Emergency Care BC

Conventional medical school and residency curricula glossed over nutrition for patients and certainly made no mention of how to look after oneself on shift.

Eric and Karine discuss the roles that caffeine, hydration and nutrition play when working in emergency medicine. They look at some good and not-so-great strategies and provide some advice for shift performance enhancement.

Coffee:

Caffeine is the most widely consumed CNS stimulant, and coffee is the world's 3rd most popular beverage. If you drink coffee, you can probably do stupid things faster and with more energy but ...

Seriously, caffeine has beneficial effects on reaction time, vigilance, and attention, but there is less to suggest that it improves decision making and problem solving.

• Caffeine is an ADENOSINE blocker. It counteracts the CNS depressant activity of adenosine.
• 2 to 3 cups are likely the ceiling of beneficial effect. Restrict caffeine the to the first half of your shift.
• Try a coffee nap: have a cup or a shot some time prior to your shift, IMMEDIATELY lie down and rest/sleep/doze for 30 minutes. When you wake, the caffeine will be starting to have effect.

Hydration:

• Dehydration of 2% can affect decision making and cognitive performance.
• 1 to 1.5 litres of water over a shift is about right.
• Caffeine does NOT dehydrate you.
• PEE before you put on your PPE (prior to a procedure, critical care etc.)
• Urine colour is a reliable marker of hydration status, so if you are yellow, have a glass!

Nutrition:

• Shift working (especially night shift working) affects circadian rhythms which has detrimental metabolic effects.
• Night workers tend to choose sugary snacks, often out of convenience. Sleep deprivation makes you choose calorie dense carbs and salty snacks.
• Aim for euglycemia, so avoid high glycemic foods (candy, donuts, fruit juice). Stick to balanced meals with roughage and high protein sources. Snack on fruits, vegetables, yoghurt and nuts.
• Avoid where possible processed foods.
• Eating at end of shift before sleeping? On one hand, you are less likely to wake up ravenous, but some data suggests that the increased body temperature generated after eating can impair sleep.
• Eric and Karine were unable to agree on the concept of comfort food at 0200 hrs being beneficial. You must decide whether a handful of jujubes will prevail over 4 carrot sticks.

In this episode, Eric and Joe do a deep dive on sepsis with Dr. Rob Stenstrom, Sepsis and Infections Lead for the EM Network. They discuss the most practical definition of sepsis in the ED and which diagnostic score to use. They find the bottom line on serum lactate, fluid treatment, and blood cultures and antibiotic timing. Rob answers questions on which pressor to use, central access timing, and the status of novel therapies. Plus, is there a genetic predisposition to developing sepsis?

Sepsis Stats

• 1 in 18 deaths in Canada involve Sepsis
• 30% of Canadians hospitalized with sepsis die within 1 month.

Related links

• Sepsis and Septic Shock – Diagnosis
• Sepsis with Hypotension and Septic Shock – Treatment
• Sepsis without Hypotension – Treatment
• Pediatric Septic Shock Management
• EM Network Sepsis and Soft Tissue Infections Research Program

End of Shift Hosts

Eric Angus
Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His nonmedical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies.

Joe Haegert
Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables.

Disclaimer
The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

Daniel Kalla - danielkalla.com
Additional reading
Daniel Kalla

• Pandemic (2005)
• Resistance (2006)
• Blood Lies (2007)
• We All Fall Down (2019)
• The Last High (2020)

Stephen King

• On Writing: A Memoir of the Craft (2000)

Michael Crichton

• michaelcrichton.com

Resources for Emergency Care Practitioners

• Oral Opioid Analgesic Conversion Table (McMaster University)
• Buprenorphine (Suboxone) Initiation for Opioid Use Disorder Patients (BC EM Network)
• Opioid Overdoses – Management (BC EM Network)
• Suboxone Take Home (Buprenorphine-Naloxone) Patient Information Sheet (BC EM Network)

Conflict of Interest Statements

• Adam Lund is an emergency physician and Clinical Associate Professor at UBC, with no conflicts related to this interview. He is the Communications Liaison for the BC Emergency Medicine Network.
• Daniel Kalla is the author of the book reviewed in this interview, as well as an emergency physician and Clinical Associate Professor at UBC.
• Neither participant received any additional/direct funding from the publisher by participating in this voluntary interview.

Disclaimer
The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

In this episode, Eric and Joe speak to Dr. David Haughton, a life-long artist and leader in his field. David practiced pediatric emergency medicine at BC Children’s Hospital until 2017 and has been painting prolifically for over 40 years.

David shares the lessons learned from his storied career, including navigating medical politics and how to balance occupation, obligations, and the pursuit of happiness. He has now retired to pursue painting full time, but would Eric and Joe welcome him back into the fold? Find out if he passes the End of Shift locum quiz.

David Haughton

David Haughton received his undergraduate degree at Harvard University. He trained at Cornell Medical College in NYC, and Children’s Hospital of Los Angeles before moving to BC in 1991.

He worked at the BC Children’s Hospital for 25 years and headed the BC Section of Emergency Medicine for 11 years. In October 2017, David worked his last night shift and gave up his medical licensure to pursue painting full time.

David has been an artist for nearly all his life. He has been sketching and drawing, painting and scumbling for over 40 years. His home studio is in New Westminster, but he has travelled to Tuscany and Tofino to find inspiration for his creations. Visit https://www.haughton-art.ca to find out more about his work.

The BC Emergency Medicine Network is a community of physicians who practice emergency care in British Columbia, Canada. Visit http://bcemn.ca for clinical resources, real-time virtual support, continuing professional training, and EM innovation.

Podcast Hosts
The End of Shift Podcast is hosted by EM Network members Eric Angus and Joe Haegert.

Eric Angus

Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His non-medical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies.

Joe Haegert

Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables.

Disclaimer
The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.

In the emergency department, we see many injured and infected hands and need to be comfortable with initial diagnosis and treatment before considering downstream follow up with a hand surgeon. Hosts Eric and Joe discuss common hand presentations, workup, and treatment with Dr. James Saunders, Head of Plastic Surgery for the Sea to Sky Corridor. They review fractures, dislocations, amputations, infections, and injuries in the ED.

James advises on the best finger to get chopped off in a hostage-taking scenario, and Joe has two practice-changing, “a-ha” moments. Plus, three ways hand injuries are mismanaged in the ED.

End of Shift Hosts

Eric Angus
Eric Angus is an emergency physician and trauma team leader at Lions Gate Hospital. He is married with 15-year-old twins. His nonmedical interests include origami, meditation, mountain biking, skiing, rock climbing, just generally being outside, and drinking wine. He has a diploma in mountain medicine and volunteers for ski patrol and the North Shore Rescue team. He is an ATLS instructor. He dabbles in stoicism and Buddhist philosophies.

Joe Haegert
Joe Haegert practices emergency and trauma medicine at the Royal Columbian Hospital in New Westminster, British Columbia. He is a talented teacher, engaging speaker, and devoted clinician. He lives in South Surrey with his wife Sandy and managed to raise three children without much incident. Known for his unflagging enthusiasm, Joe enjoys all aspects of the outdoors and recently has taken to turning wooden burls into all manner of bowls and tables.

Disclaimer
The discussion within the End of Shift podcast may be graphic, and some listeners may find the language and content disturbing. The views and opinions expressed in this podcast are those of the participants and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.