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Episode 51 Effective Patient Communication – Managing Difficult Patients

Episode 51 Effective Patient Communication – Managing Difficult Patients

If you believe that coping with some of the people we deal with in emergency medicine is difficult or impossible, you’re not alone. We all feel this way from time to time. Managing difficult patients can be a challenge to the health care provider and to the entire ED. The hostile aggressive patient, the demanding patient, the know-it-all, the excessively anxious patient, and the incessant complainer, are some of the folks that we need to know how to manage effectively. If we fail to handle these patients appropriately, they may receive suboptimal care, grind patient flow to a halt, and delay care of other patients. If the staff has to deal with a multitude of these patients on a given shift, there’s a sort of swarm-based escalation in frustration and sometimes, unfortunately, a total breakdown of effective patient communication and care.

But don’t fret. In this one-of-a-kind podcast on effective patient communication and managing difficult patients, Dr. Walter Himmel, Dr. Jean-Pierre Champagne and RN Ann Shook take us through specific strategies, based on both the medical and non-medical literature, on how we can effectively manage these challenging patients. As a bonus, we address the difficult situation of breaking bad news with a simple mnemonic and discuss tips on how to deliver effective discharge instructions to help improve outcomes once your patient leave the ED.

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Best Case Ever

Best Case Ever 29 Carr’s Cases – Drug Induced Aseptic Meningitis

Best Case Ever 29 Carr’s Cases – Drug Induced Aseptic Meningitis

drug induced aseptic meningitis
Dr. David Carr presents his third of EM Cases' Carr's Cases. This series features potentially debilitating diagnoses that may be thought of as 'zebras', but actually have a higher incidence then we might think - and if diagnosed early, can significantly effect patient outcomes. Dr. Carr tells the story of young woman with an MRSA supra pateller abscess who was put on trimethoprim sulfamethoxazole and presents looking very ill with a severe headache. Not only has trimethoprim sulfamethoxazole been implicated in aseptic meningitis, but NSAIDS, immunomodulators and antibiotics have also been implicated. The reason this is so important for ED practitioners to know, is that case reports of drug-induced aseptic meningitis have shown that symptoms will resolve completely within 24 hours, once the offending drug has been stopped. Not only that, but if the patient receives the drug again in the future, they are at risk for a more severe case of drug induced aseptic meningitis.
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Best Case Ever 28 David Carr on Anti-NMDA Receptor Encephalitis

Best Case Ever 28 David Carr on Anti-NMDA Receptor Encephalitis

anti nmda receptor encephalitis
Dr. David Carr presents his second of Carr's Cases. This series features some potentially life-threatening diagnoses that may be perceived as zebras, but actually have a higher incidence then we might think - and if diagnosed early, can significantly effect patient outcomes. This Best Case Ever is about Anti-NMDA Receptor Encephalitis, a diagnosis that was only discovered in 2005, and has only recently been recognized by the Emergency Medicine community. Anti-NMDA Receptor Encephalitis may mimic a first presentation of schizophrenia or Neuraleptic Malignant Syndrome. It may present with seizure, altered mental status, autonomic instability or movement disorder in the absence of drug exposure. When you are faced with any of these presentations and no other diagnosis seems to fit, do an LP and send the CSF for anti-NMDA receptor antibodies. The time-sensitive treatment is IVIG and steroids. Anti-NMDA receptor Encephalitis is a must know diagnosis for all emergency medicine practitioners. Learn how to pick up this important diagnosis by listening to Dr. Carr's Best Case Ever and following the links to further resources.
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Best Case Ever 27 – Sarah Reid on Pediatric Shock

Best Case Ever 27 – Sarah Reid on Pediatric Shock

dr sarah reid
Ottawa this year, I had the pleasure of discussing pediatric shock and sepsis with Dr. Sarah Reid, a good medical school friend of mine from the Gretzky Year ('99) graduating class. I knew back then that she was heading for PEM educator stardom. Lo and behold, she is the now the director of CME at the Children's Hospital of Eastern Ontario and a national PEM speaker extraordinaire. After recording an eye-opening session on Pediatric Fever Without a Source and Pediatric Sepsis, she told me the story of her Best Case Ever where the initial presumptive diagnosis was sepsis. Maximize your learning and submit your questions on 'Pediatric Fever Without a Source' on the Next Time on EM Cases page.
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Best Case Ever 26 – Mike Betzner on Chloral Hydrate Poisoning & Cardiac Arrest

Best Case Ever 26 – Mike Betzner on Chloral Hydrate Poisoning & Cardiac Arrest

torsades de pointes
I met up with Mike Betzner at North York General's Update in EM Conference in Toronto. He is the medical director of Air Transport STARS air ambulance out of Calgary and an amazing speaker on the national lecturing circuit. His Best Case Ever on Chloral Hydrate poisoning & cardiac arrest describes a young man in cardiac arrest with resistant Ventricular Fibrillation and Torsades de Pointes. There is only one class of drugs that can get him back into normal sinus rhythm. Dr. Betzner describes how he recognized that this patient was suffering from Chloral Hydrate poisoning and how he saved his life with one simple intervention.
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Best Case Ever 25 Rob Rogers on Social Media in EM Education

Best Case Ever 25 Rob Rogers on Social Media in EM Education

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One of Emergency Medicine's most cutting edge educators Dr. Rob Rogers, the brains behind iTeach EM podcast & blog as well as the director of The Teaching Course tells us the story of his Best Case Ever where he used Social Media as an EM Education tool that led to a life saved and a difficult diagnostic pick-up. In the upcoming episode on Social Media (SoMe) in EM education and FOAMed (Free Open Access Medical Education) with three prominent educators in the FOAM movement, Brent Thoma of Boring EM and Academic Life in EM, Ken Milne of The Skeptics Guide to EM & Rob Rogers, we discuss how SoMe can enhance your career, tips on how to get the most out of FOAMed without getting overwhelmed by the volume of material, swarm-based medicine, tacit knowledge sharing, the flipped classroom, the use of FOAMed in emergency medicine training curricula, how Twitter, Google+, Google Hangout and Google Glass have changed the face of medical education, and much more. To have your questions about SoMe and FOAMed answered by our guest experts and find key references go here.
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Quick Links to Recent Episodes

Login required for some posts – Entire EM Cases Library is Free Access

Episode 50 Recognition & Management of Pediatric Sepsis and Septic Shock with Sarah Reid & Gina Neto

Journal Jam 1 Age-Adjusted D-dimer with Jeff Kline & Jonathan Kirschner

Episode 49 Effective Patient Communication, Patient Centered Care & Satisfaction with Walter Himmel, Jean Pierre Champagne & Ann Shook

Episode 48 Pediatric Fever Without a Source with Sarah Reid & Gina Neto

Episode 47 Evidence Based Medicine with Walter Himmel

Episode 46 Social Media in Emergency Medicine Learning with Rob Rogers, Ken Milne & Brent Thoma

Episode 45 Swadron on Vertigo, Mattu on Cardiology Literature from EM Update Conference 2014 with Stuart Swadron & Amal Mattu

Episode 44 Whistler’s Update in EM Conference Highlights 2014 with Joel Yaphe, Lisa Thurgur & David Carr

Episode 43 Appendicitis Controversies with David Dushenski & Brian Steinhart

Episode 42 Mesenteric Ischemia & Pancreatitis with David Dushenski & Brian Steinhart

Episode 41 Hypertensive Emergencies with Joel Yaphe & Clare Atzema

Episode 40 Asymptomatic Hypertension with Joel Yaphe & Clare Atzema

Episode 39 Update in Trauma Literature with Dave MacKinnon & Mike Brzozowski

Episode 38 ENT Emergencies with Leeor Sommer & Maria Ivankovic

Episode 37 Anticoagulants, PCCs & Platelets with Walter Himmel, Katerina Pavenski & Jeannie Callum

Episode 36 Transfustions, Anticoagulants & Bleeding with Walter Himmel, Katerina Pavenski & Jeannie Callum