See One, Do One, TEACH One: My Top 5 Educational Experiences of 2013

Last blog post as 2013 comes to a close and I thought in the spirit of the holidays I would give the gift of my top five educational cases/adventures/inspirations of 2013!  Feel free to share any interesting cases/adventures/inspirations below enjoy!

1: “I guess tylenol is a common cause of liver failure in the U.S.!”

29 YOM with a psych disorder and heavy alcohol use  presents to the ED with a c/o SOB and oral abscess x 2 days. Patient recently saw a dentist and was given percocet, extra strength tylenol for pain and clindamycin. Patient was tachycardic and hypotensive upon arrival. Labs later revealed an elevated tylenol level and multiple electrolyte and hematologic derangements. Estimates had him taking 3-4 grams of acetaminophen with 6-8 alcoholic beverages a day.

What I learned:

Acute management of tylenol toxicity.

King’s College Hospital Criteria assesses for the need for transplant:

  • pH < 7.3 (metabolic acidosis) after initial fluid resuscitation

  • pH > 7.3 combined with the following:

    • Prothrombin time (PT) > 100 seconds

    • Creatinine > 3.3 mg/dL

  • Grade III or IV encephalopathy

  • Elevated serum lactate concentration

    • > 3.0 mmol/L after initial fluid resuscitation

    • > 3.5 mmol/L after 48 hours

  • APACHE II score > 15

  • Rising PT after 72 hours

  • Relative hypotension despite appropriate fluid resuscitation

  • Serum phosphate concentration > 3.75 mg/dL after 48 hours

And how to initiate NAC:

IV solution:

150 mg/kg over 15 min, followed by 50 mg/kg over the next 4 hours, then 100 mg/kg over the next 16 hours.

The patient was transferred to an outside facility with liver transplant capabilities.

2: “One man’s take on what it takes to be a good doctor”

If you have not listened to Scott Weingart’s “Pathway to Insanity” podcast even after Dr. Silverberg recommended it you are missing out!

3: “Emergency Medicine Kingdom”

What I learned:

ACEP 2013 was a blast. The learning and networking is invaluable. Did I mention there was a huge party? See you in Chicago next year!

4: “Becoming a better educator”

What I learned:

The ACEP Teaching Fellowship try and do this during your career you will always have to teach no matter what your future career path. Teaching is something to work at everyday it will help you, your colleagues and your patients.

5: “You can learn via social media”

What I learned:

Too many things to name! Effective ways to teach a topic like Salter-Harris fractures, Dr. Joshi’s board review the list is vast. Its a great catalyst to spur further reading and questions to topics that interest emergency medicine the most. Join the conversation. Don’t know how just ask me!


Didn’t take the leader quiz last month? Here’s the link to the blog post! Enjoy the rest of the year!


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