End of Shift Podcast: Viva Las Vegas

01/05/23 • 24 min

End of Shift went on the road in late 2021 to catch up with Dr. David Pledger. David practiced in both Las Vegas and Vancouver before settling in Nevada. He fills us in on the interesting differences between US and Canadian emergency care and comments about how COVID impacted his adopted state and British Columbia.

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End of Shift Podcast: Medicine on a Long Line

In this episode of End of Shift, Eric and Joe talk with Dr. Carolyn Kelly-Smith about the practice of medicine (and sometimes not) in austere environments.

Dr. Kelly-Smith is an FRCP trained attending ED physician at the Royal Columbian and Eagle Ridge Hospitals. She is an Advanced Medical Provider for North Shore Rescue, a faculty member of the Canadian Society of Mountain Medicine and a ski patroller at Whistler/Blackcomb.

Why should you care about wilderness medicine? There are many reasons – from going where the action is (increasingly outdoors) to expanding your clinical horizons by stretching your comfort zone.

We examine the utility of having a physician involved in outdoor settings, be it reasonably controlled settings like a ski resort, or a complicated rescue operation with failing daylight and minimal clinical details.

It’s not all Mission: Impossible style heroics – sometimes the most useful clinical actions and decisions are simpler than you might think.

How to get involved? We’ll tell you. You’ll learn about the North Shore Rescue Society and the Canadian Society of Mountain Medicine – and maybe get fired up to get out there!

Resources:

Documentary: Search and Rescue: North Shore
Canadian Society of Mountain Medicine

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End of Shift Podcast: Care and Feeding

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.