Where to learn about EM online?

[Symmetry11]

Hey guys I'm a premed who just wants to learn some basics behind EM (not to use this on anyone). I just want to read about it. Can you guys point me to any written material? I have been watching some you tube vids but I want something more informative. Also, why do EM people dislike psych stuff?

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[RustedFox]

Hit up the sticky at the top of the thread list for a bunch of links to core content/blogs/etc.

I understand your question; if I were you, I would be looking for a website that explains "EM for Dummies", or something equivalent... something with less technical jargon and shop-talk, but something that really let you wet your whistle. Not sure that any such site exists. Sadly, I think your best bet here is to "just jump in the pool" and see if you like swimming.

Good luck, amigo.

 

[RustedFox]

Let me set you off and running on one of my favorite topics... airway control.

In the resuscitation alphabet, "A" comes before any other letter. "A" is for "Airway". If a patient cannot breathe, or you cannot move air for them... then, they're as good as dead. Nevermind the rest.

(All you "hands-only CPR" folks, just take a step back for a hot second.)

So, check out some YouTube videos regarding basic intubation (endotracheal intubation) techniques. In "Dummies" format, here's the general scheme:

1. Get patient in your ER with an airway issue.
2. Use basic bag-valve-mask resuscitative care to optimize their oxygen reserves.
3. "Knock the patient out" using an induction medication... most commonly, Etomidate.
4. "Paralyze" the patient using a paralytic medication... most commonly, Succinylcholine.
5. Get your laryngoscope out, along with a slew of other tools. Get that scope in his airway! Position it right. See the laryngeal folds? No? Do it again!
6. Pass the tube into the airway and secure the tube.
7. Hook the tube up to your bag-valve-mask or ventilator. Now, move on to why the patient couldn't breathe in the first place.

 

[RustedFox]

EM people generally dislike psychiatric based complaints because there is little that we can do for them besides getting them to a psychiatrist.... sometime. Most often, they'd get to see a psychiatrist more expeditiously withOUT a trip to the ER.

Its just "not what we do".
You want to sit down and discuss a troubled 22 year-old female's childhood and why she acts out? Good on yah - that's for psych, not EM.
Meanwhile, EMS is coming in hot with chest pain, SOB, GSW, altered mental status, and more chest pain.
Your psych complaint can wait; and we're really not trained as to how to best help you.
In fact, we have no freaking clue. Our best advice is generally... "get a grip, honey."
Furthermore, these psych patients tie up LOTS of resources for "safety" purposes.
Also, they love to pester us every 30 seconds for their "meds", which generally include lots of habit-forming drugs of abuse.
We're generally not interested in being enablers.

 

[canigetawhatwhat]

When i was pre med I watched scrubs. It made me laugh, it had hot babes on it, had actual scenarios that super relevant now that im an attending (the laughing at death episode is an episodr I always refer my med students to), and is probably the most medically accurate of all the tv shows.

Seriously when i was in college, i did a large amount of work and coupling that with drinking heavily, i had barely any time to do anything else.

Good luck.

 

[hoot504]

Watch Code Black (not the show). It's decent enough. You'll get a sense of what EM is like

 

[e30ftw]

Also, why do EM people dislike psych stuff?

I do not enjoy treating psych patients for the following reasons:

The ER is the official dumping ground for any person "out in the world" who is acting crazy enough for an innocent bystander to call 911/police.

Every time someone gets high enough on crack/meth/etoh/benzos/opiates to lose rational thought process, these people are brought to the ED for "stabilization."

Stabilization involves figuring out why they're crazy (which is never something I can fix) and preventing them from harming myself or ED staff using chemical/physical restraints.

Often chemical restraints result in these people becoming even more verbally and physically abusive (because now they are more high) causing patients to be placed in seclusion, where now they bang on the door and scream at the top of their lungs for the next 3 days.

Psych patients lie to you intentionally and maliciously.

Psych patients have no funding, because no one at the state/federal level cares about mental health.

Psych patients rarely have insurance and often don't have family or friends who can care for them. Thus, no one will accept the patient, and they are stuck in the ED for 40+ hours, banging on doors, taking their clothes off, spitting on staff, physically assaulting nurses, singing in a tone-deaf fashion, and generally being complete ass-holes.

Adding to this, a large amount of people brought to the ED for "psych eval" actually have a Cluster B personality disorder rather than schizophrenia/psychosis. So these are essentially "unfix-able" people who are dinguses at baseline and were out stealing cars/assaulting people or whatever and do not have a treatable psychiatric illness.

Lastly, the majority of "psych patients" whom we baby sit for 40+ hours as they disrupt the ED shouting obscenities, assaulting staff, etc go via police to a "mental health hospital" where an overworked doesnt-give-a-%%%% psychiatrist takes 15 minutes to review the chart, speak with the patient, declare them "not suicidal or homicidal" and discharges them to the street where the patient then goes back into the world, acting bat-**** crazy in society until they are either arrested or sent back to the ER.

 

[bravotwozero]

Furthermore, these psych patients tie up LOTS of resources for "safety" purposes.

THIS.

At my shop, if a psych patient has any underlying medical issue whatsoever that needs to be addressed, they get a medical admission with psych on consult - TO THE ICU, because apparently that's the only place the hospital can get sitters.

Really grinds my gears when we have patients who actually need to be ICU (sepsis, Cva), that were boarding or trying to transfer out, and I'm admitting bs psych to the unit.

I've brought this up at department meetings multiple times to no avail.



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[Zebra Hunter]

Watch Code Black (not the show). It's decent enough. You'll get a sense of what EM is like

I think an even better documentary for understanding emergency medicine is "24/7/365: The Evolution of Emergency Medicine"

 

[d2305]

I do not enjoy treating psych patients for the following reasons:

The ER is the official dumping ground for any person "out in the world" who is acting crazy enough for an innocent bystander to call 911/police.

Every time someone gets high enough on crack/meth/etoh/benzos/opiates to lose rational thought process, these people are brought to the ED for "stabilization."

Stabilization involves figuring out why they're crazy (which is never something I can fix) and preventing them from harming myself or ED staff using chemical/physical restraints.

Often chemical restraints result in these people becoming even more verbally and physically abusive (because now they are more high) causing patients to be placed in seclusion, where now they bang on the door and scream at the top of their lungs for the next 3 days.

Psych patients lie to you intentionally and maliciously.

Psych patients have no funding, because no one at the state/federal level cares about mental health.

Psych patients rarely have insurance and often don't have family or friends who can care for them. Thus, no one will accept the patient, and they are stuck in the ED for 40+ hours, banging on doors, taking their clothes off, spitting on staff, physically assaulting nurses, singing in a tone-deaf fashion, and generally being complete ass-holes.

Adding to this, a large amount of people brought to the ED for "psych eval" actually have a Cluster B personality disorder rather than schizophrenia/psychosis. So these are essentially "unfix-able" people who are dinguses at baseline and were out stealing cars/assaulting people or whatever and do not have a treatable psychiatric illness.

Lastly, the majority of "psych patients" whom we baby sit for 40+ hours as they disrupt the ED shouting obscenities, assaulting staff, etc go via police to a "mental health hospital" where an overworked doesnt-give-a-%%%% psychiatrist takes 15 minutes to review the chart, speak with the patient, declare them "not suicidal or homicidal" and discharges them to the street where the patient then goes back into the world, acting bat-**** crazy in society until they are either arrested or sent back to the ER.

Anyone try Inapsine for chemical restraint? I know it's not available at some ERs, and may require cardiac monitoring.

 

[RustedFox]

Anyone try Inapsine for chemical restraint? I know it's not available at some ERs, and may require cardiac monitoring.

Hasn't been around for ages. We all want it to come back.

 

[shoal]

Hasn't been around for ages. We all want it to come back.

some of us have it.

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[Angry Birds]

When i was pre med I watched scrubs. It made me laugh, it had hot babes on it, had actual scenarios that super relevant now that im an attending (the laughing at death episode is an episodr I always refer my med students to), and is probably the most medically accurate of all the tv shows.

Seriously when i was in college, i did a large amount of work and coupling that with drinking heavily, i had barely any time to do anything else.

Good luck.

I learned everything I know about medicine from Scrubs.

(Code Black is awesome for a pre-med to watch to get a sense of what EM is like... although I hope that pre-meds understand how that level of stress is not "cool" but can be very, very taxing on the soul...)

 

[Symmetry11]

I think an even better documentary for understanding emergency medicine is "24/7/365: The Evolution of Emergency Medicine"

This was a great doc! So glad you suggested it. Do you have any others?