Managing Psychosis In The ED

Case 1.  It is a quiet Wednesday night in the emergency department when you suddenly hear someone coming down the hall continuously spouting out a string of profanities.  You leave the comfort of your chair to see what the commotion is all about only to find a 37-year-old female brought in by police for altered mental status.  She is acutely agitated on presentation, spouting obscenities non-stop, refusing to answer questions and uncooperative with a physical exam.

Case 2.  As you are pondering your next step, you see the paramedics wheeled an older gentleman past you and into the next room.  You step into the next room to get a report.  The family is at the bedside and states the patient is an 82-year-old male with a history of hypertension and BPH who has been increasingly confused and aggressive over the past two days.  You note that he is mildly tachycardic when you hear the PA system announce, “Security is needed in the critical care hallway.”

Case 3.  A nurse pops her head into the room and requests your immediate assistance.  You follow him down the hall and see your charge nurse along with three security officers trying to hold down a male patient.  The patient, who appears to be in his late twenties, is actively kicking and trying to bite and spit at the medical staff.  He appears flushed and diaphoretic.

by Michelle Chan, Nidal Moukaddam, and Veronica Tucci from USA.

A Kid With Wrist Pain!

In case you didn’t encounter a wrist pain today!

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!

Happy week with tons of education!

Being A Woman In Emergency Medicine

being a women in EM

Gül Pamukçu Günaydın


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

Choosing the Emergency Medicine As A Career

C. James Holliman

Emergency Medicine: A Unique Specialty

Will Sanderson, Danny Cuevas, Rob Rogers

Unbearable Attraction of Emergency Medicine

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 modern emergency medical care. Residency trained emergency physicians are the cornerstone of this change across the globe. Today, more than 65 countries have recognized Emergency Medicine specialty. The demand is still so big, and all systems are facing to Emergency Physician shortage. However, it is not the reason why thousands of students/interns apply for a single position every year. 

This summer many new Emergency Medicine residents will start their new career. They are the winners! They chose the best specialty ever. They chose to be the advocate for their patients. They chose the challenge themselves to save a life, many lives. 

Want to understand more “why?” We have 3 chapter to share with you. You may prefer to read or listen. Every medical student and intern should know these facts; the facts that make our specialty unique. 

Emergency Medicine: A Unique Specialty

Will Sanderson, Danny Cuevas,
and Rob Rogers

Imagine walking into the hospital to start your day – ambulances are blaring, the waiting room is clamoring, babies are crying…

Choosing the Emergency Medicine As A Career

C. James Holliman

The specialty of Emergency Medicine (EM) is a great career choice for medical students and interns. In August 2013, I celebrated my 30th year in full-time EM clinical practice…

Thinking Like an Emergency Physician

Joe Lex

Why are we different? How do we differentiate ourselves from other specialties of medicine? We work in a different environment in different hours and with different patients more than any other specialty. Our motto is “Anyone, anything, anytime.”