The famous Greek astrologer Aristotle once quoted – “A whole is that which has a beginning, middle and end.” Emergency Medicine is altogether a different type of “whole”. In this Episode, I attempt to give a sneak peek into what is Emergency Medicine. 

Drs Sanjay, Shivani and Anubhooti join us today to discuss Hyponatremia - an easy approach and how to manage it according to the pathophysiology. It's an interesting take as hyponatremia remains as one of the most common presentations to an ED but yet under/over treated. The 6 step approach that Dr Shivani describes is as follows -  First - correctly diagnose hyponatremia (Na <130) Second - classification based on  time of onset of symptoms, serum osmolality levels and volume status of the patient - Acute/chronic, hyper/hypoosmolar, hypo/eu/hyper-volemic Third  - identify the cause Fourth -  co -relate it with the pathophysiology. Fifth - calculate the actual sodium deficit and rate of correction. Sixth - correct management You can ask Drs Sanjay and Shivani more regarding hyponatremia - Their twitter handles are - @drbobby71sanjay and @drshivanisarda

This episode I have tried to educate the masses regarding when to visit an emergency department, what happens in the emergency department and open their eyes to the verbal and physical assault that takes place in the ED. This is just a basic. There would be more episodes dedicated to the work we do and regarding violence in detail in the future. Some of the references used and the ones that people can read are mentioned below -  1. https://www.hopkinsacg.org/a-plan-of-action-to-reduce-avoidable-ed-visits/ 2. Davey K, Ravishankar V, Mehta N, et al. A qualitative study of workplace violence among healthcare providers in emergency departments in India. Int J Emerg Med. 2020;13(1):33. Published 2020 Jun 17. doi:10.1186/s12245-020-00290-0 3. Lavoie FW, Carter GL, Danzl DF, Berg RL. Emergency department violence in United States teaching hospitals. Ann Emerg Med. 1988;17:1227–1233. doi: 10.1016/S0196-0644(88)80076-3 4. World Health Organization. Workplace violence in the health sector: state of the art. Available from: http://www.who.int/violence_injury_prevention/violence/workplace/en/. 5. Joshi SC, et al. Doctor becomes a patient: a qualitative study of health care work place violence related perception among junior doctors working in a teaching hospital in India. Int J Community Med Public Health. 2018;5(5):1775–1786. doi: 10.18203/2394-6040.ijcmph20181381

In this episode, we talk about ketamine and how we have been using it in our department. Our experiences, some anecdotes, some evidence. We are not endorsing that you HAVE to use ketamine, but enlightening you that it can be used and the dogmas regarding it being unsafe are exactly those - DOGMAS. Following are the papers that you may read as references. They will guide you more about ketamine. Hope you enjoy the episode!. Have a Happy New Year!  Reading material -  1. Domino EF, Chodoff P, Corssen G. Pharmacologic effects of CI-581, A new dissociative anesthetic, in man. Clin Pharmacol Ther. 1965 May-Jun;6:279-91. doi: 10.1002/cpt196563279. PMID: 14296024. 2. Godwin SA, Burton JH, Gerardo CJ, Hatten BW, Mace SE, Silvers SM, Fesmire FM; American College of Emergency Physicians. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014 Feb;63(2):247-58.e18. doi: 10.1016/j.annemergmed.2013.10.015. Erratum in: Ann Emerg Med. 2017 Nov;70(5):758. PMID: 24438649. 3. Kiureghian E, Kowalski JM. Intravenous ketamine to facilitate noninvasive ventilation in a patient with a severe asthma exacerbation. Am J Emerg Med. 2015 Nov;33(11):1720.e1-2. doi: 10.1016/j.ajem.2015.03.066. Epub 2015 Apr 7. PMID: 25895715. 4. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011 May;57(5):449-61. doi: 10.1016/j.annemergmed.2010.11.030. Epub 2011 Jan 21. PMID: 21256625. 5. Godoy DA, Badenes R, Pelosi P, Robba C. Ketamine in acute phase of severe traumatic brain injury "an old drug for new uses?". Crit Care. 2021 Jan 6;25(1):19. doi: 10.1186/s13054-020-03452-x. PMID: 33407737; PMCID: PMC7788834. 6. Cohen L, Athaide V, Wickham ME, Doyle-Waters MM, Rose NG, Hohl CM. The effect of ketamine on intracranial and cerebral perfusion pressure and health outcomes: a systematic review. Ann Emerg Med. 2015 Jan;65(1):43-51.e2. doi: 10.1016/j.annemergmed.2014.06.018. Epub 2014 Jul 23. PMID: 25064742. 7. Verma A, Snehy A, Vishen A, Sheikh WR, Haldar M, Jaiswal S. Ketamine Use allows Noninvasive Ventilation in Distressed Patients with Acute Decompensated Heart Failure. Indian J Crit Care Med. 2019 Apr;23(4):191-192. doi: 10.5005/jp-journals-10071-23153. PMID: 31130793; PMCID: PMC6521817. 8. Shaprio HM, Wyte SR, Harris AB. Ketamine anaesthesia in patients with intracranial pathology. Br J Anaesth. 1972 Nov;44(11):1200-4. doi: 10.1093/bja/44.11.1200. PMID: 4647115. 9. Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed sequence intubation: a prospective observational study. Ann Emerg Med. 2015 Apr;65(4):349-55. doi: 10.1016/j.annemergmed.2014.09.025. Epub 2014 Oct 23. PMID: 25447559.

In this episode we discuss how our team of emergency medicine specialists entered into the world of emergency medicine. It is a light hearted episode filled with anecdotes and fun. Hope it (along with future episodes) also inspires future doctors and current doctors to take up emergency medicine as a specialty.