Emergency Culture

When I walked in ED as a resident for first time, I felt something is different. At first I thought it might because of a larger hospital, larger university, academic ED or etc.; but the difference was much bigger. Now I am graduated as an emergency physician and work in various EDs and yet I can feel that difference. I don't think the different is because of a larger hospital, more equipment, an emergency medicine specialist or even an academic ED itself anymore. I think it is all about a change in thinking process and practicing medicine that I'd like to call it "emergency culture".

Emergency culture involves all emergency staffs from emergency physicians to general practitioners working in ED to ED nurses to ED securities to even ED workers. It is a change in thinking process that differentiates between well and ill patients; that can triages patients rightly. It is a change in practicing medicine so one can do best for the patient, not for the disease, on time; and one can do multiple tasks together in a so distracting environment.

Now as an emergency physician I ask myself "Is my patient is dying? Is his/her ABC are secure and maintained? Is his/her life or limb on danger?" every time I see a new patient. I think it is the difference between me and anyone without "emergency culture".

What do you think?

photo: University of Rochester Emergency Medicine Residency Program

new TINTANALLI's book & our residency program director

Yesterday, as I searched the web for new Tintinalli's book, I found something interesting that made me proud. The author of chapter 219:"Type 2 Diabetes Mellitus" is DR Mohammad Jalili, our residency program director and one of our best professors here.

see here: http://www.mcgraw-hill.co.uk/html/0071484809.html click Table of contents

Hysterical Patient: Something to Remember

I read this nice, educative post at the centarl line. Its a common error in ED and may occur for every EP.
Please read it.

Even "Puppet Ice Cream" is Sad

Sometime I heard a joke: 'Learn happiness from "Puppet Ice Cream" who always smile despite that bar in his bottom.'

It seems nowadays even "Puppet Ice Cream" is sad.

Puppet Ice Cream: A type of ice cream called "Bastani-e-Aroosaki" Sold by Mihan and maybe some other manufacturer in Iran.
Photo: I am holding ice cream in today ED class. The green blurred one is the lecturer. Ice creams were bought to us by our kind professor DR.Nejati.

What did they do in the ED?

I see them in a night shift in our ED.
What did they do in the ED? What do you think?

a diasapointed one

Yesterday was my first shift in toxicology and quite disappointing.
Despite my expectations and hopes; there were an over crowded emergency without any educational benefit for me. Most of my patients were ingested benzodiazepines or intoxicated with ethanol and a smaller group were intoxicated with amphetamines, opioids etc. Since 10pm till 1am I had 22 patients, 3 of them comatose enough to be intubated. I just saw my patients, take a very brief history (Material? Amount? Time Taken? Emesis? Reason?) and a more brief Physical examinations (ABC + V/S + pupils + rarely neurologic examination) and write my orders rapidly. Not enough time to think, consult or even concentrate at my cases.
What make the shift harder was the act of EMS and other hospitals that send any addict patient with any presentation (mostly decreased LOC) to our ED.

My resume in this shift:
about 30-40 patients admitted
2 CPRs both with ROSC
5 Intubations

The educational note of my shif:
My compatriots are mostly addict or at least have someone addict in their family; interestingly Pour Methadon syroup or liqufied opium in refrigerator.

P.S. Tonight I'll be in my favorite ED again.

my new blue scrub

After lots of delay we now have new scrubs in our ED.
Our new scrubs were supposed to be better than our olds but in my and many of my friends mind, they are not. Our main complaint is about the tight ugly colars, that are like female clothing.
Other problems include its color and the cloth itself (which contains a large amount of plastic fibers).