POTD: My Pronouns are She/Her. What are Yours?

This POTD will not be covering topics on gender, sexuality, identity, expression, etc, but I will be discussing anything and everything you have ever possibly thought about pronouns. My goal is to deepen your understanding and hopefully help y'all communicate accurately and respectfully with your friends, families, colleagues, and your patients!

"Proper use of gender identity terms, including pronouns, is a crucial way to signal courtesy and acceptance. Alex Schmider, associate director of transgender representation at GLAAD, compares using someone's correct pronouns to pronouncing their name correctly – "a way of respecting them and referring to them in a way that's consistent and true to who they are.""

Why is this important?

You can’t always know what someone’s pronouns are by looking at them. Asking and correctly using someone’s pronouns is one of the most basic ways to show your respect for their gender identity.

When someone is referred to with the wrong pronoun, it can make them feel disrespected, invalidated, dismissed, alienated, or dysphoric.

It is a privilege to not have to worry about which pronoun someone is going to use for you based on how they perceive your gender. If you have this privilege, yet fail to respect someone else’s gender identity, it is extremely disrespectful and hurtful.

For us in the medical field, we are able to create a safe environment and build rapport with our patients by using the correct pronouns!

What if I use the wrong pronouns?

It’s okay! Everyone makes mistakes from time to time. The best thing to do if you use the wrong pronoun for someone is to say something right away, like “Sorry, I meant (insert pronoun)”. If you realize your mistake after the fact, apologize in private and move on. No need to make it any more complicated than that. By doing that really simple gesture of apologizing quickly and moving on shows the other person that you care, which makes a really big difference.

How do I find out a person's pronouns?

Easy, start by giving them yours! Make it clear, straightforward, and casual — in the same way you’d share what region or city you live in.

Here's some examples:

"Hi, I'm Dr. De Guzman. My pronouns are she/her. I apologize for the long wait, what brought you to the hospital today?"

"HIIIIIIIII, I'm Cat. I'm from Queens, I love fried chicken sandwiches, and my pronouns are she/her. What about you?"

See, super easy!

How is "they" used as a singular pronoun?

"They" is already commonly used as a singular pronoun when we are talking about someone, and we don't know who they are. Using they/them pronouns for someone you do know simply represents a little bit of a switch.

An example:

Let's say you saw a member of the UST grab the U/S from south side, but you weren't quite sure who took it. Dr. Odashima comes by with the remaining UST members and asks if so and so has it. You'd most likely say:

"Oh yeah, they have the U/S." or "The U/S is with them."

In these cases, you're referring to one person with they/them pronouns. See, you've probably already been using "they" as a singular pronoun for your whole life without even realizing it!

What does it mean if a person uses the pronouns "he/they" or "she/they"?

"That means that the person uses both pronouns, and you can alternate between those when referring to them. So either pronoun would be fine — and ideally mix it up, use both. It just means that they use both pronouns that they're listing," says Rodrigo Heng-Lehtinen, deputy executive director of the National Center for Transgender Equality.

The best approach I've read is to just listen to how people refer to themselves or even simpler, just ask!

References:

https://www.npr.org/2021/06/02/996319297/gender-identity-pronouns-expression-guide-lgbtq

https://hbr.org/2021/06/my-pronouns-are-she-they-what-are-yours

https://uwm.edu/lgbtrc/support/gender-pronouns/

POTD: Wellness Wednesday Walk Up Song

Picture this: You're walking from the Fort Hamilton station on the way to your weekend south 7p-7a shift. You see a never ending row of ambulances parked in front of the ambulance bay. You can already feel the 2+ hour wait in your heart and soul.

What's the last song that's blasting through your air pods as you walk into the ED?

Hmm, don't have one? Well, my dear friends, you need a walk-up song!

In addition to being a fun form of self-branding, a walk-up song can inspire and motivate you, as well as become a part of a ritual to calm your nerves and boost your confidence. And the coolest part? There is real evidence that pre-task music can objectively improve performance.

Music captures attention, triggers a range of emotions, alters or regulates mood, increases work output, heightens arousal, induces states of higher functioning, reduces inhibitions and encourages rhythmic movement. Music has ergo-genic effect as well, it increases exercise performance, delays fatigue and increases performance and endurance, power and strength.

If this didn't convince you to pick a walk-up song, check out the talk from Dr. Joelle Borhart at FIX 19 that inspired this POTD. Link below.

https://feminem.org/2020/01/02/you-need-a-walk-up-song/

And by all means, please let me know what songs y'all are blasting or are we all just listening to Adele's latest drop on repeat? ...or is that just me?

Please, go easy on me.

Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435671/

POTD: Winter is Coming.

Let’s talk about FROSTBITE, BRRRRRRR.

Background

• Results from the freezing of tissue that are exposed to temperatures below their freezing point, resulting in direct ice crystal formation and cellular lysis with microvascular occlusion

• Most of the damage occurs as a result of a freeze thaw cycle with endothelial damage and cellular death resulting in osmotic gradient changes, initiation of the arachidonic acid cascade, vasoconstriction, and hematologic abnormalities including thrombosis

• Risk correlated with temperature and wind speed

• Risk is <5% when ambient temperature (includes wind chill) is > –15°C (5°F)

• Most often occurs at ambient temperature < –20°C (–4°F)

• Wetness and humidity increase the risk (water has 25x thermal conductivity of air)

• Can develop within 2-3sec when metal surfaces that are at or below –15°C (5°F) are touched

• Most commonly affects distal part of extremities, face, nose, and ears

• The severity of irreversible damage is most closely related to ambient temperature and length of time the tissue remains frozen

• High-risk groups: outdoor workers, elderly, homeless, drug or alcohol abusers, psychiatric disease, high-altitude or cold-weather athletes, military personnel

• "Hunter's response" - prolonged repeated exposure to cold is protective

Classification

Frostbite is classically categorized into four levels of injury.

Management

The initial treatment in the Emergency Department for all degrees of frostbite is the same. Addressing ABC’s, trauma evaluation, removing wet and constrictive clothing, treatment of concomitant hypothermia (must rewarm to a core temperature of at least 35°C), and identification of other injuries should be confirmed in all cold injury cases if warranted.

• THAWING: Do NOT attempt until the risk of refreezing is eliminated. Refreezing will cause even more severe damage. Rapid active rewarming is the core of therapy and should be initiated as soon as possible. Best performed in a circulating water bath around 37°C to 39°C. Frostbitten faces can be thawed using warm water compresses, and ears may be thawed with small bowls of warm water. Immersion rewarming can be discontinued when the affected area developed a red or purple appearance and becomes pliable to the touch.

• Analgesia: rewarming is very painful, treat your patient's pain!

• Local wound care: Gently dry, elevate, and apply bulky dressing to the affected area. Compartment syndrome is a known complication, so maintain a high suspicion.

• Update tetanus as needed

• Empiric prophylactic antibiotics are not needed and are controversial.

• Surgical management may be required if wet gangrene or infection occurs, but this is typically reserved for late frostbite management after the rewarming phase in days to weeks following initial presentation

Dispo Dispo Dispo

• Patients with superficial local frostbite may be discharged home if social circumstances allow. Patients unable to care for themselves adequately should never be discharged into subfreezing temperatures.

• Significant injuries will require admission.

References:

http://www.emdocs.net/brrr-ed-presentation-evaluation-and-management-of-cold-related-injuries/

http://emedicine.medscape.com/article/926249-treatment#showall

https://wikem.org/wiki/Frostbite

https://www.emrap.org/episode/environmentalem/hypothermia

https://www.emrap.org/episode/environmentalem/frostbite