Ischemic heart disease is a leading cause of morbidity and mortality. While atherosclerotic coronary artery disease (CAD) is the focus of most outpatient and inpatient evaluations for cardiovascular symptoms, up to two thirds of patients suffer from myocardial ischemia with non-obstructive coronary arteries (INOCA). Patients with INOCA have unique symptoms and are more likely to have functional limitation and repeat presentations for cardiovascular evaluation. While there has been increasing recognition of INOCA there is no specific functional status measure, limiting our ability to evaluate the course of illness or effectiveness of therapies. In this presentation, Dr. Samit Shah, interventional cardiologist at Yale New Haven Hospital who recently gave grand rounds recently to the Mayo Clinic Department of Emergency Medicine, reviews the causes of ischemic heart disease, challenges with current symptom assessment, and proposes a new path for better diagnosis and treatment of heart disease.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda; @SamitShahMD

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Dr. Adela Cope breaks down pelvic inflammatory disease, tubo-ovarian abscess, ovarian torsion, ectopic pregnancy and more in this densely packed chapter of Always on EM. Tune in as Alex and Venk also try to figure out which one has the correct mental model of PID and who will ask the first stupid question.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

LEARN MORE ABOUT RESIDENCY:

• https://youtu.be/gCQ0zimhhhY?si=NpsyTruGM9N_UpVM
• https://college.mayo.edu/academics/residencies-and-fellowships/emergency-medicine-residency-minnesota/

REFERENCES:

• Williams T, Mortada R, Porter S. Diagnosis and Treatment of Polycystic Ovary Syndrome. Am Fam Physician. 2016;94(2):106-113
• Rutz M, Boulger C. Early Pregnancy. Sonoguide - American College of Emergency Physicians. Accessed 8/20/2024 (https://www.acep.org/sonoguide/basic/early-pregnancy)
• Rodgers SK, et al. A lexicon for first-trimester US: Society of radiologists in ultrasound consensus conference recommendations. Radiology. 2024; 312(2):e240122
• Kreisel K, Flagg EW, Torrone E. Trends in pelic inflammatory disease emergnecy department visits, United STates, 2006-2013. Am J Obstet Gynecol 2018;218:117e1-e10
• Adhikari S, Blaivas M, Lyon M. Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. JEM 2008. 34(4):429-433
• Mohseni M, Simon LV, Sheele JM. Epidemiologic and clinical characteristics of tubo-ovarian abscess, hydrosalpinx, pyosalpinx, and oophoritis in emergency department patients. Cureus. 2020;12(11):e11647
• CDC sexually transmitted infections treatment guidelines, 2021 - Pelvic Inflammatory Disease (PID) accessed 8-20-24
• Linden JA. et al. Is the pelvic examination still crucial in patients presenting to the emergency department with vaginal bleeding or abdominal pain when an intrauterine pregnancy is identified on ultrasonography? A randomized tli. Annals of Emerg Med 2017(70):825-834
• Stein JC, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: A Meta-Analysis. Annals of Emerg Med. 2010;56:674-683
• Robertson JJ, Long B, Koyfman A. Emergency Medicine Myths: Ectopic pregnancy, evaluation, risk factors, and presentation. JEM. 2017(53)6819-828
• Brown J, Fleming R, Aristizabal J, Rocksolana G. Does pelvic exam in the emergency department add useful information? West J Emerg Med. 2011;12(2):208-212
• Lee R, Dupuis C, Chen B, Smith A, Kim YH. Diagnosing ectopic pregnancy in the emergency setting. Ultrasonography. 2018;37:78-87

This past winter, Dr. Rich Griffey, healthcare quality leader from Washington University School of Medicine and Emergency Medicine, came to present grand rounds on a new way to care for patients with mild to moderate DKA, which they call the SQuID protocol. This talk serves to inspire us to look even at some of our well established conditions and see what we could do differently, as well as appreciate the value that healthcare quality improvement integrated with research methods and implementation science thinking can do when they all come together for the improvement of patient care. Come be inspired with us!

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Dr. Ronna Campbell, professor of emergency medicine, and passionate anaphylaxis researcher schools Alex and Venk on several issues related to contrast-related anaphylaxis. She helps clarify an approach to managing ED situations where a contrasted CT is desired yet the patient has documented anaphylaxis to iodine, or how to treat a patient who returns with unexpected reaction after receiving contrasted imaging. Can you be allergic to Iodine? What is the relationship between shellfish allergy history and contrast? What is the role of steroids in anaphylaxis management? These are just some of the questions that we answer in this discussion.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Dr. Ken Milne presents his talk entitled, “Old Fashioned Doctors,” to Mayo Clinic Emergency Medicine as our keynote speaker for our annual research day. In this talk, he goes through 10 ideas that were proposed in an article by Dr. Herbert Fred as potential ways that old-fashioned doctors may practice medicine more effectively or more palatably than younger counterparts. In this talk, he challenges those ten ideas while offering insights and reflections founded from his experiences before that can help guide or shape the way people can practice tomorrow. This is all done through the use of story and humor as he does in all of his other public speaking opportunities.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda; @KenMilne4234

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

TikTok - @Dr_Venk

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Skeptics guide to emergency medicine: https://thesgem.com/
• Ken Milne’s Youtube video of his presentation: https://youtu.be/f18FmFci-BI?si=jqJ-53HMLTI-uwLy
• Herbert L Fred M.D. (1998) Old-Fashioned Doctors, Hospital Practice, 33:12, 15-15, DOI: 10.1080/21548331.1998.11443787

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

In this final chapter of the academic year 2023-2024, we celebrate our graduating EM class of residents by spotlighting a senior capstone presentation by Dr. Matthew Hamilton covering the intersection of homosexuality and medicine. In this presentation, he aims for the learner to be able to recognize pivotal movements in LGBTQ+ history and civil rights; describe structural mechanisms that excluded gay people from medicine for over 150 years; and to be able to recognize and mitigate ongoing threats to the health and wellbeing of LGBTQ+ people. Please tune in to learn more from one the great graduating senior emergency medicine resident physicians at Mayo Clinic!

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Alex and Venk talk through the medicolegal aspects of practicing emergency medicine with emergency physician and attorney, Dr. Rachel Lindor. She is previous chair of research for Mayo Clinic Emergency Medicine in Scottsdale Arizona and holds both MD & JD degrees. She outlines how the most commonly litigated conditions (MI, orthopedics etc) still only accounts for about 1/5 of medicolegal cases in the United States and the importance of certain key behaviors in our practice to maintaining legal safety. Check it out!

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Heaton HA, Campbell RL, Thompson KM, Sadosty AT. In support of the medical apology: the nonlegal arguments. Journal of Emergency Medicine 2016. 51(5)605-609
• Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and Physicians’ attitudes regarding the disclosure of medical errors. JAMA 2003;289:1001-7
• Carlson JN, et al. Provider and Practice Factors associated with emergency physicians being named in a malpractice claim. Ann Emerg Med. 2018;71:157-164
• Sachs. Malpractice claims: It’s a crapshoot-Time to stop the self-blame and ask different questions. Ann Emerg Med. 2018;71(2):165-167
• Weinstock & Jolliff. High-Risk Medicolegal Conditions in Pediatric Emergency Medicine. Emerg Med Clin N Am. 39(2021) 479-491
• Selbst, et al. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers. Pediatr. Emerg Care. 2005 Mar;21(3):165-9
• Wong, et al. Emergency Department and Urgent Care Malpractice Claims 2001-2015. West JEM. 2021. 22(2): 333-8