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Covid Lessons DR. JAQUIS Q&A SKEPTICS’ GUIDE TO EM ETHICS Leading Is POCUS Best for COVID During a Crisis Shoulder Dislocations? Talks SEE PAGE 8 SEE PAGE 20 SEE PAGE 14 MAY 2020 Volume 39 Number 5 FACEBOOK/ACEPFAN TWITTER/ACEPNOW ACEPNOW.COM PLUS FROM THE AIRWAY EQUITY EQUATION FRONT COVID-19 WHILE BLACK COVID LESSONS LINES TO SEE PAGE 19 Tips, tricks, and advice from my experience THE HOME treating COVID-19 patients in New York City FRONT Emergency physician by RICHARD M. LEVITAN, MD, FACEP parents share how they’re managing the Editors’ Note: This article was accepted on April 14, 2020, and was accurate at that time. Because informa- COVID-19 crisis tion about SARS-CoV-2 and COVID-19 is evolving rapidly, by JORDAN GRANTHAM please verify these recommendations and information. or many emergency physician par- recently spent 10 days at New York ents, the COVID-19 crisis has placed City's Bellevue Hospital, treating pa- Fthem in the unique position of man- I tients suspected of having COVID-19. aging not only the stress of caring for pa- Here are some of the things I learned tients on the front lines but also caring for their families at home. It prompted new PPE about managing these patients. concerns about their own safety and that of their families. Schools shut down, normal EM TAKING CONTINUED on page 17 THE LEAD TO routines were thrown out the window, face #GETUSPPE masks became de rigueur. EM families ex- SEE PAGE 6 perienced the disruption but with an added layer of concern for their loved ones on the front lines. ACEP Now spoke with several emergency physicians to hear what has helped them explain this pandemic—and their important FIND IT ONLINE For more clinical stories and role in fighting the virus—to their children practice trends, plus commentary and opinion pieces, go to: of all ages. www.acepnow.com SHUTTERSTOCK.COM CONTINUED on page 12 KIDS KORNER CO-INFECTION RATES & visit our website website our visit www.wileycustomerhelp.com IBUPROFEN USE If you have changed your address or wish to contact us, please please us, contact to wish or address your changed have you If Hoboken, NJ 07030-5790 NJ Hoboken, SEE PAGE 22 River Street River 111 Journal Customer Services Customer Journal WILEY PERIODICALS LLC PERIODICALS WILEY PERIODICAL PAID ADVERTISEMENT ACC’s COVID-19 Hub Your source for continuously updated tools, resources and information for cardiac-specific preparedness • Clinical Guidance • ACC Clinical Bulletin • Expert Opinion • Front-Line Experience • Coding and Billing Updates • And More ACC.org/COVID19 Resources for Health Care Providers to Help and Heal ACEPNOW.COM MAY 2020 Volume 39 Number 5 NEWS FROM THE COLLEGE UPDATES AND ALERTS FROM ACEP EDITORIAL STAFF MEDICAL EDITOR COVID-19 Field Guide: A for four Board of Directors positions are: Mi- Jeremy Samuel Faust, MD, MS, MA, FACEP Living Resource chael Baker, MD, FACEP (MI); Alison Haddock, [email protected] ACEP created the Field Guide to COVID-19 MD, FACEP (incumbent – TX); Aimee Moulin, Care in the Emergency Department to assist MD, FACEP (CA); Aisha (Liferidge) Terry, MD, EDITOR ART DIRECTOR in this crisis. This resource is a compilation FACEP (incumbent – DC); and Arvind Venkat, Dawn Antoline-Wang Chris Whissen of what we currently know on the evalua- MD, FACEP (PA). [email protected] [email protected] tion and treatment of COVID-19. It is a liv- ing document that is being updated as new ACEP STAFF information, guidance, and best practices EXECUTIVE DIRECTOR DIRECTOR, MEMBER COMMUNICATIONS evolve. This field guide aims to provide the Dean Wilkerson, JD, MBA, CAE AND MARKETING information you need to assess the available DALLAS [email protected] Nancy Calaway, CAE resources in your community and determine [email protected] your local applications. At time of publica- CHIEF OPERATING OFFICER tion, the guide includes sections on Home Robert Heard, MBA, CAE COMMUNICATIONS MANAGER ACEP20 Still on for October [email protected] Jordan Grantham Safety, Work Safety, EMS, Triage, Patient [email protected] Presentation, Assessment, Diagnosis, Risk It is unknown how COVID-19 will affect the rest Stratification, Treatment, Special Popula- of this year, but we continue to plan for the tions, Business, Regulations and Liability, ACEP Scientific Assembly Oct. 26–29 in Dallas. PUBLISHING STAFF Personal Well-Being and Resilience, and the We hope our event can commemorate a memo- Impact on Education, Licensure and Creden- rable and hard year where your bravery and EXECUTIVE EDITOR/ ASSOCIATE DIRECTOR, PUBLISHER ADVERTISING SALES tialing. Use this resource at www.acep.org/ dedication were on display. While planning Lisa Dionne Lento Steve Jezzard covid19-field-guide. the in-person event, we are exploring virtual [email protected] [email protected] options for those unable to attend. Registra- Critical Decisions in EM: tion is scheduled to open July 1 at www.acep. Special COVID-19 Edition ADVERTISING STAFF org/acep20. This special edition of Critical Decisions in EM DISPLAY ADVERTISING CLASSIFIED ADVERTISING includes lifesaving lessons focused on the ED Congratulations, 2020 Kelly Miller Dean Mather evaluation and management of COVID-19, Award Winners! [email protected] [email protected] including timely information on risk factors, Our 2020 honorees will be recognized during (856) 768-9360 (856) 768-9360 common examination findings, valuable di- ACEP20 in Dallas: agnostic tests, and the safe use of pharmaco- • John G. Wiegenstein Leadership Award: EDITORIAL ADVISORY BOARD logical treatments. The issue also takes a deep David C. Seaberg, MD, CPE, FACEP dive into personal protective equipment, the • James D. Mills Outstanding Contribu- James J. Augustine, MD, FACEP Catherine A. Marco, MD, FACEP provision of respiratory support, and what in- tion to Emergency Medicine Award: Richard M. Cantor, MD, FACEP Ricardo Martinez, MD, FACEP terventions should be avoided when manag- John J. Rogers, MD, CPE, FACEP L. Anthony Cirillo, MD, FACEP Sandra M. Schneider, MD, FACEP ing these vulnerable patients. Learn more at • Judith E. Tintinalli Award for Outstand- www.acep.org/cdem/products. ing Contribution in Education: Tracy G. Marco Coppola, DO, FACEP Jeremiah Schuur, MD, MHS, FACEP Sanson, MD, FACEP Cedric Dark, MD, MPH Robert C. Solomon, MD, FACEP Clinical Alert: Your • Outstanding Contribution in Research Jonathan M. Glauser, MD, MBA, FACEP Annalise Sorrentino, MD, FACEP COVID-19 Library Award: Alan E. Jones, MD, FACEP We continue to curate and organize relevant • Outstanding Contribution in EMS Michael A. Granovsky, MD, FACEP Jennifer L’Hommedieu Stankus, MD, JD, FACEP COVID-19 resources as part of our Clinical Award: James M. Atkins, MD Sarah Hoper, MD, JD, FACEP Peter Viccellio, MD, FACEP Alert at www.acep.org/covid-19. You will • Colin C. Rorrie, Jr. Award for Excellence Linda L. Lawrence, MD, FACEP Rade B. Vukmir, MD, JD, FACEP find member updates, federal and regulato- in Health Policy: Steven J. Stack, MD, ry news, clinical resources, recent literature, MBA, FACEP and more. • Policy Pioneer Award: Amy M. Cho, MD INFORMATION FOR SUBSCRIBERS • John A. Rupke Legacy Award: Peter M. Subscriptions are free for members of ACEP and SEMPA. Free access is also available online at www. Virtual Hill Day Focuses on Fahrney, MD, FACEP(E) acepnow.com. Paid subscriptions are available to all others for $310/year individual. To initiate a paid COVID-19 Response • Honorary Membership Award: Pat subscription, email [email protected] or call (800) 835-6770. ACEP Now (ISSN: 2333-259X print; On April 28, ACEP’s Virtual Hill Day—a reim- Hughes, CMP; Jane Scott, ScD, MSN; and 2333-2603 digital) is published monthly on behalf of the American College of Emergency Physicians by Wiley Periodicals LLC, 111 River Street, Hoboken, NJ 07030-5774. Periodical postage paid at agining of our annual Leadership & Advoca- Hugh Dean Wilkerson, JD, MBA, CAE Hoboken, NJ, and additional offices. Postmaster: Send address changes to ACEP Now, American cy Conference—gave nearly 500 emergency • Pamela P. Bensen Trailblazer Award: College of Emergency Physicians, P.O. Box 619911, Dallas, Texas 75261-9911. Readers can email physicians the opportunity to speak directly Sharon E. Mace, MD, FACEP address changes and correspondence to [email protected]. Printed in the United States by Hess Print with their state legislators about COVID-19 • Diane K. Bollman Chapter Advocate Solutions (HPS), Brimfield, OH. Copyright © 2020 American College of Emergency Physicians. All rights concerns. Participants representing 45 states Award: Robert (Bob) Ramsey, CAE reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means and without the prior permission in writing from the copyright holder. ACEP Now, an official pub- conducted 306 conference calls in small, • Community Emergency Medicine Ex- lication of the American College of Emergency Physicians, provides indispensable content that can be state-based groups. ACEP members shared cellence Award: Adnan Hussain, MD used in daily practice. Written primarily by the physician for the physician, ACEP Now is the most effec- stories about their experiences on the front • Innovative Change in Practice Manage- tive means to communicate our messages, including practice-changing tips, regulatory updates, and the lines of the pandemic while advocating for ment Award: Rahul Sharma, MD, MBA, most up-to-date information on healthcare reform. Each issue also provides material exclusive to the mem- our key COVID-19 issues: personal protective FACEP bers of the American College of Emergency Physicians. The ideas and opinions expressed in ACEP Now do not necessarily reflect those of the American College of Emergency Physicians or the Publisher. The equipment (PPE), liability, hazard pay, and • Disaster Medical Sciences Award: Irving American College of Emergency Physicians and Wiley will not assume responsibility for damages, loss, coverage. To catch up on ACEP’s federal and “Jake” Jacoby, MD, FACEP or claims of any kind arising from or related to the information contained in this publication, including any regulatory advocacy efforts during this crisis, • Council Meritorious Service Award: Mi- claims related to the products, drugs, or services mentioned herein.
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