Critical CareEmergency MedicineResuscitationSMACCPrecision Emergency Medicine

Precision Emergency Medicine & outcomes by Anand Swaminathan

Anand Swaminathan brings precision emergency medicine and outcomes in critical care into the light.

He will convince you to start calling diseases for what they are and as a result start offering the proper treatments and care. All disease exist on a spectrum. You can’t treat one end of the spectrum the same way you treat the other end.

This talk is inspired by a case of Anand’s. An older man presented to the ED with acute onset shortness of breath and crackles. He was treated with Lasix. More and more Lasix – even though he wasn’t improving.

Anand knew this presentation was more than just an exacerbation of heart failure. This was acute pulmonary oedema and this man needed a different treatment.

Disease is on a spectrum with ‘urgent’ on one end and ‘critical’ on the other.

The umbrella term that identifies the disease, needs to be spread  out so that it can be placed on this spectrum by you and others around you.

Calling a presentation an exacerbation of CHF when it is in fact acute pulmonary oedema is wrong and leads to harm for the patient. We have the medications and treatments for both ends of the spectrum. However, they aren’t always used.

Too often disease gets miscategorised on the wrong, milder end of the spectrum. Why?

Firstly, more patients exist at this end and we therefore default back to this presentation of the illness.

Secondly, there is an inverse relationship between the severity of disease and the research guiding treatment. Therefore, the temptation is to use this research to guide management all along the spectrum.

Finally, time and resources are precious. The sicker a patient is, the more of these commodities they use up so we move towards an approach for milder disease.

To counteract these points, Anand wants you to understand the diseases better. How?

Firstly, educate yourself and those around you to assess and treat disease properly. Call the disease the right thing and ensure proper allocation and adequate treatment and resources.

Secondly, spend more time at the bedside – especially early in your training. This is how you rapidly identify a sick patient, and rapidly determine what needs to be done.

After this talk, Anand hopes you are inspired and can walk into work tomorrow and make a change. Empower each other to act by calling things what they are!

Precision Emergency Medicine & outcomes by Anand Swaminathan

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Anand Swaminathan

Anand Swaminathan is a core faculty member of the St. Joseph’s Regional Medical Center Emergency Department in Paterson, NJ. He is an assistant professor of Emergency Medicine at the Hackensack Meridian School of Medicine and the Medical Education Fellowship Director at St. Joseph’s Hospital. His main interests are in resident education, faculty development, resuscitation and knowledge translation. Anand is the managing editor and conference chair for EM: RAP and the managing editor for EM Abstracts. He is a big believer in and contributor to the Free Open Access Medical Education (FOAM) movement. Anand is an associate editor for REBEL EM and REBELCast and a regular contributor to the EM Cases Quick Hits podcast. When not working, Anand enjoys long distance running and building Legos with his kids (Matt 12, Maya 9 and Luke 5).