SGEM Xtra: Auld Lang Five

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Date: December 30th, 2018

Happy New Years to all the SGEMers out there in the #FOAMed world. It is time to reflect upon 2018 and look forward to 2019. Last year we named 2017 the year of FeminEM and celebrated 15 amazing women in emergency medicine. This year I am going to highlight five of my personal favourite episodes from 2018.

It was very difficult to pick just five episodes from all the excellent episodes recorded in 2018. One of the questions I am frequently asked (besides do you pick the music first) is which episode I like the best. The answer is always the same…the one I am currently working on at the time.

Another difficulty was not to include an SGEMHOP episode in the top five. These are all fantastic episodes done in collaboration with Academic Emergency Medicine (AEM) and three great guest skeptics (Drs. Bond, Heitz and Morgenstern). It combines the best of both worlds (traditional publication and social media). To give a shoutout to just one SGEMHOP episode felt wrong, so I consciously excluded them being eligible.

Here are my favourite five SGEM episodes from 2018. Do you agree with these selections? What was your favourite SGEM episode this year? Please post your response in the comment section.

#5 Don’t Give Up – The Power of Kindness with Brian Goldman

Dr. Goldman is an Emergency Medicine physician who works at Mount Sinai hospital in Toronto. He is the host of the CBC radio show White Coat Black Art and the author of the bestselling books The Night Shift and the Secret Language of Doctors. Dr. Goldman had a fantastic new book published in 2018 called The Power of Kindness: Why Empathy is Essential in Everyday Life.

I had the pleasure of interviewing Brian at the 2018 Canadian Association of Emergency Physicians (CAEP) conference in Calgary, Alberta this summer. We sat down in a cafe and discussed kindness until they closed and asked us politely to leave. I wanted to know whether kindness was from nature or nurture, if healthcare workers’ empathy is dulled over the years and if we can do anything to be more kind.

#4) I Can See Clearly Now the Collar is Gone – Thanks to the Triage Nurse

Alison Armstrong RN

We all work with some amazing nurses in the emergency department. This SGEM episode featured one of those awesome nurses, Alison Armstrong. She is an emergency department nurse from the London Health Science Centre in London, Ontario. Alison is also a TNCC Course Director, Trauma Program Coordinator and Canadian C-Spine Rule Nurse Champion.

Alison and I reviewed a paper in Annals of EM by the prolific group out of Ottawa. Their observational study wanted to know if emergency department triage nurses can apply the Canadian C-Spine Rule (tool) to adult blunt trauma patients and safely clear the c-spine?

The results were that triage nurses removed 41% of immobilized patients’ collars and missed zero c-spine injuries. The SGEM bottom line was that properly educated emergency department triage nurses can apply the Canadian C-Spine Rule to adult blunt trauma patients and safely clear the c-spine.

#3) Message in a Book by the SGU

Interviewing Dr. Steven Novella this year about his new book was one of the highlights of 2018. Getting the opportunity to speak with him was a box checked off my bucket list.

Dr. Novella is a Yale Neurologist, host and producer of the popular science podcast called the Skeptics’ Guide to the Universe (SGU). It should be obvious that the SGU inspired the naming of this knowledge translation project, the Skeptics’ Guide to Emergency Medicine.

The SGU has been a huge part of my skeptical journey and contributed greatly to my critical thinking skills. Listen to the podcast and consider purchasing Dr. Novella’s book called the Skeptics’ Guide to the Universe of course.

#2) The Epi Don’t Work for Out-of-Hospital Cardiac Arrests

It takes a team to provide great emergency care. Part of that team are the dedicated, talented and skilled paramedics that work in the pre-hospital setting and bring in the critically ill or injured patients. This SGEM episode featured guest skeptics Jenn Doyle and Jay Loosley from the Middlesex-London Paramedic Service.

We reviewed the PARAMEDIC2 trial on epinephrine for adult out-of-hospital cardiac arrest (OHCA). While there was a statistical improvement in 30-day survival with epinephrine compared to placebo there was no difference in good neurologic outcome at discharge or at three months.

The SGEM bottom line was that the use of epinephrine in adults with OHCA to improve survival with favourable neurologic outcome is not supported by the literature and protocols should be changed to reflect the data. Instead of epinephrine, resuscitation efforts should focus on things that have been demonstrated to improve patient-oriented outcomes like high-quality CPR and early defibrillation.

#1) On the Edge of Burnout ACEM18

I spend most of 2018 looking forward and preparing for the Australasia College of Emergency Medicine 2018 Annual Scientific Meeting (ACEM18) in Perth, Australia. My good friend, Dr. Ian Rogers, invited me to be a keynote speaker at ACEM18 and speak about being on the edge of burnout.

Leading up to the event my life became very surreal with my father (Dr. Ken Milne Sr.) getting seriously ill in September. We spent a great deal of time together over the next three months on a journey we both knew would come to an end. He helped put together my talk on burnout and insisted that I did not cancel the trip to Australia.

The presentation was streamed live to his hospital bed. You can watch it by clicking this link. We spoke one last time after the keynote address and he died later that day.

I was not ok at the time. Now, due to some amazing friends and family (you know who you are), I am ok. Life will never be the same without my dad and I am learning to live with a new normal. He will always missed but never forgotten.

Keener Kontest: Last episode’s winner was Andrew Schoenling an Emergency Medicine resident from Henry Ford Hospital. He knew Joseph von Mering was the clinical pharmacologist that first tried paracetamol (acetaminophen) on humans in 1887.

The SGEM will be back in 2019 with a structured critical review of a recent publication. Cutting the knowledge translation window down from over ten years to less than one year with power of social media. The SGEM’s ultimate goal continues to be that patients get best care on best evidence.

Before 2019 starts, could you please write a review on iTunes, like the SGEM on Facebook and follow the SGEM on Twitter.