-subscribe-to-iem-student-podcast/, date accessed: September 27, 2023

Countries Recognize Emergency Medicine as a Specialty

~ Ibrahim Sarbay, Turkey ~ 8 Comments

As health care professionals working on Emergency medicine, our history is still being written. Let’s say you would like to learn which countries officially recognize Emergency Medicine (EM) as a specialty, and want to make a beautiful interactive infographic depicting these countries with their official EM recognition years (Because, why not?). It should be an easy task, right? WRONG.

What is your guess?

0
0
0
0

How many countries recognize Emergency Medicine as a specialty?

Even though it seems like a simple question which should have a clear answer, the answer is somewhat of a conundrum. There are a few difficulties for the answer. First of all, what is the definition of “recognition”? Could it be possible to consider having an EM residency program or the presence of EM specialists in a country as recognition? Probably not. Secondly, some of the countries recognize EM as a specialty but the exact year of recognition is unclear. Also, the answer may vary between articles and makes it hard to choose one. To make things clear, we have accepted the definition of “recognition” as a country’s official approvement of Emergency Medicine as a primary specialty. Countries recognizing EM as a supra-specialty (such as Switzerland) were also considered as a recognizing country in our list.

Anyway, we have rolled our sleeves up and dug deep. Many articles and tweets later, we had all the data available on this topic. To the best of our knowledge, this is the first time an article or blog post lists EM’s official dates of recognition for the entire world. We have also taken one step further and showed them on a neat interactive map.

So here we go: As of 05/2019, there are 82 countries in the world which recognize EM as a specialty. 13 countries from Africa, 27 countries from Asia, 13 countries from the America, 27 countries from Europe, and two countries from Oceania recognize EM.

As a well-known fact, the first two countries to recognize EM as a specialty are the United States and the U.K. Which are the latest? Germany and Denmark are the most recent of these countries, as both of them recognized EM in 2018. Perhaps, one year later, there will be new countries which welcome EM specialty. Who knows?

Shall we take a look at the current situation in an eye-pleasing way? Of course! You can view our interactive map right here. You can view maps with colors corresponding to the years of EM recognition for each country in the world (darker the color, earlier the date) in Figure 1. You can also view continental maps for Africa, Asia, Americas, Europe and Oceania in Figures 2, 3, 4, 5, 6, respectively.

iEM world

Figure 1. Countries Recognize Emergency Medicine as a Specialty

WORLD

iEM world

Figure 2. Countries Recognize Emergency Medicine as a Specialty

AFRICA

iEM world

Figure 3. Countries Recognize Emergency Medicine as a Specialty

ASIA

iEM world

Figure 4. Countries Recognize Emergency Medicine as a Specialty

AMERICA

iEM world

Figure 5. Countries Recognize Emergency Medicine as a Specialty

EUROPE

iEM world

Figure 6. Countries Recognize Emergency Medicine as a Specialty

OCEANIA

For the ones who believe nothing is better than a list, all countries are listed in alphabetical order in Table 1. Table 1. List of counties which recognize EM as a specialty (alphabetical order).

Table 1. List of counties which recognise EM as a specialty (alphabetical order).
Country Name Year of Recognition
Albania 2011
Argentina 2010
Australia 1993
Bahrain 2001 *
Belgium 2005
Bulgaria 1996
Botswana 2011
Brazil 2016
Canada 1979
Chile 2013
Colombia 2005
Costa Rica 1994
Croatia 2009
Cuba 2000 §
Czech Republic 2013
Denmark 2018
Dominican Republic 2000
Egypt 2003
Estonia 2015
Ethiopia 2010
Finland 2012
France 2015
Georgia 2015
Germany 2018 #
Ghana 2015
Greece 2017 #
Haiti 2014
Hong Kong 1997
Hungary 2003
Iceland 1992
India 2009
Iran 2002
Iraq 2013
Ireland 2003
Israel 2009
Italy 2008
Japan 2003
Jordan 2003
Kenya 2017
Laos 2017
Lebanon 2012
Libya 2013
Lithuania 2013
Malaysia 2002
Malawi 2010
Malta 2004
Mexico 1986
Morocco 2002
Myanmar 2012
Netherlands 1998
New Zealand 1995
Nicaragua 1993
Norway 2017
Oman 1999
Pakistan 2010
Peru 1999
Philippines 1988
Poland 1999
Qatar 2000
Romania 1999
Rwanda 2013
Saudi Arabia 2001
Serbia 1992
Singapore 1984
Slovakia 2003
Slovenia 2006
South Africa 2004
South Korea 1996
Sri Lanka 2011
Sudan 2011
Sweden 2015
Switzerland 2009 #
Taiwan 1998
Tanzania 2011
Thailand 2003
Tunisia 2005
Turkey 1993
United Arab Emirates 2004
United Kingdom 1993
United States 1972
Vietnam 2010
Yemen 2000

* Exact year of EM recognition in Bahrain is unknown and establishing of The Bahrain Emergentologist Association (BEMASSO) in 2004 accepted as the recognition year for this infographic.
§ Cuba has an EM/intensive care unit (ICU) training program which was begun in 2000.
# EM is considered as a supra-specialty in Germany, Greece, and Switzerland.

That is all for now! Please feel free to share it and comment on this list. Also, please tell us if we had any countries left behind or if there were any mistakes. EM family grows every day!

Together we are stronger!

References and Further Reading

  • Swanson RC, Soto NR, Villafuerte AG, Emergency medicine in Peru, J Emerg Med. 2005 Oct;29(3):353-6, DOI:10.1016/j.jemermed.2005.02.013
  • Garcia-Rosas C, Iserson KV, Emergency medicine in México, J Emerg Med. 2006 Nov;31(4):441-5, DOI:10.1016/j.jemermed.2006.05.024
  • Al-Azri NH, Emergency medicine in Oman: current status and future challenges,Int J Emerg Med. 2009 Dec 11;2(4):199-203. doi: 10.1007/s12245-009-0143-6.
  • Sakr M, Wardrope J, Casualty, accident and emergency, or emergency medicine, the evolution, J Accid Emerg Med. 2000 Sep;17(5):314-9.
  • Pek J.H., Lim S.H., Ho H.F., Emergency medicine as a specialty in Asia, Acute Med Surg. 2016 Apr; 3(2): 65–73, doi: 10.1002/ams2.154
  • Fleischmann T, Fulde G.,Emergency medicine in modern Europe, Emerg Med Australas. 2007 Aug;19(4):300-2.
  • Partridge R., Emergency medicine in Cuba: an update, Am J Emerg Med. 2005 Sep;23(5):705-6, DOI: 10.1016/j.ajem.2005.03.006.
  • MacFarlane C, van Loggerenberg C, Kloeck W.,International EMS systems in South Africa–past, present, and future,Resuscitation. 2005 Feb;64(2):145-8,DOI:10.1016/j.resuscitation.2004.11.003
Cite this article as: Ibrahim Sarbay, Turkey, "Countries Recognize Emergency Medicine as a Specialty," in International Emergency Medicine Education Project, May 13, 2019, https://iem-student.org/2019/05/13/countries-recognize-emergency-medicine/, date accessed: September 27, 2023