SEMS 2014: Chong Shu Ling – Paediatric head injury

Our last paediatric video from SMS ASM 2014 is a must listen for all branches and levels of the ED.
Dr Chong Shu Ling is a senior clinician and articulate educator who delivered a tour de force on paedatric head injury. This will not just give you the "what-to-do" but also the "why-we-do-it".

Slides are here:

The Changing Role of Palliative Care in the ICU

Hola a tod@s, my dear friends:

Just ending the week thanks to Dra. Mari Cruz Martín, head of service at ICU of
Hospital Universitario de Torrejón, who sends us this awesome article: The Changing Role of Palliative care in the ICU, published in the issue of November 2014 in Critical Care Medicine.

There is a growing recognition that a effective integration of palliative care during acute and/or chronic critical illness could help patients and families, who could be found in very difficult situations after discharge from ICU.

Regardless of the diagnosis or prognosis, palliative care are being objective of our eyes. And also we are becoming more aware of what prolonged ICU stay is for everybody, and the sequels that can develop our actions.

In the article the prior evidence is reviewed and outlined strategies for the improvement of palliative care in ICU, identifying resources for its implementation.

1. Opportunities to relieve physical and emotional symptoms, improve communication and provide support for patients and their families

2. Models and specific interventions to improve the palliative care in the ICU

3. Resources for the improvement of palliative care of ICU

4. To promote research in this field to carry out an integrative medicine that seeks to effectively and efficiently.

For me, you should read this article, because there is much to improve in this field. And what important thing is to stop and thinking about it.

Happy Saturday, and remember...See you at #SOMIAMA!

Film Review – Interstellar

My reviews have been delayed for the past year, but I persist because for some reason, people are reading them. :)

And while this probably isn't going to make a huge difference since most moviegoers catch new releases within the first week, I hope this post will make you ponder over a few things, and perhaps help you pass a bit of time in a pleasant manner.

The spoiler-free verdict: 9/10, definitely worth seeing.


First, I don't consider Interstellar a film about space. Or space travel.

I realize it sounds preposterous, but that's exactly how I feel.

And it isn't a bad thing. Not by a long shot. In fact, I give writers Jonathan and Christopher Nolan huge credit for once again exceeding all my expectations, just like they did with Inception and The Dark Knight.

So what do I think Interstellar is really about?

The full answer is extremely complex - and I no longer have the luxury of time ( or brain stamina ) to pen lengthy essays like I used to. But the main message I took home was how extraordinary human beings are, in both good and terrible ways.

The concept of planet Earth being in peril and prompting heroic measures to save it isn't new, of course. Remember Armageddon and Deep Impact?

Where more cerebral versions are concerned, there's Contact ( which coincidentally also starred Matthew McConaughey ) - and hey, turns out it's also NOT about space after all! But it's one of my favourite "space" films of all time, and now, Interstellar joins the list.

While there're more than enough scenes to satisfy those who expect a grand spectacle, for me, those are merely the icing on the cake. Instead, the main course comes in the form of astute and multi-layered character studies, all of which got my synapses firing, and which will likely stay in my head forever.

Two, in particular, stand out. Professor Brand - aka the guy who came up with the whole save-the-Earth plan, and wonderfully portrayed by Nolan's regular collaborator, Michael Caine - initially comes across as a veritable saint, only to be revealed near the end as duplicitous. Because despite formulating 2 possible outcomes, he opted not to tell anybody that he always knew only one of them might succeed. This was a major WTF moment for me. I mean, my jaw literally dropped. I don't expect many viewers to agree, but Brand's action struck me as shockingly ruthless and cruel. And yet, one can also argue that he may have done it out of love, because he also sent his own daughter on the mission, hoping to save her above anyone else.

The other is Dr. Mann, featured in one of the best cameos I've seen in a long time. Played perfectly by Matt Damon, Mann also possesses a dark side, manipulating others with great skill, but only for the purpose of self-preservation. A tense sequence involving Mann's struggle with and subsequent overpowering of Cooper ( McConaughey ), followed by an adrenaline-pumping explosion and a split-second life-saving decision made by Cooper, was exhilarating! A truly magnificent example of movie magic!

The entire cast is excellent, and I can't single anyone out because they're all great. However, I do love TARS the robot. A lot. I was curious about this character after reading about it in Empire magazine's interview with Nolan ( there wasn't a picture attached, just a bunch of cryptic descriptions ), but the final product is marvelous! Indisputable proof that less can be more, because our notions of artificial intelligence in a physical form ( as opposed to computer software like what we saw in Her ) have been tainted by the likes of Star Wars, A.I., Wall-E and countless other shows. And Nolan cleverly subverts this influence by crafting a machine which is honestly quite ugly, but gradually reveals a personality ( snarky humour! ) and quite a few nifty abilities ( it's made up of 4 finger-like pieces, which form a cogwheel that can whirl through a body of water and save people! ). Super cool. :)

Then there's the soundtrack by Hans Zimmer - nothing short of AWESOME. I'm familiar with his signature style ( he also wrote music for other Nolan films like The Dark Knight trilogy and Inception, as well as Man Of Steel ), but this is by far his best. I've read complaints about the ear-splitting volume on Interstellar - which I disagree with - but this may have highlighted the score much more clearly, with gut-wrenching effect. Unfortunately, there was a lot going on so I can't name specific scenes, but if you decide to watch the film again in the future, keep your ears open!

Last but not least, Mr. Nolan the director.
I've been a fan since 2000's Memento, and have seen every single one of his movies since then. He never disappoints, and has only gotten increasingly better with time. In addition to handling action on a grand scale with amazing skill ( and style ), he always manages to inject a distinctly human element into his work, through a thought-provoking script filled with classic quotes ( remember The Joker's line in The Dark Knight? "Insanity is like gravity - all you need is a little push." ), complex scenarios that test the limits of one's conscience, and numerous career-high performances which only he can draw out.
( I also think he's absolutely gorgeous. Who does his hair? It's glorious! :))

Interstellar isn't flawless, of course. I was completely confused by the last 15 minutes, although there're a few helpful explanations on the Internet, and a hokey bit about "love and gravity" which I think I blocked out ( the repressed memory was triggered by this rather hilarious piece ). Perhaps I'll appreciate the movie more after figuring out what the heck happened, but in spite of this, I still think it's an incredible achievement, and a terrific way to spend 3 hours of my precious time.

Comments are welcomed! For the next entry, I hope to review The Newsroom season 3, which just started airing this week. It is just sooooo freaking fantastic! :)

Intern Report Collection, Vol. 4

For your Friday afternoon, here’s another batch of excellent write-ups from the EM interns at UT Southwestern. Our ongoing intern report series is the product of first-year residents exploring clinical questions they have found to be particularly intriguing, with an intended audience of med students & junior residents. Enjoy!

[Note: These are PDF files.]

The post Intern Report Collection, Vol. 4 appeared first on emDocs.

Not just S1Q3T3: Look at the other 10 leads!

It was a slow morning in the ED, so I was able to catch the medic as she came in with the patient. “Hey Leigh, what do you have for us? Got an interesting ECG?”

“Well, maybe,” she replied as she wheeled by with a comfortable looking middle-aged male, “here, take a look at it while I give report to the nurse.” She handed me the 12-lead:


After leaving the patient with the RN, Leigh came back. “This is a guy with a history of CHF, with an AICD placement. He’s had shortness of breath for 4 days, worse when he walks. He passed out today when he was walking, so his family called us. He looked fine when we got to him, just needed 2 liters of O2 to keep him at 98%. No chest pain.”

“Yeah,” I said, “he certainly looked fine when you rolled past. Okay, so probably just a CHF admission. I’ll go see him right now.”

“Yeah, it’s probably just his CHF,” she continued, “but I expected worse. His lungs sound just fine, totally clear. Plus, he says it doesn’t get worse when he lays flat. Seems funny for CHF… Plus, I didn’t like my ECG – did you notice the S1Q3T3?”

“Well, I pulled his old ECG, just done a few weeks ago in fact, and I see it looks like there’s a S1Q3T3 too. So, probably doesn’t mean much.” I showed her the ECG I had dug up:

“Okay, Dr Walsh, maybe the S1Q3T3 is old, but I still see…” She paused, and appeared to be looking for a diplomatic way to phrase her thoughts. “How about using the ultrasound, checking to see if there’s any CHF?”

“Good idea Leigh! I’ll go show you how we do those, especially since some EMS systems are using this these days.”

After introducing myself to the patient, gathering a history, and finding that the lungs were, indeed, completely clear, I wheeled over the ultrasound. A quick check of the lungs confirmed that there was no edema in the lungs. I then took a look at the heart. (The image quality is not great, I realize.)

Just so you know what is what:

Legend for Dil RV clip-1

I then turned to Leigh and asked her “What else did you see on your ECG that you were too polite to point out to me?”