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In Emergency Medicine Brown University Providence, RI EMRA Provides Many Opportunities for You to Grow Your Career Early in Emergency Medicine ResidentOfficial Publication of the Emergency Medicine Residents’ Association February/March 2014 EM VOL 41 / ISSUE 1 Intubation, hyponatremia, billing, fellowships and more Observe vs. Admit What it means for doctors and patients What I need now and what I’ll want later! FLEXIBLE, CUSTOMIZABLE BENEFITS AND CAREER PLANS! For more information contact Amy Spegal (800) 726.3627 x3682, or [email protected] “Premier is providing for my medical leadership training.” Emily Maupin, DO Medical Director Premier clinician since 2010 “My pension and shareholder status make it easier to save for retirement.” John Lyman, MD Regional Medical Director Premier clinician since 1997 Ownership. Integrity. Values. www.premierdocs.com www.erdocsalary.com CONTENTS Heart 18 OF THE MATTER New Studies on Pediatric Myocarditis Luke Espelund, MD The majority of children with myocarditis present with acute or fulminant disease, as opposed to adults, in which the disease is usually more indolent. WATER 24 Therapeutic Hypothermia David Pearson, MD; Shawn Shaji, MD; Michael Merrill, MD; SALT Margaret Hauck, MD and Jessica Baxley, MD New literature has emerged in the arena of therapeutic cooling Evaluation and Management of Hyponatremia for the treatment of out-of-hospital cardiac arrest. This has resulted Parisa P. Javedani, MD and Jarrod Mosier, MD in tremen dous discussion of how to best implement therapeutic 30 Discovering the cause of hypona tremia can be directed hypothermia. by answering four key questions. 3 PRESIDENT’S MESSAGE 28 SPORTS MEDICINE 5 LEGISLATIVE ADVISOR 30 CRITICAL CARE 7 RESIDENCY LIFE 32 WILDERNESS MEDICINE 8 EMERGENCY MEDICAL SERVICES 34 CRITICAL CARE FELLOWSHIPS 10 MEDICAL STUDENT LIFE 36 ACEP REP UPDATE 12 SOCIAL MEDICINE 38 SPECIAL EDITORIAL 15 RRC-EM UPDATE 40 CRITICAL CARE 16 CASE REPORT 42 MONEY MATTERS 18 EM PEDIATRICS 45 VISUAL DIAGNOSIS 20 EMPOWER 47 EM REFLECTIONS 22 EM PEDIATRICS 49 BOARD REVIEW QUESTIONS 28 24 LANDMARK — GUEST FEATURE 50 PEARLS AND PITFALLS 27 CASE REPORT 52 REFERENCES/RESOURCES BOARD/STAFF BOARD OF DIRECTORS EDITORIAL STAFF Jordan Celeste, MD Bree Alyeska, MD EDITOR-IN-CHIEF President Informatics Coordinator Nathaniel Mann, MD Brown University University of Massachusetts University of Cincinnati Providence, RI Boston, MA [email protected] [email protected] EMRA STAFF EDITOR Rachel Donihoo Ije Akunyili, MD, MPA Matt Rudy, MD MEDICAL STUDENT SECTION EDITOR Speaker of the Council President-Elect Karen Bowers, MSIII Medical Center Emergency Physicians Washington University in St. Louis Virginia Tech/Carilion School of Medicine St. Louis, MO Baylor College of Medicine [email protected] Houston, TX CRITICAL CARE SECTION EDITOR [email protected] Keegan Tupchong, MD Cameron Decker, MD New York University/Bellevue Immediate Past-President/Treasurer Anant Patel, DO Baylor College of Medicine Vice Speaker of the Council EKG SECTION EDITOR Houston, TX John Peter Smith Health Network Dyllon Martini, MD [email protected] Ft. Worth, TX SUNY Upstate [email protected] PEDIATRICS SECTION EDITOR John Anderson, MD Sarah Hoper, MD, JD Sean Michael Thompson, MD ACEP Representative Legislative Advisor Indiana University Denver Health Medical Center Vanderbilt University Denver, CO Nashville, TN RESEARCH SECTION EDITOR [email protected] [email protected] Josh Bucher, MD UMDNJ-Robert Wood Johnson David Diller, MD Brandon Allen, MD Medical School Academic Affairs Representative RRC-EM Representative St. Luke’s Roosevelt Hospital Center University of Florida ULTRASOUND SECTION EDITOR New York, NY Gainesville, FL Rachel Berkowitz, MD [email protected] [email protected] New York University/Bellevue Nathaniel Mann, MD Zach Jarou, MSIV EM RESIDENT EDITORIAL Secretary/Editor, EM Resident Medical Student Governing Council Chair ADVISORY COMMITTEE University of Cincinnati Michigan State University Erin Brumley, MD Cincinnati, OH College of Human Medicine University of Louisville [email protected] Lansing, MI J. Reed Caldwell, MD [email protected] New York Methodist Hospital Kene Chukwuanu, MD Sammi Paden, MD Membership Coordinator Washington University in St. Louis St. Louis University School of Medicine St Louis, MO James Paxton, MD [email protected] Detroit Medical Center ¬ ¬ ¬ ¬ EMRA STAFF MISSION STATEMENT Michele Byers, CAE, CMP Leah Stefanini The Emergency Medicine Residents’ Interim Executive Director Meetings & Advertising Manager Association is the voice of emergency [email protected] [email protected] medicine physicians-in-training and the future of our specialty. Rachel Donihoo Linda Baker Publications & Communications Coordinator Marketing & Operations Manager ¬ ¬ ¬ ¬ [email protected] [email protected] 1125 Executive Circle Irving, TX 75038-2522 Chalyce Bland Administrative Coordinator 972.550.0920 Fax 972.692.5995 [email protected] www.emra.org EM Resident is the bi-monthly magazine of the Emergency Medicine Residents’ Association (EMRA). The opinions herein are those of the authors and not those of EMRA or any institutions, organizations, or federal agencies. EMRA encourages readers to inform themselves fully about all issues presented. EM Resident reserves the right to review and edit material for publication or refuse material that it considers inappropriate for publication. © Copyright 2014 | Emergency Medicine Residents’ Association PRESIDENT’S MESSAGE Laying a Firm Foundation Jordan Celeste, MD EMRA President in Emergency Medicine Brown University Providence, RI EMRA provides many opportunities for you to grow your career early in emergency medicine. Here are just a few ways to learn more about specific areas of the specialty, find your niche, and start laying the foundation for the rest of your career. Join an EMRA Committee designed to assist the EMRA Board of you are eligible to be an EMRA program or Division — right now! Directors in its work and are, therefore, rep. Residency programs differ in how assigned objectives. While it is accurate they select or elect their representatives, great way to get involved with the that the committees help accomplish so be sure to speak with your program organization is to join an EMRA important work for the association, in director (especially since serving Committee or Division. These are A reality, the objectives are developed in requires attendance at the spring and groups of members who all share a specific a very collaborative fashion. Divisions fall meetings). You can also serve interest in emergency medicine and work develop their own objectives, but again, a as an alternate program rep. More together to promote that interest. collaborative approach is taken. information is available on emra.org, What are my options? and we encourage you to attend the Each committee and division is assigned EMRA Rep Council meeting to check Fortunately, EMRA has a very active a board liaison, who helps ensure that the out the action. and involved membership; this has lines of communication are open, and is been reflected by the growth of our available to answer questions and help Why should I be a program rep? membership groups – our committees facilitate projects and proposals. Program reps get to serve as the link and divisions. EMRA currently has five between EMRA and their colleagues. Make plans to check out the dynamic committees that are open to all You will be able to provide up-to-date EMRA Representative Council at members – editorial, education, health information regarding EMRA news the SAEM Annual Meeting in May! policy, research, and informatics. The and offerings, as well as current events organization also boasts an active and What is the EMRA Rep Council? in emergency medicine. You will bring engaged awards committee, in which The EMRA Representative Council is the your program’s perspective to the rep past EMRA award recipients are invited body that represents the membership of council meeting, and speak on behalf to participate, and a Medical Student our organization. It convenes bi-an nually of your fellow residents. You will gain Governing Council, which is a group of (in the spring at the SAEM Annual access to information and opportunities medical students who have been selected Meeting and in the fall at ACEP’s Scientific that you can’t find anywhere else – to serve. EMRA also has seven divisions Assembly) to discuss and pass policy meeting residents from all over the focused on the subspecialties of critical regarding issues related to residency country, hearing from leaders throughout care, EMS, international, pediatrics, training, professional development, and emergency medicine, and having the simulation, ultrasound, and wilderness a number of other pertinent topics. The chance to leave your mark on the medicine. council also influences the structure of specialty through resolutions. the organization itself through amend- What’s the difference between a What is a resolution, ments to the bylaws and by electing the committee and a division? and who can write one? Board of Directors. There is very little difference between A resolution is a formal motion that states the two; both groups are comprised How do I get involved? a belief of the Association or directs the of members with shared interests. Per If you are an EMRA member in an Association to take specific action. Once the EMRA bylaws, committees are RRC-EM approved training program, continued on page 4 February/March 2014 | EM Resident 3 PRESIDENT’S MESSAGE continued from page 3 a resolution is adopted, it becomes work with specific sections
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