In case you didn’t encounter a patient with hand pain today!
Doc! My Hand Hurts.
Happy week with tons of education!
ACS in 12 minutes!
by Khalid Mohammed Ali, Shirley Ooi from Singapore.
A 46 years old man with a past medical history of hypertension and hyperlipidemia developed central crushing chest pain associated with sweating and shortness of breath while driving. He presented to the emergency department 1 hour after the onset of chest pain. On physical examination, his vital signs were as follows; pulse rate: 60 beats per minute, blood pressure: 100 over 50 mmHg, respiratory rate: 20 per minute, Oxygen Saturation: 98% on room air. Patient has no leg edema, new murmur or features of heart failure. ECG is given on the side.
What is your diagnosis?
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ECG
ECG features are ST elevation in inferior leads with reciprocal changes in lateral leads of I, aVL and ST depression in lead V1, V2. The ECG is diagnostic of inferior and posterior wall ST elevation MI.
Answer
Being A Woman In Emergency Medicine
Watching the famous TV series “ER” in my 3rd year of medical school I decided to be an “ER doctor.” I started my Emergency Medicine residency in 2003. So this is my 15th year in Emergency Medicine. I have not regretted my choice yet, and I cannot imagine myself being anything else but an Emergency Physician.
Emergency medicine is indeed a fulfilling career choice for a variety of reasons: first of all, we are cool, we never panic over an emergency. Secondly, emergency medicine is never boring, every shift in the Emergency Department is filled with diverse cases waiting to be solved, like a puzzle. We treat patients in every age group with all kinds of chief complaints, and we hear all sorts of exciting stories. We are there for people who need us most, 24/7, on one of the worst days of their lives, regardless of their background and financial status. We bring patients who are near death back to life, and in every shift, we feel that we make a real difference.
Having said all this, I admit that the life of an Emergency Medicine physician is not a perfect fit for everyone. For example, although shift work is flexible by its nature and you have control over your schedule, shift work is not desirable to everyone. If you plan ahead shift work will allow you to take more vacations any time during the year but if something comes up last minute, there is a pretty good chance that you will miss it. Night shifts may easily disrupt your body cycle even if you follow the recommendations for sleep and it gets harder with age. Working weekends and holidays will mean missing some family gatherings or events at your children’s school and may make your social life difficult. On the bright side, you will always have free weekdays to run errands or catch up with friends on their lunch breaks. Although you do not bring work to your home, (when your shift is over you just pass your patients to another doctor, leave emergency department, and you are not on call) sometimes your shift is so physically exhausting and emotionally draining that you have little energy left for home.
If you are living in a culture where child raising, housework or care of the elderly is seen primarily as women’s duty, or you choose a partner that thinks so, you may have a harder time in life regardless of the specialty you choose as a woman. You may solve some of this issue by willing to accept all help you are offered from close ones and purchase help when necessary to share some of these duties. You may find fewer role models in Emergency Medicine compared to your male peers, but if you look carefully, you will recognize female or male leaders close to you, who understand the difficulties you face and offer you their mentorship.
When choosing any specialty, think about not just now but try to imagine what would make you happy in 10-20-30 years. Yes, being an Emergency Medicine specialist has its challenges and is harder in some aspects compared to other specialties, but I think most of the challenges are there regardless of being men or women. I also believe that with a little flexibility and creativity you can overcome the difficulties, so join us who find joy and feel content in the vibrant and exciting environment of emergency medicine.
Suggested Chapters
I can’t breath Doc!
In case you didn’t encounter shortness of breath today!
A 68-year-old with wheezing
Chronic Obstructive Pulmonary Disease (COPD)
by Ramin Tabatabai, David Hoffman, and Tiffany Abramson, USA
A 68-year-old male presents to the emergency department (ED) with audible wheezing, and he is in severe respiratory distress. He is speaking in 2-3 word sentences, and he is diaphoretic and slightly confused. Per the paramedic report, the patient is a two pack per day smoker. On physical examination, the patient demonstrates poor air movement, and you note that he has a “barrel chest.” As you pick up the phone to call the respiratory therapist for airway management, you wonder, “What other interventions should I initiate and are there other diagnoses I should be considering?”
What is the value of BiPAP on COPD?
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BiPAP on COPD
The use of BiPAP led to decreased mortality (NNT=10), reduction in treatment failure (NNT=5) and decreased need for intubation (NNT=4).
Answer
iEM Weekly Feed
Welcome to iEM Weekly Feed!
With this feed, you do not miss anything. You will find all published blog posts during this week. Click the “title” or “read more” to open each page you interested in.
Unbearable Attraction of Emergency Medicine
June 29, 2018
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Where This Attraction Come From? Emergency Medicine! It is maybe the most desired specialty all around the world. Countries are rapidly changing their systems to
Is this AAA going to be ruptured?
June 30, 2018
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Abdominal Aortic Aneurysm (AAA) Lit Sin Quek A 75-year-old obese man comes to the emergency department. He has history COPD, hypertension. He is a smoker
Did You Encounter Poisoned Patient Today?
July 1, 2018
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“Approach to poisoned patients” is one of the core EM clerkship topics! Poisonings Harajeshwar Kohli and Ziad Kazzi, USA An 18-year-old, previously healthy female, presents
Elderly With Abdominal Pain!
July 1, 2018
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Acute Mesenteric Ischemia Rabind Antony Charles, Singapore A 75-year-old woman presents to your Emergency Department (ED) with diffuse abdominal pain for the past day, associated
Feel Responsible?
July 2, 2018
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You may wonder “how to contribute” Promoting Emergency Medicine and improving undergraduate Emergency Medicine education (UEME) are the responsibility of all of us. We believe
Take EM Clerkship Seriously!
July 2, 2018
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This chapter describes how and why important the emergency medicine clerkship is. Although it aims to reach medical student/interns, there are many lessons to learn
Secure With Square Knot
July 3, 2018
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Topic Today, we just wanted to emphasize a vital part of the suturing procedure which is sometimes forgotten. This is square knot. Simple, easy and important. Problem Suturing is
GI Bleeding in 12 min
July 4, 2018
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Gastrointestinal Bleeding by Moira Carrol, Gurpreet Mudan, and Suzanne Bentley, USA A 61-year-old man with a history of liver cirrhosis secondary to chronic EtOH abuse
Give Me A Headache!
July 4, 2018
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Headache by Matevz Privsek and Gregor Prosen, Slovenia A 52-year old male comes to the ED with a severe headache. A triage nurse gives you
A 24-year-old female with pelvic pain
July 4, 2018
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How ectopic pregnancy should be delivered to the students/interns. Clear, to the point! Ectopic Pregnancy by Dan O’Brien, USA A 24-year-old woman presents to the
Dramatic Flail Chest
July 5, 2018
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In case you did not encounter a flail chest today. https://youtu.be/k78yENIpmFE
A 22-year-old male
July 5, 2018
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Acute Appendicitis by Ozlem Dikme, Turkey A previously healthy 22-year-old male was brought to the emergency department (ED) with recently-started abdominal pain. He had not
Dramatic Diaphragmatic Hernia
July 6, 2018
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In case you didn’t encounter shortness of breath today! Go To “Respiratory Distress” Chapter Go To “Chest Pain” Chapter iEM Education Project Team uploads many
Severe Fecal Impaction And…
July 6, 2018
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In case you didn’t encounter abdominal pain today! Go To “Abdominal Pain” Chapter iEM Education Project Team uploads many clinical picture and videos to the
Severe Fecal Impaction And…
In case you didn’t encounter abdominal pain today!
Dramatic Diaphragmatic Hernia
In case you didn’t encounter shortness of breath today!
A 22-year-old male
Acute Appendicitis
by Ozlem Dikme, Turkey
A previously healthy 22-year-old male was brought to the emergency department (ED) with recently-started abdominal pain. He had not eaten anything since that morning due to loss of appetite. He was nauseated and vomited three times. His abdominal pain started around the umbilicus and epigastric area. His pain increased as it moved towards his right lower quadrant (RLQ). The maximum pain was felt on the right iliac fossa. He had not taken any medication. His social history revealed that he was non-drinker, non-smoker and did not use any illicit drugs. His diet mostly consisted of carbohydrates. The past and family histories were unremarkable. His blood pressure was 120/70 mmHg, pulse rate was 100/min, the temperature was 37.8°C (100°F), and respiration rate was 22/min.
Physical examination showed normal bowel sounds, tenderness and voluntary guarding, particularly over the right iliac fossa. The costa-vertebral angles were not tender. Oral intake was stopped, intravenous (IV) catheter was inserted, blood and urine tests were planned, and fluid therapy was started. The urinalysis was normal. White blood cell (WBC) count was 14,500 with 89% polymorphous and 11% lymphocytes. The ultrasonography (USG) showed a non-compressible tubular structure of 9 mm in diameter at RLQ. He admitted to the surgical ward with the diagnosis of acute appendicitis.
Dramatic Flail Chest
In case you did not encounter a flail chest today.
A 24-year-old female with pelvic pain
How ectopic pregnancy should be delivered to the students/interns.
Clear, to the point!
Ectopic Pregnancy
by Dan O’Brien, USA
A 24-year-old woman presents to the emergency department with the complaint of lower abdominal pain and vaginal spotting. She has never been pregnant. Her last normal menstrual period was two months ago. She had light spotting last month and states that her period this month is late. Her history is notable for one episode of lower abdominal pain two years ago thought to be the pelvic inflammatory disease that responded to a two-week course of oral antibiotics. She has no medical allergies and is not on any medications.
Review of systems and family history are unremarkable. Her social history is significant in that she is in a monogamous relationship and is not using birth control. Her general appearance is that of a well-developed female with a temperature of 37ºC, a blood pressure of 110/70 mm Hg and a pulse of 90 bpm. An examination of her abdomen reveals normal bowel sounds, no masses, distension, organomegaly or rebound tenderness. She is mildly tender to palpation in the left lower quadrant. Pelvic exam reveals left adnexal tenderness without palpable masses. The rectal exam is normal with hemoccult negative stool. Pertinent lab values: urine dip pregnancy testing is positive, quantitative serum B-hCG is 2000 mIU/mL, hemoglobin 13 gr/dL, hematocrit 40%. She is Rh-positive. A transvaginal ultrasound performed by the emergency physician during the pelvic exam fails to demonstrate an intrauterine pregnancy. There is a small amount of fluid in the rectouterine cul-de-sac. 2 cm ectopic pregnancy was identified. Two large-bore IV’s were started, the patient was crossmatched for blood and OB-GYN was consulted. Treatment options were discussed.