Objectives: Intensive care unit (ICU) readmission is associated with poorer outcomes as compared to primary admissions. Recognizing new or recurrent critical care issues on the wards postICU discharge may improve outcomes, especially in those subsequently requiring readmission. Herein, we describe and evaluate a pilot surgical critical care outreach initiative to reduce mortality in patients ultimately requiring ICU readmission. Methods: Each patient discharged from the ICU was visited within 48 h by a Critical Care Advanced practitioner who examined the patient, reviewed the chart, recent laboratory results, and orders, and then communicated any concerns to the primary service. Patient demographics, outreach issues identified, and severity of issues were recorded prospectively. Retrospectively, patient outcomes were assessed including the need and timing of any ICU readmission and mortality both before and after outreach implementation. Results: Pre and postoutreach readmission rates were 2.41% (37/1534) versus 3.54% (54/1524), respectively (P = 0.07). Mortality rates before and after outreach were 5.08% (n = 78) versus 5.64% (n = 86) overall (P = 0.052) and 18.9% (n = 7) versus 9.25% (n = 5) for readmissions (P = 0.21), respectively. Conclusions: Critical care outreach postICU discharge did not decrease readmission mortality in this pilot study. Further studies are required to evaluate its effects on not only readmission mortality but also readmission rates and timing along with the incident of subsequent ICU complications. The following core competencies are addressed in this article: Patient care, Systems based practice, Communication.

Objective: To review emotional intelligence (EI) literature in the context of how its application can help mediate various stressors among medical students, physicians-in-training, and faculty. Also, discussed are potential barriers to why EI-based programs face challenges to full implementation in medical education. Literature Search: MEDLINE, PsychINFO, EMBASE, Google Scholar, and Web of Science were searched for English language articles using various combinations of the following terms: EI, medical students, medical education, graduate medical education, trainees (including intern, resident, and residency), practitioners, and physicians. Electronic publications and printed books referenced by primary sources were also included. Results: Although there is increasing evidence for EI implementation being favorably associated with physician wellness, decreasing burnout, building better physician-patient relationships, and even better patient outcomes, there has so far not been a large scale movement to integrate EI into medical school curricula. The main barriers to wider implementation of EI are general lack of awareness, insufficient time and resources, and paucity of qualified faculty. Conclusions: Despite a number of associated potential benefits, EI has been facing various implementation hurdles in the medical education setting. Increasing awareness of EI and its benefits could help medical schools and residency programs around the globe to more actively engage in the implementation of EI training into medical school and residency curricula. We expect that such interventions would have several desirable outcomes, including improved overall physician wellness, enhanced patient experience, and perhaps even improved patient outcomes. The following core competencies are addressed in this article: Practice-based Learning and Improvement, Patient care, Professionalism, Interpersonal and communication skills, Systems-based practice.

Low serum potassium has been linked to classic signs and symptoms including mental status changes, muscular dysfunction and paralysis, and cardiac arrhythmias. Frequently, it has been listed as a cause for paralytic ileus, and correcting electrolyte anomalies is one of the first steps in treatment of a patient with nonfunctioning bowels. However, our review of the literature does not support a clear causative link. Older studies cite potassium as one of the many factors to optimize to regain bowl function, while newer studies do not support hypokalemia as a cause of ileus. Current treatment of ileus supports focusing on reversal of the effect of opiates on the gut, while electrolyte therapeutic goals are directed to prevent complications outside of the gastrointestinal (GI) tract. We review the cellular physiology and clinical data to elucidate the nature of the link between low potassium values and its impact on GI motility. Patients: Patients with hypokalemia and ileus. Intervention: Potassium repletion. Comparison: Patients with normal potassium values. Outcomes: Resolution of ileus. Population, intervention, comparator, and outcomes questions: Does low serum potassium cause intestinal ileus, and will correction of this deficit correct the intestinal paralysis?. The following core competencies are addressed in this article: Practice-based learning and improvement of medical knowledge. This article addresses the evidence linking hypokalemia and ileus to improve medical knowledge and enable physicians to put this evidence into practice.

When analyzing data for two independent groups (e.g., males vs. females), the Student's t-test is commonly used for normally distributed data measured on a continuous/interval scale (e.g., body mass index). The mathematical formula for the Student's t-test includes the mean between-group difference in the numerator and between-group variability in the denominator. The following core competencies are addressed in this article: Medical knowledge.

We report a rare cause of isolated acute traumatic aortic injury in a 58-year-old woman with a body mass index (BMI) of 19.4, following cardiopulmonary resuscitation (CPR). Our case is unique in that CPR was performed by a single CPR provider, no significant trauma occurred with the preceding syncope, and aortic injury occurred in isolation without fractures or other traumatic injury. Healthcare providers need to be aware that although chest compression of at least 2 inches depth is needed for effective CPR, the force required to achieve this compression is much less in an individual with a BMI of around 20 as opposed to a BMI of 40. Excessive chest compression can lead to acute traumatic aortic injury. We review appropriate resuscitation and chest compression depth, CPR associated injuries including aortic injuries and mechanisms of acute traumatic aortic injury. The following core competencies are addressed in this article: Patient care and medical knowledge.

We report a 45-year-old African-American female who presented with 20/400 acuity in the right eye and no light perception in the left eye. Based upon a magnetic resonance imaging displaying periventricular white matter enhancement and a lymph node biopsy revealing noncaseating granulomas, we made the diagnosis of neurosarcoidosis which is the only diagnosis that can explain both. Neurosarcoidosis is difficult to diagnose, has high rates of treatment failure, significant morbidity, and 5–10% mortality. We review the differential diagnosis for periventricular white matter and granulomas, presentation of neurosarcoidosis, ocular involvement of neurosarcoidosis, treatment, and patient outcomes. The following core competencies are addressed in this article: Patient care and medical knowledge.

Type 1 neurofibromatosis (NF1) is also known as von Recklingausen's disease. Among patients affected by NF1, fast-growing plexiform type neurofibromas have a high rate of malignant transformation and need to be distinguished from benign plexiform neurofibromas. Here, we describe an emergent case presentation with rapid transformation of neurofibromatosis into a malignant peripheral nerve sheath tumor in a male patient in his early 20's, who was admitted with a 4-day history of urinary retention, pelvic “fullness,” and lower back pain. Highlighted are computed tomography imaging characteristics of malignant peripheral nerve sheath tumor, exemplified by a large retroperitoneal/pelvic mass compressing the bladder and both ureters, resulting in bilateral hydronephrosis and urinary retention, and prompting urgent surgical resection. Associated MRI images and an intraoperative photograph are also presented. The following core competencies are addressed in this article: Patient care, Medical knowledge, Systems-based practice