Archive for the ‘_lecture’ Category

  SMACC Page with streaming audio & slideset    

HelpCard and Opioid Misuse

September 3rd, 2016
by reuben in _lecture, opioid misuse

          HelpCard for printing with your printer HelpCard for submitting to printing company Pain, Compassion, Addiction, Malingering How to use opioids and how to not use opioids Video + Slides (University of Toronto) (35 minutes + questions) SMACC 2015 Audio (right click to download) (25 minutes) SMACC 2015 Slideset SMACC Podcast Page EM Cases Discussion with Anton Helman and David Juurlink   Opioid Misuse Phraseology My job is to manage your pain at the same time that I manage the potential for some pain medications to harm you. I know you are in pain and I want to improve your pain, but I believe that opioids are not only the wrong treatment for your pain, but that opioids are the cause of your pain. I think pain medications are harming you, and if you could stop taking them, your pain and your life would improve. Can I offer you resources that will help you stop taking pain medications? Prescription pain medications, even when used as directed, can cause patients to become dependent, and I’m concerned that the pills we prescribed for you in the past, even though you were using them appropriately, you may now be dependent on them. We can help you break free of that dependence. My most important job as an emergency doctor is to make sure there’s no emergency, so I would like to do some tests to make sure there’s nothing dangerous happening to you, and also I want to relieve your pain. But you will not receive…

Most of us were taught to place central lines using the wire through needle Seldinger technique, but using the introduction catheter instead of the needle makes successful wire insertion more likely and facilitates venous confirmation. A 7 minute screencast. on vimeo operating room video of wire through catheter technique. recommend viewing at 2x speed. Update 1 Lee 2015 compares wire through needle and wire through catheter and shows that wire through needle is (slightly) better. The operators were anesthesiologists very experienced in central line insertion, which may account for their results. In the less controlled ED environment, with providers who don’t place a lot of lines (especially learners), the tendency of the needle to move before the wire can be transmitted may be more important. Also they did not confirm venous location in this study, which should be done whenever feasible and is greatly facilitated by the wire through catheter technique. Still, I’m aware of no data comparing the two techniques other than this (which appeared a few weeks after I posted the video), so though my success rate is definitely higher since I switched to wire through catheter, your mileage may vary. Update 2  There are two advantages of the wire through needle (conventional approach): the needle is functionally slightly longer than the catheter, and the needle doesn’t kink. Neither of these advantages make a difference at the IJ site, and where I work almost all lines are IJ, so I didn’t mention this in the video. Based on feedback, I am surprised (and pleased) at how many non-IJ lines are…

Audio Slides References

  Ten minute screencast describing an expanded ABCs mnemonic. Mobile phone optimized cheat sheet at emupdates.com/resus. Slides. Audio. Resus Room pic.

Three part screencast covering the essentials of procedural sedation and analgesia for emergency clinicians. Part one covers how to think about and prepare for PSA, including a discussion of fasting guidelines. 13 minutes. Part two describes how patients are harmed during PSA and how to prevent patients from being harmed during PSA. 29 minutes. Part three discusses contemporary PSA pharmacology. 16 minutes.   References Slideset Emergency Department PSA Checklist  

Ventilation is the most important skill in airway management, and most of us learned to do it incorrectly. Slideset. As given at Emcrit’s critical care conference.

  slideset available here.

30 minute presentation on optimal patient assessment in the emergency department. garbled audio resolves at the one minute mark. Slides and Handout.   More recent live version. EM Thinking in Polish (credit: Janusz Springer)

high-def vimo screencast here. slideset here. audio here.