POTD:  An Uninvited Guest (Wellness Friday)

POTD:  An Uninvited Guest (Wellness Friday)

an uninvited guest

settles in the valley of my heart

makes a home within my chest

and refuses to depart

 

the mountains of my lungs

are crumbling down beneath his weight

as he pollutes the peace once there

with oppression and hate

 

there are waves of emotions

that pound against my veins

lost in a whirl of wind

as they rage in a hurricane

 

the currents get rough

and I find myself lost at sea

within a jagged ocean as vast

as the emptiness I flee

 

my nights have grown longer

as I struggle to fall asleep

my days have blurred together

and my body has grown weak

 

tracks run over my wrist

as the departing train voices its last call

is it better to feel pain

than to feel nothing at all?

 

emotions cloud my thoughts

smoke fogs up my mind

they tell me I’m not good enough

that I’m not worth it to the Divine

 

my faith is shaking

I can’t find who I am

I am enchained by anxiety

as desolation takes command

 

saltwater shakes my core

and spills over the rims of my eyes

as the ocean drowns me

I succumb to numbness inside

 

I frantically glance into the distance

and find His lighthouse shining from miles away

guiding me home

from tides that make me stray

 

He shows me the universe;

constellations trace my skin

and even when I’m breaking,

my galaxies shine from stardust within

 

He shows me the dawn;

as it breaks, so do I

but there’s a beauty in my breaking

as red and gold paint the morning sky

 

To Him I am worth more

than this world entirely

and that’s all I need to overcome

my haunting thoughts of mortality

 

an honorable guest

has settled in the valley of my heart

He illuminates it with hope and light

in places I’ve broken apart

 

-SS Barkat

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It's World Mental Health Day tomorrow!

One in five adults suffer from a mental illness each year within the United States. More Americans struggle with depression than they do with coronary heart disease, cancer, and HIV/AIDS2. Unfortunately, stigmas founded on misunderstandings of mental illnesses are common. Some may inappropriately label the lack of energy that a depressed individual struggles with as laziness. In turn, those that are suffering turn away from getting the professional help that they need from fear of what people may say.

The “uninvited guest” in this poem refers to depression. The poem’s title aims to demonstrate that depression is just as real as any other physical disease that one may have. It isn’t a state that those suffering choose to be in; rather, depression appears uninvited and begins to govern the mind and body of the victim. Overall, the purpose of this poem is to share the complex nature of depression, the thoughts that may plague the minds of those that are depressed, and ways in which we can all look at the signs around us to remember our self worth in times that we feel lost and hopeless.

By sharing experiences and having open and honest conversations about mental health, we can become a step closer to shattering stigmas and improving access to treatment and services as a community of health care workers.

Have a friend who needs help?; Give them a hug, a pat on the back. Let them cry on your shoulder or your lap. Don't underestimate the power of simple things.

 Ask for help when it gets too much:

National Suicide Hotline: 1-800-273-8255

NYC Well: 1-888-NYC-WELL or Text "WELL" to 65173

In-house: Erica Hutchinson, Ph.D.

Office: (718) 283-8174

Work Cell: (347) 996-6090

 

Have a great weekend and stay well,

TR Adam

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POTD: Eye Stuff (Trauma Tuesday!)

POTD: Eye Stuff (Trauma Tuesday!)

A.

Seidel's sign: Fluorescein stained vitreous flowing from the site of globe perforation. Should protect the globe from any external pressure with eye shield, elevate head of bed 30 degrees, analgesia, control hypertension, and prevent vomiting. Emergent Optho consult.

B.

Teardrop pupil: Usually indicated globe rupture/ FB. See management for Seidel's sign above.

C.

Corneal foreign body with rust ring: remove foreign body, urgent follow up for rust ring removal which should be done after 24 hours from initial injury- this is because reepithelialization makes removal easier.

D.

Exophthalmos: if in setting of trauma with increased intraocular pressure suspect retrobulbar hematoma. Obtain STAT CT scan, perform STAT lateral canthotomy and emergent optho consult.

E.

Hyphema: Blood in the anterior chamber of the eye. Elevate head of bed, control intraocular pressure. Patients on anticoagulation or antiplatelet agents should be admitted for reversal and observation. Consult ophthalmology depending on size of hyphema and rebleed risk.

Stay well,

TR Adam

A.

A.

B.

B.

C.

C.

D.

D.

E.

E.

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EMS Protocol of the Week - Asthma

EMS Protocol of the Week - Asthma 

From the perspective of an ED physician, Protocol 507 – Asthma (attached below) is one of the most frustrating ones to encounter. Not because it’s particularly complicated, but rather because it often doesn’t leave you with anything to do. The Standing Orders for 507 include almost everything you would do yourself for a patient coming through walk-in triage with an acute asthma exacerbation: albuterol/ipratropium nebs x3 followed by continuous albuterol, IV access, steroids, magnesium, and even IM epinephrine for severe exacerbations. Checking an EKG is also included for appropriate patients. The only MCO for these cases is for the patient that may benefit from a repeat dose of IM epi. Otherwise, everything else is done by the paramedics on their own. It’s not unusual to receive a patient who was in extremis on EMS arrival, got IM epi, multiple nebs, steroids, and magnesium, and who now feels entirely better on ED arrival and wants to go home. And maybe sometimes the patient can go home, but be extraordinarily careful in these instances that you’ve fully reviewed the patient’s prehospital course. Note that in this case, the patient in front of you is wildly different from the one EMS encountered, and consider that fact at length when determining the patient’s disposition. In any event, whether it’s admission, discharge, or observation, the only thing left for you to do at that point is order the chest x-ray and maybe labs.

See? Boring for us, fun for the medics. And good for the patient, which I GUESS is what really matters.

Questions, comments, concerns? Send an email! Otherwise keep checking www.nycremsco.organd the protocol binder for more fun stuff.

 PS, while it doesn’t say so explicitly, this protocol is written for adults. What do we do with the kids? Stay tuned!

David Eng, MD

Assistant Medical Director, Emergency Medical Services

Attending Physician, Department of Emergency Medicine

Maimonides Medical Center

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