These Are Our People – Episode 11

These Are Our People – Episode 11

If you have ever worked in an ED, you have taken care of a homeless patient. In fact, you’ve probably taken care of many patients you didn’t even know were struggling with homelessness. As providers, we know these people well. They are often labeled “superusers” and, in addition to sometimes acting as their primary care physicians, we often find ourselves trying to sort out their myriad social issues. In this episode, we talk with a homeless patient, multiple ED providers, and expert Dr. Bisan Salhi, about some of the health challenges that our undomiciled patients face, and what role the ED should play in caring for these patients. You’ll hear a variety of opinions on this controversial topic. We then talk with health policy experts, Dr. Nick Sawyer and Dr. Aimee Moulin, about the recently signed California Senate Bill 1152, and how it will affect hour care and discharge of self-identified homeless patients. 

Do you screen for homelessness? How do you care for homeless patients in your ED? Will you be affected by CA Senate Bill 1152? This topic is likely to generate some heated conversation. Join us on social media, @empulsepodcast, or on our website, ucdavisem.com, to keep the discussion going. 

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Bisan Salhi,  Assistant Professor of Emergency Medicine at Emory and PhD in Anthropology

Dr. Nick Sawyer, Assistant Professor of Emergency Medicine at UC Davis, California ACEP Board Member

Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and President of California ACEP

Resources:

Homelessness and Emergency Medicine: A Review of the Literature.

Salhi BA, White MH, Pitts SR, Wright DW.

Acad Emerg Med. 2018 May;25(5):577-593. doi: 10.1111/acem.13358. Epub 2018 Jan 11.

Get involved through California ACEP!

Read the complete California Senate Bill 1152.

******************************************************

What better place to earn CME than Maui! There’s still time to register for the 15th Annual Emergency Medicine Hot Topics conference taking place Nov. 6-10, 2018 in Hawaii. Earn up to 20.5 CME credits!

Register today at tinyurl.com/EMHOTTOPICS

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Excuse me, Your Bias is Showing – Episode 10

Excuse Me, Your Bias is Showing – Episode 10

We all have biases lurking in our unconscious mind. These are our implicit biases, and they affect how we relate to patients and, in turn, how they relate to us. But if these biases are unconscious, how do we identify them? And is it possible to change them? We share our own experiences with implicit bias, and we hear Dr. Rupa Marya’s story that went viral on social media. Then we dive a little deeper with researcher and pediatric emergency medicine physician, Dr. Tiffani Johnson.

Want to check your own biases? Take an implicit association test (IAT) through Project Implicit. Let us know what you found and let’s continue the discussion on social media, @empulsepodcast. If you’d like to keep your results more private, send us a comment on our website, ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Tiffani Johnson, Pediatric Emergency Medicine Physician and Faculty at the Policy Lab at Children’s Hospital of Philadelphia (CHOP) 

Special thanks to Dr. Rupa Marya and Bonnie Castillo for allowing us to use the audio from this video that was featured on NowThis Politics

Resources:

The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias.

Johnson TJ, Hickey RW, Switzer GE, Miller E, Winger DG, Nguyen M, Saladino RA, Hausmann LR. Acad Emerg Med. 2016 Mar;23(3):297-305. doi: 10.1111/acem.12901. Epub 2016 Feb 22. PMID: 26763939

Comparison of Physician Implicit Racial Bias Toward Adults Versus Children.

Johnson TJ, Winger DG, Hickey RW, Switzer GE, Miller E, Nguyen MB, Saladino RA, Hausmann LR. Acad Pediatr. 2017 Mar;17(2):120-126. doi: 10.1016/j.acap.2016.08.010. Epub 2016 Sep 13. PMID: 27620844

Project Implicit – take an IAT!

*******************************************************************

Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open!

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Dr. Tiffany Johnson (center)

 

Thriving not Surviving – Episode 9

Thriving, not Surviving – Episode 9

Are you well? In this episode we tackle the issue of physician wellness. What does that mean? Why is it a problem? And what can we do to thrive, not just survive, in medicine? We discuss strategies with EM physicians of all levels, including Cal ACEP President, Dr. Aimee Moulin, and Dr. Katren Tyler, Vice Chair of Wellness for the UC Davis Department of Emergency Medicine.

How do you define physician wellness? What is your personal recipe for THRIVING, not just surviving? Join the conversation on social media, @empulsepodcast, or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and President of California ACEP

Dr. Katren Tyler, Professor of Emergency Medicine and Vice Chair for Faculty Development, Wellness and Outreach in the UC Davis Department of Emergency Medicine

Various UC Davis Department of Emergency Medicine residents, fellows, and faculty.

Resources:

Ten commandments of physician wellness.

Krall EJ. Clin Med Res. 2014 Sep;12(1-2):6-9. doi: 10.3121/cmr.2013.1211. Epub 2014 Jan 10. No abstract available. PMID: 24415746

What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement.

Brady KJS, Trockel MT, Khan CT, Raj KS, Murphy ML, Bohman B, Frank E, Louie AK, Roberts LW.

Acad Psychiatry. 2018 Feb;42(1):94-108. doi: 10.1007/s40596-017-0781-6. Epub 2017 Sep 14. Review. PMID: 28913621

****************************************************************************************

Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open!

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

 

 

Don’t Be A Jerk – Episode 8

Don’t be a Jerk – Episode 8

Dr. R Nick Gorton and Dr. Kara Toles are back to talk about transgender care in the Emergency Department. Did you know you already have the skills to advocate for and care for transgender patients? You do! Let’s sum it up in four words: DON’T BE A JERK! Treat your patients like you’d want your family member to be treated. We’ll explore some of the challenges and concerns specific to transgender patients — JM Jaffe shares a very personal account of their experience. Drs. Gorton and Toles then review Nick’s recent paper on the topic and give us some practical tips to help us gracefully navigate the complexities of the gender spectrum in the ED. 

How does your department (or residency, med school, etc.) address the topic of transgender care? Join the conversation on social media, @empulsepodcast, or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

JM Jaffe, Trans Health Manager at Lyon Martin Clinic

Dr. Kara Toles, Assistant professor of Emergency Medicine at UC Davis and Emergency Physician at UTMB Health. 

Dr. R. Nick Gorton, Emergency Physician at Sutter Davis, and Primary Care Physician at the Lyon-Martino Clinic in San Francisco. 

Resources:

TRANSLINE national online transgender medical consultation service – free and confidential. 

Lyon-Martin Health Services, San Francisco, CA.

Improving the Quality of Emergency Care for Transgender Patients

Gorton RN, Berdahl CT. Ann Emerg Med. 2018 Feb;71(2):189-192.e1. doi: 10.1016/j.annemergmed.2017.12.003. Epub 2018 Feb 5.

“Sometimes You Feel Like the Freak Show”: A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients

Elizabeth A. Samuels, Chantal Tape, Naomi Garber, Sarah Bowman, Esther K. Choo

Ann Emerg Med. 2018 Feb;71(2):170-182.e1. doi: 10.1016/j.annemergmed.2017.05.002. Epub 2017 Jul 14.

Transgender and Gender-Nonconforming Patients in the Emergency Department: What Physicians Know, Think, and Do

Makini Chisolm-Straker, Cathleen Willging, Adrian D. Daul, Shannon McNamara, S. Cham Sante, Daniel G. Shattuck II, Cameron S. Crandall

Ann Emerg Med. 2018 Feb;71(2):183-188.e1. doi: 10.1016/j.annemergmed.2017.09.042. Epub 2017 Nov 3.

Improving Care for Lesbian, Gay, Bisexual, and Transgender Patients in the Emergency Department 

Ann Emerg Med. 2015 Oct;66(4):417-23. doi: 10.1016/j.annemergmed.2015.02.004. Epub 2015 Mar 5.

Sara Jalali, Lauren M. Sauer

***************************************************************************************

Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open at www.cevs.ucdavis.edu/confreg/?confid=960

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

 

 

 

LGBTQI, MD

LGBTQI, MD

Happy Pride, everyone! June is coming to an end and we’ve enjoyed celebrating all the diverse and beautiful people in our communities. In the spirit of Pride month, this Heartbeat explores what it’s like to be an LGBTQI physician. For those unaware, LGBTQI stands for lesbian, gay, bisexual, transgender, queer (or questioning), and intersex. Many people also add an A for asexual, or allies. Dr. Kara Toles and Dr. Nick Gorton graciously share their stories with us, as well as their advice for future doctors who may identify with any of the letters in the acronym. Dr. Gorton and Dr. Toles will also be joining us in an upcoming full episode that we are really excited about. Stay tuned!

Do you identify as LGBTQIA? We’d love to hear your story. Please send us your thoughts or experiences through our website, ucdavisem.com, or on social media, @empulsepodcast. We look forward to hearing from you!

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Kara Toles, Assistant professor of Emergency Medicine at UC Davis and Emergency Physician at UTMB Health. 

Dr. R. Nick Gorton, Emergency Physician at Sutter Davis, and Primary Care Physician at the Lyon-Martino Clinic in San Francisco. 

Resources:

GLMA – Gay and Lesbian Medical Association – Ensuring equality in healthcare for LGBT individuals and healthcare professionals. 

It Gets Better Project

Lyon-Martin Health Services, San Francisco, CA. 

***************************************************************************************************

Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open at www.cevs.ucdavis.edu/confreg/?confid=960

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Breaking Out of Concussion Jail – Episode 6

Breaking Out of Concussion Jail – Episode 6

Suffering a concussion can make you feel like a prisoner, especially if you’re a student athlete. Cameron Wright, a division I water polo player who suffered a concussion last year, knows this first hand. In this episode, he shares his experience with concussion, and how he finally returned to the sport he loves. Dr. Roger Zemek, one of the leading investigators studying concussion and return to play, discusses how recent research is changing our approach to recovery. Finally, Dr. Jeremiah Ray, a Sports Medicine and Emergency trained physician, talks about how he manages concussion in his college athletes, and gives us his recommendations for assessing and counseling patients in the ED. 

How do you manage concussion in your practice? Does what you’ve heard change anything for you? Continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Cameron Wright, Men’s Water Polo Player at UC Berkeley

Dr. Roger Zemek, FRCPC Associate Professor Pediatrics and Emergency Medicine University of Ottawa, Vice chair pediatric emergency research Canada (PERC), Clinical Research chair in Pediatric Concussion University of Ottawa 

Dr. Jeremiah Ray, Head Team Physician for UC Davis Intercollegiate Athletics

Resources:

SCAT 5 (Sports Concussion Assessment Tool – 5th Edition)

CDC HEADS UP to Brain Injury Awareness

NCAA Concussion Diagnosis and Management Best Practices

The National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements Version 1.0 Recommendations.

Broglio SP, Kontos AP, Levin H, Schneider K, Wilde EA, Cantu RC, Feddermann-Demont N, Fuller G, Gagnon I, Gioia G, Giza CC, Griesbach GS, Leddy JJ, Lipton ML, Mayer A, McAllister T, McCrea M, McKenzie L, Putukian M, Signoretti S, Suskauer SJ, Tamburro R, Turner M, Yeates KO, Zemek R, Ala’i S, Esterlitz J, Gay K, Bellgowan PSF, Joseph K. J Neurotrauma. 2018 May 2. doi: 10.1089/neu.2018.5643. [Epub ahead of print] PMID: 29717643

Full Interview with Dr. Roger Zemek

Not so FAST – Episode 5

Not so FAST – Episode 5

Should we be doing FAST exams on all pediatric trauma patients? In this episode, we hear about a case where the FAST may have saved a child’s life. Then we talk with peds trauma experts, Drs. Nate Kuppermann and Jim Holmes, about their recent study on the utility of the FAST exam in stable pediatric trauma patients. Ultrasound expert, Ken Kelley, shares his thoughts on the paper and the role of the FAST exam in kids.

Do you FAST all of your pediatric trauma patients? Join the conversation on social media @empulsepodcast or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guest Host: Dr. Michael Schick, Assistant Professor of Emergency Medicine and Global Ultrasound Fellowship Director at UC Davis

Guests:

Dr. Nate Kuppermann, Professor and Chair of the Department of Emergency Medicine at UC Davis, Founding Chair of the PECARN Steering Committee

Dr. Jim Holmes, Professor of Emergency Medicine at UC Davis, SAEM Secretary-Treasurer

Dr. Ken Kelley, Associate Professor of Emergency Medicine and Ultrasound Fellowship Director at UC Davis

Case retold by Dr. Nathan Vanden Berge, Emergency Medicine Resident at UC Davis

Resources:

Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial.

Holmes JF, Kelley KM, Wootton-Gorges SL, Utter GH, Abramson LP, Rose JS, Tancredi DJ, Kuppermann N. JAMA. 2017 Jun 13;317(22):2290-2296. doi: 10.1001/jama.2017.6322. PMID: 28609532

Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma.

Menaker J, Blumberg S, Wisner DH, Dayan PS, Tunik M, Garcia M, Mahajan P, Page K, Monroe D, Borgialli D, Kuppermann N, Holmes JF; Intra-abdominal Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). J Trauma Acute Care Surg. 2014 Sep;77(3):427-32. doi: 10.1097/TA.0000000000000296. PMID: 25159246

Sonostuff.com

FAST in Trauma Part 1 Video

FAST in Trauma Part 2 Video

SAEM: FAST examination

ACEP Pediatric Emergency Ultrasound Update: The Unique Pediatric FAST

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

 

The FAST exam from the case in this episode reveals a massive hemopericardium with tamponade, shown here in the subxiphoid view.

The Game Has Changed – Episode 4

The Game Has Changed – Episode 4

Let’s talk about the opioid crisis. One woman tells her powerful story of opioid addiction, treatment, and recovery. Then, we discuss the role Emergency Physicians can play in controlling this epidemic with experts, Dr. Gail D’Onofrio and Dr. Josh Elder.

How do you manage opioid use disorder in your practice? Join the conversation on Social Media @empulsepodcast or at ucdavisem.com

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Gail D’Onofrio, Professor and Chair of the Department of Emergency Medicine at Yale

Dr. Josh Elder, Assistant Professor of Emergency Medicine at UC Davis Health

Resources:

Screening Brief Intervention & Referral to Treatment (SBIRT)

National Institute on Drug Abuse (NIDA) information on opioids

Buprenorphine vs. Methadone on atforum.com

Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.

D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. JAMA. 2015 Apr 28;313(16):1636-44. doi: 10.1001/jama.2015.3474. PMID: 25919527

Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention.

D’Onofrio G, Chawarski MC, O’Connor PG, Pantalon MV, Busch SH, Owens PH, Hawk K, Bernstein SL, Fiellin DA. J Gen Intern Med. 2017 Jun;32(6):660-666. doi: 10.1007/s11606-017-3993-2. Epub 2017 Feb 13. PMID: 28194688

Cost-effectiveness of emergency department-initiated treatment for opioid dependence.

Busch SH, Fiellin DA, Chawarski MC, Owens PH, Pantalon MV, Hawk K, Bernstein SL, O’Connor PG, D’Onofrio G. Addiction. 2017 Nov;112(11):2002-2010. doi: 10.1111/add.13900. Epub 2017 Aug 16. PMID: 28815789

You can listen to the entire interview with “Rachel” here: Rachel’s Story

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

 

 

 

I’m just a Reanimatologist – Episode 3

I’m just a Reanimatologist – Episode 3

This month’s episode explores the controversial topic of Emergency Department initiated extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS). Dr. Jonathon Ford relives a challenging case of beta blocker and calcium channel blocker overdose. Then, we have a front row seat in the heated battle of words between Dr. John Rose and Dr. Dan Colby on the pros and cons of ED ECMO.

Where do you stand? Join the conversation on Social Media @empulsepodcast or at https://ucdavisem.com

Hosts:
Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis
Dr. Julia Magaña, Assistant Professor of Emergency Medicine at UC Davis – Pediatric Emergency Medicine

Guests:
Dr. Jonathon Ford, Assistant Professor of Emergency Medicine, and Medical Toxicologist at UC Davis Health
Dr. Dan Colby, Assistant Professor of Emergency Medicine, and Medical Toxicologist at UC Davis Health
Dr. John Rose, Professor of Emergency Medicine at UC Davis Health, and EMS Medical Director for Yolo County

Resources:
Massive diltiazem and metoprolol overdose rescued with extracorporeal life support
https://www.ncbi.nlm.nih.gov/pubmed/28705745
Chenoweth JA, Colby DK, Sutter ME, Radke JB, Ford JB, Nilas Young J, Richards JR. Am J Emerg Med. 2017 Oct;35(10):1581.e3-1581.e5. doi: 10.1016/j.ajem.2017.07.023. Epub 2017 Jul 6. PubMed PMID: 28705745.

The ED ECMO Project and Podcast with Doctors Joe Bellezzo, Zack Shinar, and Scott Weingart. http://edecmo.org

ECLS Registry Report on http://elso.org

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Episode 2: Sold for a Chrysler 300

Episode 2: Sold for a Chrysler 300

January is National Human Trafficking Awareness Month. In light of this, we have a very special episode for you. Annika Huff (formerly Annika Mack), a trafficking survivor, speaks with us about her experiences in the life, how she got out, and what she is doing now. Then, Dr. Bryn Mumma takes us through her research on how we can better identify potential victims in the ED. Dr. Rachel Robitz shares some advice on how to approach these patients, create a safe space, and offer support and resources, and our own Dr. Julia Magaña discusses how she manages this in pediatric patients.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Emergency Medicine at UC Davis – Pediatric Emergency Medicine

Dr. Nick Sawyer, Assistant Professor of Emergency Medicine at UC Davis, California ACEP Board Member, and Director of UC Davis UNITED

Guests:

Annika Huff (formerly Annika Mack), Advocate, Speaker and Survivor

http://annikahuff.com/

Dr. Bryn Mumma, Assistant Professor of Emergency Medicine at UC Davis

Dr. Rachel Robitz, Assistant Clinical Professor of Psychiatry, Associate Training Director of Family Medicine/Psychiatry

Resources:

Screening for Victims of Sex Trafficking in the Emergency Department: A Pilot Program.

https://www.ncbi.nlm.nih.gov/m/pubmed/28611881/

Mumma BE, Scofield ME, Mendoza LP, Toofan Y, Youngyunpipatkul J, Hernandez B. West J Emerg Med. 2017 Jun;18(4):616-620. doi: 10.5811/westjem.2017.2.31924. Epub 2017 Apr 17. PMID: 28611881

National Human Trafficking Resource Center 1-888-373-7888

https://humantraffickinghotline.org/

WEAVE is the primary provider of crisis intervention services for survivors of domestic violence and sexual assault in Sacramento County

https://www.weaveinc.org/

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.