EM Pulse Podcast™

In this episode, the we welcome back guest host, Dr. Neelou Weeker, and ED nurse, Leigh Clary, to discuss the critical intersection of language barriers, patient equity, and emergency care. Through two powerful clinical scenarios, the team explores the “gold standards” of medical translation, the challenges of resource-limited community settings, and how TeamSTEPPS tools—specifically closed-loop communication and situational monitoring—can be leveraged to ensure true informed consent and patient safety. The Gold Standard vs. Clinical Reality Providing equitable care means ensuring every patient, regardless of language or culture, fully understands their medical team. While academic centers are often highly resourced, executing communication seamlessly remains a universal challenge. 1. Translation Tools and Hierarchy The Gold Standard: Video- or audio-based professional interpretation tablets allow face-to-face or direct vocal translation. The Secondary Backup: In-house dual-handset “blue phones” connect directly to professional phone lines when tablets experience connectivity issues. The Tertiary Backup: Multilingual staff members can help act as a bridge. Many institutions feature language fluencies on staff ID badges. Note: Staff members should only be used to establish initial rapport or identify the required dialect, not as official medical interpreters. The Danger of Family Interpreters: While family members bring invaluable cultural context and an understanding of the patient’s baseline, studies show they only correctly interpret medical dialogue 19% of the time. The Bottom Line: Always utilize the official route first. When technology fails, do your absolute best—never settle for “good enough” when better communication is possible. 2. Academic vs. Community and Rural Settings Emergency medicine requires extreme adaptability. In resource-limited community or rural hospitals, finding an interpreter for less commonly spoken languages can take upwards of 30 minutes. Physicians must sometimes physically carry translation phones from room to room while managing other patients just to maintain an open line with a rare-dialect interpreter. Applying TeamSTEPPS to Patient Communication We routinely use TeamSTEPPS tools to communicate with our fellow clinicians, but we must remember that the patient is the most important member of the healthcare team. 1. Closed-Loop Communication & The Teach-Back Method To confirm true patient understanding, avoid simple “yes or no” questions, nods, or smiles. Instead, utilize the Teach-Back Method, requiring the patient to repeat the instructions or choices back to you in their own words. How to Phrase It (Taking Responsibility): “I want to make sure that I have been clear in what I’ve said to you. To help me feel reassured that I communicated everything correctly, could you tell me what you understand is going on?” Clinical Value: This is particularly vital for high-stakes decisions and ED discharge instructions. Multimodal Approach: In high-stakes moments, combine professional translation, family context, and teach-back to minimize errors. 2. Situational Monitoring Resuscitative environments are chaotic, and the primary physician trying to run a cod or secure an airway has immense cognitive load. The Team Safety Net: Other team members (nurses, techs, scribes) can help monitor the situation and catch critical communication errors. Reconciling Clinical Urgency with Informed Consent How do you balance the immediate need to save a life with the time-consuming process of formal translation? The ABC Priority: First and foremost, secure Airway, Breathing, and Circulation. If a patient presents to the ED in extremis and cannot communicate, clinicians must operate under the assumption that the patient wants life-saving measures performed. Task Delegation: While the medical team manages the immediate ABCs, immediately task support staff (such as social workers) with finding an official interpreter, locating family members, and gathering background information. Next Steps: Once the ABCs are stable, the team has the time and space to pause, establish formal translation, and dive deeper into informed consent for further procedures. Key Takeaways Acknowledge the Bias of Urgency: Time pressure can tempt us to bypass official translation channels. Guard against this by maintaining an equity-first mindset. Close the Loop with Patients: Ensure they can paraphrase their care plan or consent choices. Protect the Team via Shared Roles: Trust your teammates to monitor the big picture and catch subtle communication gaps during high-stress resuscitations. Do you use TeamSTEPPS or a similar model in your ED? We’d love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com Host: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guest Host: Dr. Neelou Tabatabai, Assistant Professor of Emergency Medicine at UC Davis Guest: Leigh Clary, RN, BSN, RN, CEN, ADCES, MICN , ED Nurse and TeamSTEPPS Project Lead at UC Davis Resources: TeamSTEPPS Player of the Month Program, Presentation by Leigh Clary and Jose Metica TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety Heidi B. King, MS, CHE, James Battles, PhD, David P. Baker, PhD, Alexander Alonso, PhD, Eduardo Salas, PhD, John Webster, MD, MBA, Lauren Toomey, RN, BSBA, MIS, and Mary Salisbury, RN, MSN. TeamSTEPPS Pocket Guide – Agency for Healthcare Research and Quality EM Pulse: TeamSTEPPS, September 17, 2021 *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services. Disclaimer: The opinions expressed on this podcast are those of the hosts or guests and do not necessarily reflect the views of UC Davis Department of Emergency Medicine, UC Davis Health, or their parent organizations.  

In the second episode of our Medicine on the Go series, we step beyond the ED to explore how UC Davis Health and Sacramento County are partnering to deliver care directly to the community through the Wellness Without Walls (W3) street medicine program. We’re joined by Dr. MK Orsulak, Assistant Professor of Family Medicine at UC Davis. We discuss how a mobile clinic staffed by interdisciplinary teams brings primary care, wound care, mental health services, HIV/STI testing, vaccinations, and substance use treatment to people experiencing homelessness—meeting patients where they are and reducing preventable ED visits. This episode offers a powerful look at how innovative, cross-system collaboration can extend emergency care beyond hospital walls and improve access to the right care at the right time. Do you have a program similar to W3 in your area? We’d love to hear about it! Share with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. MK Orsulak, Assistant Professor of Family and Community Medicine at UC Davis Resources: Sacramento County Department of Health Services: Wellness Without Walls (W3) Street medicine team improves lives of unhoused patients, by Edwin Garcia, Feb 27 2024 *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode of EM Pulse, guest host Dr. Neelou Tabatabai joins Julia in a discussion with ED nurse and TeamSTEPPS advocate, Leigh Clary, to explore how structured communication tools can transform even the most high-stress medical and trauma resuscitations. Through a real-life story of conflict and resolution in the emergency department, Leigh illustrates how TeamSTEPPS strategies—like assertive communication, the Two-Challenge Rule, and CUS words—empower teams to speak up, de-escalate tension, and protect patient safety. Together, they unpack how calm, composed dialogue preserves respect, strengthens teamwork, and ensures every voice is heard when it matters most. Do you use TeamSTEPPS or a similar model in your ED? We’d love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guest Host: Dr. Neelou Tabatabai, Assistant Professor of Emergency Medicine at UC Davis Guest: Leigh Clary, RN, BSN, RN, CEN, ADCES, MICN , ED Nurse and TeamSTEPPS Project Lead at UC Davis Resources: TeamSTEPPS Player of the Month Program, Presentation by Leigh Clary and Jose Metica TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety Heidi B. King, MS, CHE, James Battles, PhD, David P. Baker, PhD, Alexander Alonso, PhD, Eduardo Salas, PhD, John Webster, MD, MBA, Lauren Toomey, RN, BSBA, MIS, and Mary Salisbury, RN, MSN. TeamSTEPPS Pocket Guide – Agency for Healthcare Research and Quality EM Pulse: TeamSTEPPS, September 17, 2021 **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

What happens when a febrile infant presents at 61 days old? Are they suddenly low risk for invasive bacterial infections? In this episode, we explore the gray zone of managing febrile infants aged 61–90 days with the help of two new clinical prediction rules from PECARN. Joining us are two powerhouses in pediatric emergency medicine: Dr. Nate Kuppermann and Dr. Paul Aronson, who walk us through their recent study published in Pediatrics. We discuss why prior research has traditionally stopped at 60 days, what the new data shows about risk in this slightly older age group, and how these rules might help guide clinical decision-making. This study fills a long-standing gap—but should we start using the rules now? Tune in for a nuanced discussion on sensitivity, missed cases, practical application, and the future of risk stratification in young infants with fever. What is your practice in terms of work-up of 2-3 month old febrile infants? Will this change what you do? Hit us up social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Paul Aronson, Professor of Pediatrics (Emergency Medicine); Deputy Director, Pediatric Residency Program at Yale University School of Medicine Resources: “Hot” Off the Press: Infant Fever Rule Do I really need to LP a febrile infant with a UTI? Aronson PL, Mahajan P, Meeks HD, Nielsen B, Olsen CS, Casper TC, Grundmeier RW, Kuppermann N; PECARN Registry Working Group. Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections. Pediatrics. 2025 Sep 1;156(3):e2025071666. doi: 10.1542/peds.2025-071666. PMID: 40854562; PMCID: PMC12432541. Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281. Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Summer hikes and backyard play mean we’re bound to see a few snakebites in the ED—and getting the first steps right makes all the difference. In the first half of this 2 part series, Medical Toxicologist Dr. Jonathan Ford joins us to walk through the key steps in caring for patients with snake envenomations. We’ll walk through what to do (and not to do) in terms of pre-hospital care, how to triage and assess patients when they arrive in the ED, and how to decide which patients need antivenom. Dr. Ford reviews dosing strategies, monitoring, and key considerations for children, elderly, and pregnant patients. And we discuss practical guidance on supportive care, from pain control to wound management. By the end of this episode, you’ll be ready to provide effective, evidence-based care for your next snakebite patient. Have you had a patient with a serious or challenging envenomation? How did you manage it? Share your story with us social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Jonathan Ford, Professor of Emergency Medicine and Medical Toxicologist at UC Davis Resources: Seifert SA, Armitage JO, Sanchez EE. Snake Envenomation. N Engl J Med. 2022 Jan 6;386(1):68-78. doi: 10.1056/NEJMra2105228. PMID: 34986287; PMCID: PMC9854269. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this high-yield two part episode, we dive into the evolving world of resuscitation with Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis. From the shift in priorities from ABC (Airway-Breathing-Circulation) to CAB (Circulation first) to the practical use of peripheral vasopressors and rapid infusion catheters, this episode breaks down how frontline ED care is adapting to sicker patients, longer ICU boarding times, and limited resources. Tune in for insights on advanced access strategies, pre-hospital blood products, and why old tools, like whole blood and vasopressin, are making a powerful comeback. What do you think of Dr. Leon’s tips? Are you using these tools in your practice? We’d love to hear from you. Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis Resources: American Heart Association (AHA) Algorithms Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; American Heart Association. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. PMID: 38108133. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode, we welcome back Dr. John Rose as cohost for a conversation with Dr. Gary Tamkin—Emergency Physician and Vice President of Provider Development at US Acute Care Solutions. Together, they explore what it really takes to find happiness and fulfillment in the high-stakes world of emergency medicine. From the trap of the arrival fallacy to the pressure of always chasing the next milestone, Dr. Tamkin shares personal insights and practical strategies tailored to the unique challenges EM clinicians face. You’ll come away with two actionable tools to help build more meaning, balance, and joy—both on shift and off. What are your tips for avoiding burnout and finding balance? Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest Host: Dr. John Rose, Professor of Emergency Medicine and EMS Medical Director at UC Davis Guest: Dr. Gary Tamkin, Emergency Physician and Vice President of Provider Development and US Acute Care Solutions Resources: Podcast: 10% Happier with Dan Harris Podcast: Hidden Brain with Shankar Vedantam Transitions by William Bridges, PhD with Susan Bridges The Happiness Advantage by Shawn Achor **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.