RESUSCITATOR
WAYNE STATE UNIVERSI TY VOLUME 5, ISSUE 1 SCHOOL OF MEDICINE DEPARTMENT OF EMERGE NCY MEDICINE
LETTER FROM THE CHAI R INSIDE THIS ISSUE:
New direction inspired by an cigars and told me, “With these R E D S H O E 2 old sage. cigars, you roll the windows DIARIES up.” Ron had more one-liners I am honored to become the than Henny Youngman, in fact I third Chair for the Department just quoted him the other day CLASS OF 2016 4 of Emergency Medicine at WSU- stating, “I do not mean this to SOM. I attribute my success to be demeaning, but I want you the tremendous fortune of to take care of the patient.” being able to stand on the CLASS OF 2013 5 I would like to dedicate my GRADUATES shoulders of giants like Drs. Ronald Krome, Blaine White Chairmanship to his spirit, and Brooks Bock. Although I willing to take calculated risks, putting our people first and TRIP SITTERS 6 never agreed with any of them 100%, except for maybe Ron, I bucking the system for all the now understand each of them right reasons. better. With the passing of Dr. Ron in particular was able to CHIEF 7 Krome, Emergency Medicine build much with little. In my CHATTER has lost one of its founding chairmanship I will be tasked 8 fathers and true visionaries. with the same—with a For those who did not have the BACK TO 9 scheduled cut in funding BASICS honor of knowing Ron, he was a National Institutes of Health by treasure. Ron was a visionary $5.4 billion (18.6%) for fiscal Brian J. O’Neil, MD who truly changed the face of year 2014, which is in addition Edward S. Thomas Endowed AUNT MINNIE 12 medicine. Ron was a straight to to another $1.7 billion cut due Professor & Chair PASSES THE the point, colorfully accented to sequestration. This would SPIT TEST... orator and a shrewd negotiator equate into a $15.3 million cut who had a quick wit and when to research funding at Wayne needed a sharp tongue. This State University School of was not the person you wished Medicine. Furthermore, the to debate either at the bedside WSU-SOM received a $6 million SPECIAL POINTS or in conference, although I haircut last year, a $4 million to make it in today’s OF INTEREST: truly enjoyed the sport. He buzz cut this year, and an environment. I am confident would defend his people to the expected shave of $3 million that we have the innovation, Emergency Medicine Grand hilt. He told me once, “You can next year. Ouch! You know, creativity, and work ethic to Rounds, Every Thursday, say anything you want………as there was a time we did be successful. Detroit Receiving & Sinai- long as you are right” and research with little to no money. I am humbled by your Grace Hospitals “Don’t let anyone get to your It was dedication, sweat, unanimous vote to make me people directly, make them go partnerships and innovation your permanent chair and I ACEP Scientific Assembly through you.” Ron was willing to that drove much of my early will strive to make this October 14-17, 2013 take chances and would buck research. I remember going excellent department even the system, for all the right with Blaine to Meijer to better. I will, as my compass, DRH/SGH Combined Journal reasons. I never told Ron how purchase a baking pan, a peg first do the right thing, take Club December 10, 2013 much he influenced me, but I board, a furnace filter and a calculated risks, put our (Location TBD) think he knew, because it was bathroom mat to make a gel people first and buck the obvious how much I enjoyed his dryer. Pure genius…inspired by system for all the right DMC Emergency company. After his CABG he fiscal constraints. We are going reasons. Department Holiday Party, handed me a box of Cuban to need this kind of innovation December 20, 2013 MotorCity Casino
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RED SHOE DIARIES
When I get older, losing my hair ourselves. I also began to years mirrors inexorably get realize that despite loss or thicker at the bottle and the Many years from now graying of hair, wrinkles, and images sort of ‘sag’. Will you still be sending me a 100 pounds of fat (AND valentine? The theory that came to mind MUSCLE!) there are still as I studied Chris Heberer’s Birthday greetings, bottle of inherent traits that we retain. photo [Picture 1] is that no wine? These traits, I believe, are matter how old we may As I looked upon the old why 50 or 60 year old men become, certain innate photograph that Dr. Chris still visualize themselves as mannerisms still remain and Heberer forwarded to me, I they looked 30 years earlier— since we still ‘act’ the same, both thanked him and cursed despite what their eyes may in our limited male brains, we him. be seeing in the mirror must still ‘look’ the same. (cataracts and macular (How else can one explain degeneration not the rich, fat ancient Philip A. Lewalski, M.D. withstanding). billionaire with his trophy Assistant Professor Men, I believe, age a little wife? If he really saw himself Editor-in-Chief differently than women—at as rest of the world did, how least until the metro-sexual could he face the world with era came into being. Sure a provocatively clad version many men may “tweak” their of a granddaughter on his hair with either color arm? Maybe there is another enhancement or thickness male gene that gets enhancement (or both), but expressed when a man [Picture 1] I was thankful this is not done to ‘improve’ becomes extremely wealthy. that he provided me with an how we look, but to realign With my children’s parochial idea for my editorial article. I the mirror’s image with how school and university bills, I cursed him, however, we know we truly look. don’t have to worry about because he reminded me (“There must be something that gene turning on, so I’ll that no matter how old I may wrong with this mirror!” “I leave that research to [Picture 3] plasmid that escaped think I look, I am no longer don’t look like that.”) This someone rich!) from Jonathan Sullivan’s lab. that 20-something stud “mirror image dysmorphia” is Getting back to photo 1, Sully had very long hair for muffin that I still imagine a Y chromosome inherited there is no difficulty in decades and this genetic mutation myself to be. [Picture 2] trait and present in >95% of picking out Rob Welch. The must be a slowly expressed gene men. Look at your fathers, mannerisms are all still the that finally infected Freeman and sons and brothers. I have same even 30 years later. me after knowing Sully for watched my 17 year old son The flannel, the khakis, the approximately 15 years. Luckily, innumerable times as he stance against the wall are Sullivan’s lab developed a cure walks down the hallway in all still seen today. Sure the and Sully, Freeman and I all cut our house toward a large hair and beard were a little our pony tails a few years ago. mirror in our foyer. (There is darker, but I’m sure in Rob’s Scott and I have discussed my always that one special ‘magic mirror’ these are male aging theory and he sees its mirror in a man’s house that barely noticeable. validity. He has often said that he he uses to confirm that all is still feels 18. Again, that magic right with the world—and his Scott Freeman is also easily mirror allows us to see past any reflection.) Even though my recognizable in photo 1. The imperfections in the reflection (the son is an athlete and in way he is sitting and the red mirror’s fault) and see the same excellent condition, his eyes suspenders continue into the smile and mannerisms that have go to the mirror and the 21st century. His famous been present since our youth. shoulders go back and the smile that can either mean stomach draws in. “There, “Everything is fine and I really I must admit, the man in the now the mirror has it right. like you” or at the same time middle of photo 1 took me a This is how I always look.” “If you even breathe wrong minute or two to identify, but then After I got over the initial The problem is, the older we your world will end” is still it came to me. The icy stare with shock and depression and get, the more defective the frightening medical students, just a hint of an impish after I began to realize that I mirror becomes. “What is residents and junior faculty to (leprechaun?) grin, mixed with the don’t really look that much wrong with this stupid this day! I’m not quite sure head cocked to one side and the different after all (no, really!), mirror?” I believe it has to do how to factor in the pony tail. overall intensity that radiates from I began to contemplate how with glass being a very There must have been a this image could be no one other we—at least we men—view viscous liquid and over 70-80 than Padraic Sweeny. The fact (continued on page 3)
We aspire to be competent, trustworthy, and empathetic physicians.
VOLUME 5, ISSUE 1 Page 3
RED SHOE DIARIES… (CONTINUED FROM PAGE 2)
that he is wearing a tie when at all in 12 years was at first I am now! Ouch, I hate these others are casual cements the troubling. The answer is in the forced reality checks!) In my deal! (The early eighties must hair (or lack thereof). The mind’s eye now, I picture him as have been a wild and crazy smooth, shiny shaved head a fine ‘early’ middle-aged man time in our department look makes age identification and unchanged in 20 years—just because when I first met him difficult. Is he gray? Is he like the rest of us. in 1987, Pat Sweeny already balding? Who knows? Despite Thank you, Dr. Heberer for had ‘salt and pepper’ hair.) I a ’few more pounds of muscle’ sending me the photograph that was going to ask Pat if he added, I of course look the sent me on a bizarre tangent agreed with my theory or if he same. (There is no more fat, and thank all of you for reading still feels he looks the same as just ‘loose muscle’.) The ‘Cruz my light hearted treatise on the this picture, but the more I stance’ is undeniable and minds of men. We truly picture looked at his intense, burning hasn’t changed since I met him ourselves as looking the same gaze, the more afraid I in 1989. Alvan truly hasn’t as we did at our ‘physical peak’ became. I’ll just assume he aged at all. (I was a little and because most men still does. confused by the big smile, but have the same mannerisms, then I realized that it was 2001 tastes in clothes and behave and he was looking forward to like they did in their teens or eight years of a conservative twenties, there is nothing to White House!) I’m sure when break the illusion—except Cruz gazes into his magic mirror irrefutable visual evidence. he sees the same man he did Heberer’s and my photos can be 20+ years ago. The Hedge dangerous therefore, as one smile and posture cannot be should ‘never challenge a fixed denied and despite some more delusion’, so trips down memory ‘muscle’, he is the same as lane should be made sparingly. The early well. (Luckily for Matt, he has Picture 4 offers more support Excessive reality checks can be more of the ‘firm muscle’ and to my theory. Despite a ’few expensive as that is where little eighties must less of the ‘loose muscle’ than pounds of muscle’ added, I of red sports cars, plastic surgery I.) Unfortunately, he must have have been a wild course look the same. Brian and trophy wives originate! been recently infected with the O’Neil must carry the same I do believe that women’s latent “Sully long hair plasmid”. and crazy time Irish gene as Sweeny that minds behave differently then It is okay Matt, as I’m sure your codes for the intense stare men’s (thank God) when it magic mirror is telling you, your in our and boyish grin. The Irish comes to how we envision hair is looking good and if you must also have a gene for ourselves through the years, but department ... ever change your mind, Sully great hair as well! The man in I cannot hope to understand a has the cure! (Either that, or he the middle is not Dennis the women’s mind—and I do not is getting ready to star in an Menace by the way. He is the dare to try. If one of my female episode of Duck Dynasty!) father of our toxicology colleagues would like to program, Jim Cisek and he Interestingly, the male trait of enlighten me, I welcome an hasn’t aged either. seeing ourselves and our article that explains how they friends as looking the same picture themselves as they age. Give me your answer, fill in over decades (at least in our Now if you will excuse me as I a form minds) is not retrospective. In suck in my gut, square my Mine for evermore other words, the ‘clock doesn’t shoulders and adjust the hair on stop” as it were, until we meet the crown of my head, I am Will you still need me that person. For example, Dr. about to pass a mirror which will Will you still feed me Schwartz, I am sure, still confirm the fact that I am still When I’m sixty-four? identifies himself as a young the same 26 year/old awesome (hair covered??) man, but in my specimen that I was, am and [Lennon & McCartney] mind he looks the same as always will be… when I met him in 1993. I have
no ability to see him as a Philip A. Lewalski, M.D. younger man. Odder still, when Editor-in-Chief I first met him, I thought, “Jeez, Picture 5 is mainly supportive what an old-timer.” (That ‘old of my theory. The fact that man’ was 5 years younger than Binesh Patel hasn’t changed
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WELCOME EMERGENCY ME DICINE RESIDENTS CLA SS OF 2016
Detroit Receiving Hospital Sinai Grace Hospital St. John Hospital/Medical Ctr Kevin Belen, Eastern Virginia Abdallah Ajani, Boston Parag Amin, Wright State Medical School University School of Medicine Boonshoft Medical School Nile Chang, Case Western Tamara Augustine, Ross Ashley Bowerman, St. Reserve University School of University School of Medicine George’s University School of Medicine Andrew Berwick, Wayne State Medicine Hannah Ferenchick, University School of Medicine Riley Jakob, St. George’s Michigan State University Luke Bisoski, Wayne State University School of Medicine College of Human Medicine University School of Medicine Trevor Kuston, Wayne State Lauren Holmquist, Wayne Natalie Eggleton, Wayne State University School of Medicine State University School of University School of Medicine Marson Ma, III, Wayne State Medicine Steven Irvin, St. George’s University School of Medicine Derek Kennedy, Yale University School of Medicine Fei Lu Ye, Rosalind Franklin University School of Medicine Sharmin Kalam, Wayne State University Chicago Medical Lyudmila Khait, Michigan University School of Medicine School State University College of Veronica Miles, Wayne State Human Medicine Usama Khalid, Wayne State University School of Medicine University School of Medicine Justin Stimac, Oregon Health Nicholas Morelli, Wayne State Ashwin Sabbani, Wayne State & Science University School University School of Medicine of Medicine University School of Medicine Sameed Shaikh, Michigan Lindsay Richmond, Wayne Jessie Swan, Wayne State State University School of University School of Medicine State University College of Human Medicine Medicine Sean Teshima-McCormick, Margeaux Snell, University of Andrea Patineau, University of Ohio State University College Minnesota Medical School of Medicine Arizona College of Medicine Lindsay Taylor, St. George’s Grant Nelson, Wayne State Jeffrey Van Laere, Case University School of Medicine Western Reserve University University School of Medicine School of Medicine Mohamed Moussa, Wayne State University School of David Viau, Wayne State Medicine University School of Medicine Henry White, Northeast Ohio Medical University Megan Wolf, Oregon Health & Science University School of Medicine Joseph Wollman, University of Michigan Medical School
VOLUME 5, ISSUE 1 Page 5
CONGRATULATIONS EMERGENCY MEDICINE CLASS OF 2013
Detroit Receiving Hospital Sinai Grace Hospital St. John Hospital/Medical Ctr Jeanise Butterfield, MD, Amit Bhambri, MD Rhett Brandenburg, MD Medical Center Emergency Advocate Health System, Emergency Medicine Srvs, Detroit Receiving, Illinois Specialists St. John Michigan Aaron Brody, MD Providence Hospital, Michigan Jeff Cloyd, MD Medical Center Emergency Brandon Briggs, MD University of Tennessee Srvs, Sinai-Grace, Michigan Unity Pointe Health, Iowa Medical Center, Tennessee Suhas Channappa, MD Simon Katrib, MD Ryan Doss, MD Marshfield Clinic, Wisconsin Emergency Medicine Locum Tenens—Vista, Joe Hild, MD Specialists St. John Georgia (then New Zealand) Emergency Medical Providence Hospital, Michigan Daniel Helzer, MD Associates, Florida James Kelly, MD Emergency Medicine Residents Medical Center Emergency Adam Leisy, MD Emergency Medicine Detroit Receiving Hospital Srvs, Detroit Receiving, TeamHealth Florida Specialists St. John Class of 2013 Michigan Patrick Meloy, MD Providence Hospital, Michigan Sarah Hyatt, MD Emory Clinic, Georgia Chad Kovala, DO Tucson Medical Center, Puja Patel, MD Emergency Medicine Arizonia Medical Center Emergency Specialists St. John Deepa Japra, MD Srvs, Sinai-Grace, Michigan Providence Hospital, Michigan Staten Island Hospital, New Derek Schaller, MD Emmanuel Oke, MD York EmMed, Michigan Sinai Hospital of Baltimore, Justin Kessler, MD Katie Schroeder, MD Maryland Medical Center Emergency Presence Medical Group, Lyle Patterson, MD Srvs, Detroit Receiving, Illinois Halifax Medical Center, Michigan Jessica Taylor, MD Florida Cameron Kyle-Sidell, MD Emergency Medicine Lindsay Showers, MD Maimonides Medical Center, Physicians North Carolina War Memorial Hospital, New York David Zodda, MD Michigan Deshon Moore, MD Hackensack Medical Center Pankaj Singhal, MD Advocate South Suburban Faculty Practice, New Jersey QuestCare, Texas Hospital, Illinois Nastaran Solano, MD Emergency Medicine Residents Daniel Paling, MD QuestCare, Texas Sinai-Grace Hospital Emergency Medicine Jared Zelinski, MD Class of 2013 Specialists St. John Hospital/ Infinity Healthcare, Wisconsin Med Ctr, Michigan Sam Sadler, MD Locum Tenens, Indiana Kevin Sprague, II, MD Bridgeport Hospital, Connecticut John Wilburn, MD Medical Center Emergency Srvs, Detroit Receiving, Michigan Stephanie Wise, MD Medical Center Emergency Srvs, Detroit Receiving, Michigan Emergency Medicine Residents St. John Hospital & Medical Center Class of 2013
We will strive to provide competent, compassionate care to all person.
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TRIP SITTERS
THE DOSE MAKES THE only about 8% of the world’s reality. Our patients frequently POISON population. Drug related lack health insurance and are fatalities currently exceed the unable to see a primary care These words have echoed number of fatalities related to physician. Management of through my training and my motor vehicle collisions. What pain, particularly chronic pain is life in general, although I is worse is this overdose complicated. We certainly didn’t always use those epidemic is by our own hand. don’t have large amounts of terms. More commonly this According to the CDC there time to spend, and that primary expression can refer to the were greater than 11,000 care provider who is getting balance we need to strike as prescription opioid overdose pressure from the insurance clinicians in terms of the risk- deaths—greater than heroin providers to see more patients benefit ratio we need to and cocaine combined. We and spend less time with them, address when treating our may have a problem. Now that also is not in a good position to patients. we have admitted that we may give patient appropriate Life is pain. have a problem, we can work at consulting regarding correcting the problem. management of their pain. Pain is the fifth vial sign. How did this come to be? We Additionally, that primary care Now we need to find the have been taught that single physician’s livelihood depends balance. opioid prescriptions would not on his patient satisfaction Matthew W. Hedge, M.D. cause addiction. While this scores and the pharmaceutical I would like to use this Assistant Professor opportunity to discuss opiate was the standard teaching, industry is telling him the use and hopefully get you to where did it come from? A answer for the patient’s pain think about your practice and retrospective chart review had and his satisfaction score your prescribing patterns. 60 out of 11,000 exhibiting problem is just a little pill. This is an opinion piece and addictive behaviors, not a great While we can look back and not even expert opinion at methodology. As a side note, say, “What did they think would that, so grade the evidence the vast majority of these happen?”, I would hope these as you see fit. As always I patients were on low dose policy and prescribing changes would encourage you to seek opiates, largely codeine and were done for the right reasons, and read the literature propoxyphene, relatively weak although the cynical part of me yourself, as your analgesics. These drugs are would like to point out that the interpretation of the data not even in the same league as consensus statement and the the dosing regimens that are initiative on pain management may be different from my I would like to own. currently presenting to our did come about shortly after emergency departments. This Oxycontin was introduced and use this Some background was followed by a consensus during an era where spending information that is telling of statement from the American by the pharmaceutical industry opportunity to our society. The opiate Academy of Pain Medicine and towards physicians was largely equivalent of the American Pain Society unregulated. discuss opiate acetaminophen/hydrocodone which helped physicians as a 500/5mg tablets that are group feel comfortable with Pain is debilitating. Pain is use and dispensed each year is opioids for chronic and acute what our patient’s are coming enough for every man, pain. When it comes to the to us for help in alleviating, heal hopefully get you woman and child in the the sick…right? These are evidence to back these to think about country to take two tablets statements, there was not admirable things and opioids every six hours for two much in the way of data at the are certainly very effective at your practice and weeks. Hydrocodone in time to either support or refute treating pain, but what are our combination with their claims other than opiates goals and what are we trying to your prescribing acetaminophen is the are effective for treating pain. accomplish? Should we be number one prescribed The JCAHO initiative on pain trying to achieve a pain score of patterns. medication in the country management pushed our zero or is decreasing the pain and has been since the mid- prescribing of opioids onward scale by two or three 1990s—greater than from that point, again, they will adequate? Are those two or simvastatin, metformin and lower pain scales. This may three points enough to give lisinopril. Patients in the have worked if patients had improved function for your United States consume in good continuity of care. patient so they can go about their day to day activities? excess of 70% of the world’s Unfortunately that is not our opiates while representing (continued on page 10)
VOLUME 5, ISSUE 1 Page 7
CHIEF CHATTER
THE THINGS THAT MATTER… yet. Just after my conversation perspective. By this time in with the husband of 42 years, I our training, we have seen If you’ve ever worked with Dr. caught myself complaining and dealt with so many sticky Scott Freeman, you know he’s about how slow my voice- or sad situations that no one full of classic quotes. One of recognition program was is better prepared to sit down my favorites is, “We have a working. Talk about a loss of with the people we care for, to great job, don’t we?” I agree, perspective! I mean, if I look them in the eye, and to we have a sweet job, but have actually noticed these kinds of tell them news that can be you ever thought about the conversations twice in one day, devastating. We do this day impact we have? Just how many times do I miss in and day out, and though it yesterday, I sat down with a them? I’d be willing to bet I am might be routine to us, it isn’t husband and wife to explain the not the only one who spends to them. stroke we had just found on CT, more time considering my own Now that I think about it, likely the explanation for his pesky inconveniences than the loss of vision. Just hours later, DRAGON dictation isn’t so pain that I come into contact bad, and I’m not going to die the conversation was with with routinely. another family. Only this time, if I don’t eat right now. it was to tell him that his wife of Maybe we need a shift in our thinking. Consider what we do 42 years had just died. Our job puts us in a position to be every day at work. We reduce present for people in their times broken bones, stick 18 gauge IV’s in neck veins and check of great hurt and affords us the DRH Chief Resident s prostates (!). Sometimes our chance to make a difference. Jeff Cloyd, M.D. exams or interventions hurt. Deshon Moore, M.D. You know what’s embarrassing, The news we share to families John Wilburn, M.D. though? Just a few minutes can be painful in a very Stephanie Wise, M.D. before we had this conversation different way. It’s easy to about the stroke, I was thinking become numb to what we see, about how I hadn’t eaten lunch but it is important to keep our
A PURPLE CRAYON
There are innumerable small medications the wall moments its analgesic, antimicrobial, to find a space to draw a to call to praise, to call to anti whatever door pause patients flow, and at some with my purple crayon between the gurneys, point there to the moment when I walk hustle of EKG machines, is a hush, a lull when the out of those sliding doors volley of nurse between supply cleaning crew greeted by the cars room gets a chance to disinfect, some backing out of the and bedside sterilize. parking lot medical students, residents, And it lasts just enough time, the pedestrian light turns interns, before anything has a chance white ...“We have a various species that pull up the to dry to walk. chart an ambulance, five minutes great job, don’t while patients moan forth their before stories my shift ends, an hour clock we?” I agree, we that gets to wait again, the facts checked have a sweet job, against the body--s to watch, who said time The phone that never stops its doesn't stand still but have you conversation while a patients is hefted out the admitting doctors, outside of the hands of paramedics Shradha Shah, MD ever thought consultants into the hospital's San Francisco, California to parlay their problems into an and like Harold, I crawl November 2012 about the impact with my bald white tumuli Class of 2008 OR we have? and the families who call-- towards the ceiling This shop keeps running its or behind the machines, on
We came to Detroit to train with the best.
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THE “NEW” CHIEF CHATTER CLASS OF 2014
“My PCP is [Insert ED Doc’s quote the literature, who know “This isn’t an emergency, sir”. else to go to, and may have no name]” blow-by-blow the most current “Why didn’t you follow up like better example to learn from. research developments (and we told you the last time?” Welcome to another year of This is their emergency, or are often on the cusp of Have you heard this in your their perception of an living the dream. You are an developing them), but still live department? Have you emergency department doctor, emergency. If they are short by their clinical gestalt, thought or said these things? with you, it may be because an adrenaline junkie, an “I history, and physical exam How do we, as the skydiver, hope this trauma code is a they have no other options. techniques…all of which you balance the reality of our This ED is their safety net. Try good one” personality. You live hope to acquire and refine patient population’s need for for the chance to get the to keep your perspective and one day. You secretly gaze in the parachute-packer, with the compassion through your history first, to throw the chest admiration at your favorites. rush of experiencing the free tube in, for the moment-to- training and your career. Live “I’ll be like them one day…”, fall that we all live for? for the thrill ride, but also be moment life saving decisions you quietly say to yourself. based on little to no The answer is to keep, or able to temper that ride with information, and ultimately, for As ED residents, we are here rediscover, your empathy. providing the ordinary miracles to learn, absorb, and mold our that are disguised as the every the war stories. Many of the patients in own practice in the likeness of -day. You may not ever see a underserved populations such The ambulance sirens fire you those attendings who most tangible result to know that as ours simply do not have up, even when you aren’t influence us, and with whom your extra two minutes of access—access to medicines, working. When the alert goes we identify. You take from counseling has reached to medical care, to basic off for a code in your ED, your each attending what you hope someone, but you will rest medical knowledge, to the ears perk up, your senses are for in yourself. We did not easier knowing that you’ve ways to seek a PCP, to the heightened, and you are ready necessarily choose this tried. Recognize that you are means to seek care. Cultural for it. Is it mine? You can’t profession to manage the living the dream, and many norms and perceptions that wait for it. You thrive on it. You mundane, the chronic pain, would love to be in your shoes. YOU may have are not need to be the first in line to the ear infection, or the STD necessarily that of your see it. The busy night in the ED check. But we see it—a lot of DRH Chief Resident s patients. You will, we when everyone is sick suddenly it. Francesca Civitarese, D.O. guarantee, at one point or clicks you into a higher gear. Vit Kraushaar, M.D. All too often, our patients here another, feel the need to roll Kristi Maso, M.D. Over the course of your career, in Detroit do not have a your eyes at the “flu like Tim Scott, M.D. you will come to admire the primary care physician. The symptoms” patient. battle-hardened attending answer to “Who is your PCP?” The goals for your year should physician who rarely seems occasionally is “Huh?”, “I don’t be to be patient. Be shaken up by even the scariest have one”, “I don’t know”, or compassionate. And realize of cases in resuscitation. The even a familiar ED attending’s that you are the authority. The “sphincter tightening” rapidly name. In many cities, they one they come to for answers. expanding hematoma in the rely on us, the emergency Try to learn as much as you When the alert neck becomes commonplace doctor, to answer what may can, absorb as much as you and the difficult airway is not appear to the medical can, so that you KNOW the goes off for a an obstacle, but an opportunity professional to be some of the answers for them. The 21 year to “get the great tube” and live most basic of health code in your ED, old with chest pain has no one to tell the tale. You eventually questions, questions that marvel at the faculty who can should be addressed by their your ears perk PCP. up, your senses are heightened, CONGRATULATIONS! and you are ready for it.
Ciara (Barclay) and Steve ReneeMary Alexan and James Mandy and Marcus Moore are Buchanan are the proud Paxton are the proud parents the proud parents of a baby parents of a baby boy, Calder of a baby girl, Genevieve Bree, boy, Asher Robert, born on April Jackson, born on December born on January 21st. 22nd. th 9 . Catherine and Brian Reed are Amy and Duane Robinson are the proud parents of a baby the proud parents of a baby girl, Lydia Miriam, born on girl, Gabriella Rose, born on March 22nd. June 22nd.
The Department of Emergency Medicine is committed to being the leaders in undergraduate, graduate and continuing medical education.
VOLUME 5, ISSUE 1 Page 9
BACK TO BASICS
The basic science research tests adjunct therapies to on post-ischemic cerebral laboratory in the Wayne State augment hypothermia. All therapy serving as a simple, University Department of these projects are separate, non-invasive treatment for Emergency Medicine has a long yet highly intertwined, early reperfusion, potentially -standing research focus providing the investigators augmenting therapeutic initiated well over 30 years ago ample collaborative hypothermia. Based on our by Blaine White, MD. The opportunities. studies, IRL is a neuro- overarching goal is to An immense strength of a protective treatment that does understand and develop basic science research lab in not have any recorded side therapies for cerebral ischemia. a clinical department is the effects and therefore may be Throughout the years, this opportunity to translate basic easily introduced in a clinical research group has trained science discoveries from the setting for patient treatment. leaders in the field of bench to the bedside. A We are currently designing pre- Emergency Medicine, including specific example of this is clinical, large-animal studies to our current chair at DMC/ provided by a research project gain the necessary information Wayne State, Brian O’Neil and for design of clinical trials. currently being conducted by The basic the chair of Emergency the Sanderson lab. This therapeutic development Medicine at the University of Reperfusion is critical to limit is just one of many studies science research Michigan, Robert Neumar. damage after brain ischemia currently being conducted by The basic science research lab but also causes significant the investigators of the basic lab has changed has changed dramatically damage by generating science research group. The throughout the years, but the reactive oxygen species early research team also takes the dramatically scientific focus has remained during reperfusion. time to train Emergency the same; to understand the Therapeutic hypothermia has Medicine residents and throughout the neurologic damage caused by emerged as the primary medical students in basic ischemia and improve the intervention for minimizing science research. years, but the neurologic outcomes of cerebral damage; however, it Opportunities to learn and scientific focus patients who suffer a stroke or is initiated in a delayed actively participate in a basic are resuscitated from cardiac manner, thus missing a science research project are has remained arrest. Our current research critical window for therapeutic always available for group of Thomas Sanderson, intervention. The Sanderson enthusiastic students wishing the same... PhD, Rita Kumar, PhD, and lab has recently developed a to augment their clinical Anthony Lagina, MD are novel therapeutic strategy training. A key goal of our continuing this exciting capable of attenuating the research program is to expand research with a diversified early reperfusion-induced the scientific knowledge of the approach. Each member of the ‘burst’ of reactive oxygen future leaders of Emergency research team has developed species. This approach is non- Medicine. Any students or their own independent, yet invasive and based on the residents looking for research highly integrated research photoreceptive properties of opportunities can forward their program. Dr. Sanderson’s cytochrome c oxidase for information to Dr. Sanderson at research is focused on infrared light (IRL). This [email protected]. understanding the mechanisms technology utilizes specific IRL of cellular damage caused by wavelengths to control cerebral ischemia and the cytochrome c oxidase in the development of a novel brain, thereby controlling therapeutic intervention that mitochondrial activity. By was designed and tested in our modulating mitochondrial lab. Dr. Kumar focuses on activity during early fundamental investigations into reperfusion, IRL effectively neuronal damage using inhibits mitochondrial reactive molecular interrogation of oxygen species and was Thomas Sanderson, Ph.D. isolated neurons. Dr. Lagina profoundly neuro-protective in Assistant Professor, investigates the underpinnings small animal models of brain Basic Sciences of hypothermic neuro-protection ischemia. This novel for cardiac arrest victims and technology seeks to improve
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TRIP SITTERS… (CONTINUED FROM PAGE 6)
I would like to touch on the concentrations. How long treatment. Well, the first part risks and benefits of this class does this syndrome last? you should definitely do and of medications. I know you Good question. in an ideal world they would know this already… respiratory Unfortunately, again there make it to a rehabilitation depression, loss of protective are no good answers. Rats program. reflexes and addiction… easy, will take three-five days to Now you need to look at your right? Ok, a little more come back to baseline pain practice pattern. There are complicated than that, first tolerance, how to translate some things you need to do question I would like to put to that to humans, no idea. to become part of the you is what is an acceptable What about the question of solution. If you don’t have risk to your patient for addiction? While our initial access to your state’s potential benefit? Is an 8-10 assumption that patients are automated prescription fold increase in mortality unlikely to become addicted database, get it. When you acceptable to alleviate this as a result of therapeutic use do find a patient that has a patient’s pain? Why is that of opioids is clearly incorrect, suspicious pattern of multiple acceptable when a two fold how frequently this happens providers, several recent increase in myocardial is not clear. Couple of side prescriptions, you should not infarction, not fatalities, was points—addiction versus think, “Look I caught a drug intolerable with rofecoxib dependence. Addiction abuser”, but as someone (Vioxx)? represents a maladaptive who you can potentially help Next, am I really helping this pattern of behavior involving with their disease—which is patient? As most physicians, I craving and persistent use not chronic pain. It is find the physiology of the without heed to addiction. “Does this patient human body fascinating. The consequences of continued really require an opiate?”, body knows where it wants to use. Dependence would be should be your next question The body be and it will make changes to better described as a and if you decide to give that get there no matter what you homeostatic process in patient a NSAID and their knows where it do—homeostasis. When you response to the drug with the reply is they have been taking meddle, the body will respond development of tolerance them by the handful, is that wants to be and with use and withdrawal someone who can follow so that pharmacologic it will make treatment of their condition will symptoms upon the removal directions and take a drug as of the drug, but without the prescribed? Americans have provoke a change. Down- changes to get regulation of the opiate maladaptive behaviors such been taught the customer is system, decreased expression as craving and misuse. Once always right. I think it is time there no matter of opioid receptors, decreased a patient is an addict why do we as physicians need to release of endogenous opioids, they keep using? To get high take more of a parental role what you do— up-regulation of nociceptive of course, isn’t it? Not really, with our patients. I transmission—this is referred many addicts may start out remember an oath homeostasis. to as “opiate induced abusing prescription opioids somewhere about prescribing hyperalgesia syndrome”. How in a recreational fashion but for the good of my patient fast does this syndrome once the addiction has taken and not giving poison even if happen? There is no real great hold many of these patients asked; there was also evidence to give you firm are using just to obtain a something in there about not numbers, but probably faster “normal” or “functional” doing harm. This is not than you would like. The status. There is no high. always easy and the patients anesthesia literature, suggests There is no fun. Their life may not always like our this is a very rapid process, revolves around obtaining the practice but this is our with the use of intra-operative drug so they don’t feel bad. contract and pact. You chose opioids increasing post – Addiction is neither good nor the path, now walk it. operative use of patient- bad but a disease and needs Unfortunately, I don’t controlled analgesia. In a trial to be treated with remember anything about studying patients chronically compassion and definite patient satisfaction scores in taking methadone, they had a treatment goals. As an that oath….I should have paid lower threshold to painful emergency physician your more attention. stimuli than control patients goal should be identification, with cold water immersion followed by a brief even while the serum intervention to assess if your Matthew W. Hedge, M.D. concentrations of Methadone patient is ready to recognize Assistant Professor were within normal therapeutic their problem and referral to
VOLUME 5, ISSUE 1 Page 11
2013 RESIDENT, TEACH ING, SERVICE AND HUMANITARIAN AWARDS
MUNUSWAMY DAYANANDAN, RESIDENT AWARDS TEACHING AWARDS FACULTY SERVICE AWARDS MD HUMANITARIAN AWARD— 10 YEAR— Resident of the Year— Distinguished Teacher of the Kerin Jones, MD and Sarkis Kouyoumjian, MD, Deshon Moore, MD Year Award— Carolyn Sabbagh Robert Wahl, MD Phillip Levy, MD, Alice Dea, Medical Student Resident MD, Patricia Wilkerson- Voluntary Teacher of the Teaching Award- Uddyback, MD, Marc- Year Award— Jeanise Butterfield, MD and Anthony Velilla, MD, Claudia Jeffrey Janowicz, MD Jeff Cloyd, MD Whitaker, MD, and Marc Norman Rosenberg, DO Lawrence R.Schwartz, MD Rosenthal, PhD, MD. Faculty Teacher of the Year Award– Jeff Cloyd, MD 15 YEAR— Award— Cynthia Lepak-Hitch, MD, Resident Humanitarian Trifun Dimitrijevski, MD Award– Deepa Japra, MD William Lusk, DO, Regina Noack, MD, and Kamal Scholarly Achievement Nangia, MD. Awards- 20 YEAR— st 1 Year—Sean Michael, MD Suzanne White, MD. 2nd Year—Craig Sharkey 3rd Year—Cameron Kyle-Sidell, MD
A CALL FOR YOUR HELP
We at the Resuscitator would Sandie Garling for artistic pursuits you would Philip A. Lewalski, M.D. like your input. We would love publication in the like to share. Finally, to our Editor-in-Chief to hear from both our faculty “Ventilator” column. If you core faculty and researchers, [email protected] [email protected] and our graduates scattered have any funny stories or please send me information throughout the country. If any anecdotes, we will try to about your on-going or future of you have any gripes, include them in the “Doctor projects. concerns or comments, Aware” column. For the please submit them to me or creative among you, please feel free to send me any
NEW ATTENDING PHYSICIAN AND PHYSICIAN AS SISTANTS
We would like to welcome the Aaron Brody, MD-SGH Barbara Morris-MCES Admin. following physicians and Colby Brown, PAC-SGH Puja Patel, MD-SGH physician assistants to the Jeanise Butterfield, MD-DRH Daniel Salinsky, MD-SGH Wayne State University John Gallien, MD-DRH Phawanjit Sekhon, DO-HUH Department of Emergency Daniel Helzer, MD-DRH John Wilburn, MD-DRH Medicine. We look forward to Justin Kessler, MD-DRH Stephanie Wise, MD-DRH working with you. Andrew King, MD-SGH Kristy Smith, MD-HUH
VOLUME 5, ISSUE 1 Page 12
AUNT MINNIE PASSES T HE SPIT TEST...
Those who attended the examples of the different specifics on equipment, cost Bedside Teaching and ways that adults learn and and troubleshooting. Integrating Technology into strategies to provide the This Bedside Teaching and Education Conference on April learner with information that Integrating Technology into 25th understand the title’s is appropriate to their level of Education Conference, deftly reference to bedside teaching training in a rapid, efficient organized by our own medical techniques. The conference, and useful manner. Some of education expert and legend, organized by Dr. Gloria Kuhn the teaching tools had catchy Dr. Gloria Kuhn (with and hosted by the acronyms like SNAPPS, RIME, significant assistance from Department of Emergency and the popular SPIT test. Sandie Garling, Gloria Medicine at the WSU SOM, Others had fun names like the Daniels and Shazzandra featured two national experts AUNT MINNIE. The important Doze) was extremely in Emergency Medicine lesson for the medical important to our daily education from outside our educator is that each of these practice and responsibilities. department—Dr. Diane M. (and other) techniques are It is not just germane to the Birnbaumer from the very effective and can be attendings, but also to our University of California, Los done very quickly. The more residents who provide a great Angeles, Harbor-UCLA and Dr. education ‘tools’ that one has deal of teaching to junior Mary Jo Wagner from Central in their ‘teaching toolbox’, the residents, rotators and Michigan University in Mount more effectively one can medical students. The Pleasant Michigan. In educate at the bedside, commitment to education by addition, our own Drs. Adam despite the chaos and time our faculty, residents and Rosh and Shereaf Walid demands of the ED. supported strongly by our provided information and The importance of timely and administration is the reason perspective on integrating constructive feedback in the that our department and the technology into teaching. learning process was emergency medicine The educational experience highlighted by Dr. Wagner as clerkship is rated the best in was both informative and well as the future of the the country by graduating interactive as the attendees evaluation process in the medical students. The Some of the were split into groups to computer age as it relates to conference gave us a few teaching tools identify and then solve some residency review and new tools to add to our of the myriad difficulties certification. It was toolbox. had catchy inherent in providing bedside fascinating how subtle instruction to residents and changes in language and style acronyms like students in emergency can turn well-intentioned departments that demand feedback into a negative SNAPPS, RIME, increasing amounts of our experience and vice versa. attention and time. We were and the popular Finally, Dr. Rosh provided Philip A. Lewalski, M.D. also taught better ways of insight into the pros and cons Editor-in-Chief SPIT test. providing feedback and of integrating new technology evaluations on the fly and the into the teaching of residents difference between the two. and medical students. Dr. Dr. Birnbaumer provided Walid brought a practical interesting lessons and approach to technology, with
We strive to maintain excellence in our clinical care through evidenced-based practices and peer review.
Website: www.med.wayne.edu/em
WSUSOM EDITORIAL BOARD Department of Emergency Medicine University Health Center Editor-in-Chief: Philip A. Lewalski, M.D. 4201 St. Antoine, 6G Assistant Professor
Managing Editor:
Sandra L. Garling Phone: 313 993-2530 Emergency Medicine Coordinator Fax: 313 993-7703 Photographer: E-mail: [email protected] Kerin A. Jones, M.D. Assistant Professor
“ WE ARE COMMITTED TO BEING THE LEADERS.. ”
KUDOS
Congratulations to the following faculty members: Brian O’Neil, M.D. for receiving the ACEP Outstanding Contribution in Research Award. Rita Kumar, Ph.D. and Thomas Sanderson, Ph.D. on receiving a NIH Grant for $1.7 million over five years. Kerin Jones, M.D., Robert Sherwin, M.D. and Jonathon Sullivan, M.D. promotion to Associate Professor (Clinical Educator). Ciara Barclay-Buchanan, M.D. has been appointed the Associate Program Director of the Sinai-Grace Residency. Padraic Sweeny, M.D. has been appointed Co-Chair of the Physician Leadership Council at Detroit Receiving Hospital. Trifun Dimitrijevski, M.D., on receiving the Lawrence M. Weiner Award. This award honors outstanding contributions of non- alumni to the School of Medicine through the exceptional performance of their teaching, research and/or administrative duties. Brian O’Neil, M.D. was elected Immediate Past President of the American Heart Association Emergency Care Science Sub- Committee. Sean Michael, M.D., Timothy Scott, M.D., Craig Sharkey, M.D. and John Wilburn, M.D. for winning EMRAM SIMWARS at the 2013 EMRAM Annual Meeting and Research Forum. Sara Lolar, PA-C received the Dale Sillix Award of Excellence which is historically given in recognition of an outstanding intellectual contribution to the education of WSU Physician Assistant students. Gloria Kuhn, D.O., Ph.D. for receiving the 2013 MCEP Lifetime Achievement Award. Melissa Barton, M.D. for receiving the MCEP Ronald L. Krome Meritorious Service Award.