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Be yourself; Everyone else is already taken.

— Oscar Wilde.

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Palliative Emergency Medicine – What Is It?

When working in the emergency department, the number one goal is usually to prolong life. Success is usually achieved by avoiding a patient’s death, but sometimes it’s not possible. Depending on what the patient is there for you may have to consider if you’re just prolonging the dying process, as opposed to the living. This is why palliative care principles have begun to arise in emergency medicine as of late. These care principles put the patient at the centre of care, taking into consideration their feelings, concerns and decisions so they can have a better experience and a stronger relationship with their physician. 

To put it simply, palliative care is defined as an approach that improves the quality of life of patients and their families who are facing problems associated with a life-threatening illness. Palliative care brings many benefits to patients in the emergency department. Since the emergency department typically acts as a “front door” for many conditions and injuries, it can similarly be a front door for palliative care as well. Introducing palliative care in the ED as opposed to later on when they’ve become an inpatient can improve satisfaction for patients and their families, improve system management, and can lessen the time spent in the intensive care unit, among other things. In fact, the length of stay for many ED patients has decreased by an average of 4 days.

Palliative care doesn’t need to benefit only the patients though. It can benefit emergency medical providers as well. Burnout is a serious problem in emergency medicine due to a large amount of emotional exhaustion and an overwhelming number of patients seeking medical attention. Palliative care can help EM providers avoid burnout by providing them with true empathetic engagement with their patients which in turn provides them with a greater sense of satisfaction from helping their patients. Burnout in emergency medicine is sometimes blamed on the fact that many hospitals have moved on from the bedside care aspect of the industry and instead focusing on efficiency, so they can treat as many patients as possible while still providing quality care. Many enter the medical field to help people and by moving towards palliative emergency medicine, physicians are more likely to move towards that. 

Having palliative care conversations with patients as soon as they enter the emergency department can be crucial to providing them with a comfortable experience during their time of need. There are many ways this can be handled, from the simpler task of having emergency department doctors provide the care to hiring a team that is there specifically to have these conversations with patients. However it may be done, it’s important that palliative care finds its way into the emergency department.

This article was originally published at DrAdrianCohen.co

How Failure Can Help Leaders Succeed

Leaders need many things in order to help them succeed. The greatest leaders will often display abilities such as excellent communication skills, critical thinking abilities and the ability to stay cool in a crisis, which has helped them get to where they are, but one of the most vital parts of being a successful leader is having experienced failure. Many of the most successful people on the planet failed time and time again before finding the success they have now. You might be wondering how that’s possible, so read on for a few ways in which failure can help you succeed as a leader.

Failure Gets You Out Of Your Comfort Zone

One of the worst things you can do as a leader is to become too comfortable. If things are going well in your business or organization, it can be rather easy to go with the flow and just let things happen. While this is an understandable feeling, it can also be detrimental to your leadership abilities and can stunt further growth. Think of leadership the way you would think of lifting weights. If you’re lifting weights and aren’t struggling to do so, you likely aren’t lifting enough. Leadership is similar, and we must constantly challenge ourselves if we want to grow at all.

Failure Makes You More Grateful

While failing is never a fun experience to have, it tends to help individuals be more grateful once they’ve actually succeeded. This is true not only of leaders but practically anyone who has experienced failure at one point or another. Having gratitude for the circumstances that brought you to your success, as well as the people who helped you get there helps you be a better person, which can help improve your leadership abilities by making you more motivated, amongst other things.

Failure Teaches You What Doesn’t Work

One of the hardest parts of being a leader is knowing what tactics do or do not work, whether they be for you specifically or for your business. You can often look at other people’s success and the failures they’ve experienced in order to give yourself an idea of what may or may not work for you, but you’ll never truly know if something works for you until you try it for yourself. Failure can help you realize that the great idea you had might not be working for you and that it’s time to try something new.

This article was originally published on DrAdrianCohen.org

How Leaders Can Keep Cool In A Crisis

When leading a team or business, crises are bound to happen from time to time. No matter how hard you try to avoid them, they’re inevitable and cannot be run away from. In situations like that, it’s important that leaders are able to keep their cool and figure maintain a level headed view of the situation. On top of that, their team members will likely look to them for more information on the event as well as an indicator of how they should be acting or feeling. When leadership can stay calm, it tends to help everyone else maintain their cool as well. While keeping your cool can be difficult, there are plenty of things you can do to in order to help. Read on for a few ways in which leaders can stay cool in a crisis.

Don’t Take Failure Personally

The first thing to remember when trying to stay cool in a crisis is that you should separate your personal feelings from whatever the situation is. By separating these emotions you can then put more focus on achieving success not only for yourself but for the rest of your business. A successful leader makes sure they focus on the crisis at hand and leaves their personal feelings at the door.

Be Transparent

Being open and honest is one of the best ways for leaders to keep their cool during a crisis, especially if they are open and honest from the get-go. By being timely about providing your team with information, you’re more likely to avoid widespread confusion and rumours. Be sure to stay on top of communication throughout the entire crisis, and remember to never leave out details, otherwise, information can get twisted if people hear about it from the wrong person.

Be Accountable

In a similar vein to being transparent with your team, if your companies crisis was caused by something you did, it’s important to take accountability for it. By being accountable for your mistakes, your team is more likely to respect you. Your team will also be more inclined to put their all into fixing the crisis because you were honest with them, as opposed to just doing it because it’s their jobs. 

Self-Care

It can be easy to throw self-care to the side when you enter crisis mode. As a leader, you’re likely hyper-focused on trying to resolve the crisis as soon as you can, but it’s important to take a break from time to time so you can sleep, eat, and mentally reset. By making sure you have time for yourself, you can go into work each day with a clear mind, ready to tackle whatever crisis you might be dealing with.

This article was originally published on DrAdrianCohen.org

Drowning – What Happens And How Can We Help?

One of the leading causes of mortality in children is drowning, specifically for boys between the ages of 5 and 14. Unsurprisingly, over 500,000 drowning related deaths occur around the world each year, with the main causes being hypoxic injury as well as respiratory failure. Read on for more information about drowning, and how a drowning victim should be approached in an emergency medical setting. 

Let’s start with explaining what actually occurs in the human body when somebody is drowning. According to the World Health Organization, drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. When a person goes through the experience of drowning, they experience laryngospasm caused by small amounts of water getting into their lungs. This eventually leads to hypoxia, followed by loss of consciousness, respiratory failure and finally cardiac arrest. Pulmonary aspiration can also occur at small volumes which don’t get in the way of airways but have the ability to cause chemical changes in the body. Because of this, resuscitation for drowning focuses on reversing respiratory failure and hypothermia.

The symptoms usually associated with drowning can be different depending on how long they were submerged underwater. Victims with shorter submersion times typically suffer from more mild symptoms, such as coughing and shortness of breath. Occasionally they’ll experience nausea or vomiting as well. In situations where the submersion occurred for a longer period of time, symptoms can be far worse. These victims are usually at risk for hypothermia, cardiac arrest, and sometimes an altered mental status which may be secondary to hypothermia, hypoxia or head injury. It’s also important to find out how they rank on the Glasgow Coma Scale (GCS), as having a decreased score once arriving in the emergency department can increase the odds of cardiac arrest occurring as well as having poor neurological outcomes later down the line. 

One of the most difficult aspects of treating a drowning victim is predicting the actual outcome of the drowning. A grading system known as the Szipliman Drowning Classification exists to try and help with that. The system breaks victims down into 6 grades starting with a normal pulmonary exam with coughing to cardiac arrest. Other predictors of poor outcomes include elevated liver enzymes and severe acidemia, in addition to the altered mental status and longer submersion times mentioned previously. 

In regards to actual treatment, your main goals should be to provide the victim with positive pressure ventilation, active rewarming to at least 34°C and possibly extracorporeal life support (ECLS). Body temperature is always something to think about in drowning situations, regardless of the temperature of the water itself. Commons strategies for rewarming include radiant heat, heat packs and forced air, with more invasive techniques including warmed IV fluids, peritoneal lavage, and more.

This article was originally published on DrAdrianCohen.net

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