Letter From America #3

Essentials kicked off for real today, and it did so with a bang.

The bang was provided by the force of nature otherwise known as William “Billy” Mallon, M.D. perhaps the most natural candidate for F.UCEM status alive today. His keynote consisted of a few trademark rants…

Lamentation on the ‘teaching to the tort‘ approach that seems to dominate residency teaching in the US. The very notion of teaching medicine in a way that is centered on keeping lawyers happy seems abhorrent to me. The main focus of medical education should be on keeping doctors and patients happy, not our damnable brethren in the court-room. To my eyes the medicolegal climate in the US looks frankly oppressive — I’m glad this particular climate crisis is not (yet) my problem.

Billy also decried the ‘medicinification‘ of emergency medicine. He claims that our specialty is becoming dominated by a physician mindset and is losing it’s surgical roots. According to Billy, This is not a good thing as emergency medicine is primarily about action, not being a ‘geek‘. I disagree with him a little on this – I prefer to think of us as  ‘action geeks‘ as it is our particular cognitive skills that define us… Nevertheless I do suspect that modern trainees know less about anatomy, procedures and core surgical skills than our predecessors.This is a shame.

Finally, It was great meet the BIG man in person briefly — he is truly larger than life — and I may look to test his hypothesis about altitude sickness contributing in part to jet lag in the very near future…

A large portion of today’s talks were on critical care in the ED — staple stuff for a dual ED/ICU trainee like myself, though perhaps not everyone’s cup of tea. The debate about etomidate raged on — bottom line is adrenal suppression is real, though of uncertain clinical significance. Again this particular furore seems like a teacup storm to doctors in Australia — as we dont have access to the drug, and I don’t think we miss it either. After all, ketamine is called special K for a reason. Other topics included the emerging roles of dexmedetomidine for ER sedation; why VBG means an ABG is not needed (that old chestnut), and how to improve oxygenation in acute lung injury.

Scott Weingart MD presents at USC Essentials

There was also a great talk by Michael Winters, M.D. of EM:RAP Critical Care fame on extubation in the ED — it’s well worth hunting down some of his previous talks on EM:RAP, his talk on the post-tracheostomy bleed will scare the crap out of you. It was also good to see a fair amount of skepticism about tranexamic acid in trauma and the crash-2 trial, though I think we’ll hear lots more about drug. Jeff Tabas’s point that we’d all be using tranexamic acid if it was an expensive drug backed by Big Pharma is a chilling indictment on what modern medicine has become.

LITFL (t-shirt)
LITFL (t-shirt) takes center stage…sort of

Away from the lecture hall, Egerton Y Davis IV was on hand to induct even more Fellows to the Utopian College (F.UCEM). The new inductees include:

  • Leon Gussow MD of The Poison Review and winner of the infamous Staghorn challenge. Leon was finally inducted in person after a long wait and stated that he looks forward to his qualifications being reviewed next time he appears as an expert witness in court. He also graciously acknowledged that UCEM’s poison preview was a great leap forward for toxicology.
  • Michelle Lin MD received her Fellowship for contributions to Academic Life, rather than strife, in emergency medicine. As one of the first female F.UCEMs her achievement should not be underestimated. I’m not sure why exactly… but it shouldn’t.
  • Scott Weingart MD of the EMCRIT blog attained his Fellowship for providing the inspiration for UCEM’s revolutionary ‘downstairs patients, upstairs‘ approach to patient care. More than most, Scott really gives medicine to the people… Or sometimes not as we found out in his notorious awake intubation video.
  • Anton Helman MD for being Canadian and for his Utopian efforts in providing the Emergency Medicine Cases podcast — as if just being Canadian wasn’t meritorious enough.

Egerton had a great time meeting all these fucems. Today Egerton is on the look out for some Aussies… You have been warned.

Finally congratulations to Big Jim on winning the USC iPad…

Further Reading

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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