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New York American College of Emergency Physicians New York American College of Emergency Physicians Improving ED Care For Sexual and Gender Minorities Page 5 Press Ganey, ED PEC, HCAHPS, ED-CAHPS: What’s the Story?? Page 8 CMS Emergency Preparedness Final Rule Basics Page 18 Empire State EPIC VOL 34-04:17 EMERGENCY PHYSICIANS’ INTERIM COMMUNIQUE 1 Empire State EPIC VOL 34:04:17 Align Your Personal and Professional Goalsls with Us in New York Explore Great CCareerareer PPositionsositions in NEWNEW YORKRK withwith EmCareEmCare CAPITAL REGION NEWBURGHNEWBUR AREAAREA St. Peter’s Hospital, AlbAlbanyany SIGN-ON SSt.t. LuLuke’ske’s Cornwallwall HospitHospital,p al,, Newburghg A 487-bed communityy teachingteaching BONUS! A 128-bed128-bed communitymuunity hospitalhospital hospital with 59,500 annualnnual ED visits. witwithh 55,055,0000 annualnual ED visits. SIGN-ON Staff Physician openings.ngs. StaffStaff Ph Physicianys op popenings.enings. BONUS! 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THE EMCARE DIFFERENCE: INCREASED RATE FOR Q Country’s most experienced physician-led Q Leadingng compensation and ALL SITES! practice management company benefitt packages Q Exceptional quality of provider practice Q Unparalleled alleled clinical education, supported on a local, regional and career growth, mentoring and national level leadershipship opportunities Contact EmCare — Physician Recruiting: 855.367.3650 | [email protected] www.EmCare.comwww.EmCare.com 1 New York American College of Emergency Physicians PRESIDENT’S MESSAGE Brahim Ardolic, MD FACEP Chair, Department of Emergency Medicine Vice President, Department of Research Staten Island University Hospital Last week one of the nurses at my emergency one media reported assault each day. It’s just department (ED) was attacked by a patient. not an acceptable number. There needs to be In an instant, she went from someone who a new standard set and there are many aspects was trying to do her job taking care of people of this issue that need to be changed. with medical needs to a victim of violence. First, we as providers need to start making We often lament burnout amongst emergen- an issue of this. In many EDs, staff members WHAT’S INSIDE? cy providers, both physicians and nurses. do not want to report assaults or are even We have already written volumes of articles actively discouraged from doing so. This is Features about diff erent reasons for burnout, yet many not acceptable. Sedating an agitated patient Albany Update | 40 have not asked basic questions about violence is not assault, but actual assaults need to be Ask the Experts | 30 and burnout. According to the Massachusetts reported every time. Education | 12 Nursing Association, an emergency depart- Second, our communities need to take EMS | 18 ment nurse, our colleagues, are four times these assaults as seriously as those against New York State of Mind | 14 Practice Management | 8 According to the Massachusetts Nursing Association, President's Message | 2 an emergency department nurse, our Sound Rounds | 3 colleagues, are four times more likely to be Insights Improving ED Care for Sexual and Gender assaulted than a police offi cer. Minorities | 5 Leadership & Advocacy Award Winner more likely to be assaulted than a police other civil servants. I would like to thank Refl ections | 38 offi cer. This is a statistic based upon reported DA Michael McMahon and Assistant DA Pushing Daisies: The Use of Push-Dose assaults. Now I will ask the question: What Michael Tannousis for their handling of this Vasopressors in the Emergency percent of the assaults in your EDs get report- case, and even more importantly for their Department | 36 ed? In most EDs, it is a small percentage of statement that assaults of this nature need to The Importance of Open Data Sets in the total assaults that occur. lead to jail time, period. More DAs in more Medical Research | 34 In 2008, Kansangra et al in Academic municipalities need to take the same stance. Emergency Medicine found that 25% of ED The message needs to be sent that this will Events personnel don’t feel safe. This has to play not be tolerated, just like it should never be a major role in burnout amongst staff . How tolerated against any civil servant, police or Calendar | 42 could feeling at risk of violence not shorten otherwise. Once people are afraid to care Resident Career Day & Job Fair | 20 a career. One would conjecture it would be for one another, what do we have left as a Resident Research Conference | 35 even truer after an assault actually occurred. society? Scientifi c Assembly | 42 Just before I started writing this, I typed in If you knowingly assault an emergency Scientifi c Assembly Calendar | 13 my search engine three searches: “assault department provider, you should go to jail, nurse emergency” “assault doctor emer- every time, with no exceptions. Last week, gency” and “assault physician emergency”. one of my staff was assaulted while taking There were 10 hits that related to a nurse or care of someone. Sadly, I think some of you physician being attacked in an emergency can say the exact same thing. department in the last 14 days! That’s almost 2 Empire State EPIC VOL 34:04:17 SOUND ROUNDS Penelope C. Lema, MD RDMS FACEP Director, Emergency Ultrasound Division and Fellowship; Assistant Professor, Department of Let’s Twist Again…. A Case Emergency Medicine, University at Buff alo Report of Recurrent Testicular Torsion After Orchiopexy Guest Author: Mathew Nelson, DO Guest Author: Program Director, Emergency Medicine Jakub Bartnik, DO Residency Director, Emergency Ultrasound Emergency Ultrasound Fellow Chief, Division of Emergency Ultrasound Department of Emergency Medicine, Department of Emergency Medicine, Northwell Health-North Shore University Northwell Health-North Shore University Hospital, Manhasset, New York Hospital, Manhasset, New York A 19-year-old male presented to the Emergency Department with severe left testicular pain for two hours. The patient had a history of testicular torsion on the left and was s/p bilateral orchiopexy and salvage of the aff ected testicle two months prior. The patient was sitting in his car when he felt acute testicular pain radiating to the left fl ank, associated Figure 3. Ultrasound of the with nausea and vomiting. The patient’s vitals were unremarkable other left testicle post detorsion than tachycardia of 114 BPM. The patient reports that the pain was with return of power and spectral Doppler signifying similar to his previous testicular torsion. The physical exam revealed return of blood fl ow. fi rm and exquisitely tender left testicle with absent cremasteric refl ex. Intravenous analgesia was given and point-of care-ultrasound (POCUS) Introduction was performed. Ultrasound demonstrated an unremarkable right testicle Testicular torsion is a “can’t miss” diagnosis in emergency (Figure 1). A small left hydrocele and lack of color fl ow Doppler was medicine. It is a urologic emergency aff ecting 0.0038% of males visualized in the left testicle (Figure 2). The diagnosis of testicular annually. This twisting of the spermatic cord and its contents requires torsion was made and Urology was emergently consulted. The left prompt diagnosis and treatment to prevent decreased fertility or testicle was manually detorsed approximately 540 to 720 degrees (1.5 to orchiectomy.1 Clinically, males typically present with acute scrotal pain, 2 turns) with immediate improvement of pain. Repeat POCUS showed nausea, and vomiting. Tenderness, absent cremasteric refl ex, scrotal return of blood fl ow to the left testicle (Figure 3). The patient was taken skin changes and abnormal testicular positioning are classically present to the operating room by urology for a repeat orchiopexy. Operative on physical exams. fi ndings showed physiologic hydrocele fl uid with a left testicle that was Although this presentation may be typical, the physical exam is pink and viable and an absent appendix testis, indicating prior surgical far from diagnostic. With such high stakes, the diagnosis should be intervention.