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Implicit Bias and ED Overcrowding ResidentOfficial Publication of the Emergency Medicine Residents’ Association October/November 2018 VOL 45 / ISSUE 5 Implicit Bias in Overcrowding Contrast-Induced Nephropathy SMART Trial Overview The Pediatric ECG ENVISION PHYSICIAN SERVICES OFFERS ... programs that align physicians to become leaders MANSOOR KHAN, MD, MHA, FAAEM EMERGENCY MEDICINE Why EM Residents choose Envision Physician Services ■ Professional Development and Career Advancement ■ Employment Flexibility: Full-Time, Part-Time, moonlighting and travel team. Employed and Independent Contractor options ■ Practice Variety: Coast-to-coast opportunities at well-recognized hospitals and health systems ■ Unparalleled practice support ■ Earn While You Learn Program: Provides senior residents with $2,500/month while you complete your residency For more information, contact: 877.226.6059 [email protected] EDITOR’S FORUM Quality of Life-Saving Care in the ED Tommy Eales, DO (20.4.4.1) as a core competency of the an excellent complement to the wealth of @tommyeales practice of emergency medicine. Advance knowledge acquired during these rotations. M has come a long way from its directives, coordination with hospice In addition, many residency programs offer humble beginnings as a specialty services, and organ donation are all the ability to work directly with hospice Epracticed in hospital basements with specific topics that emergency physicians and palliative medicine services during scarce resources and minimum hospital are expected to understand and apply elective months. Fellowship in hospice support. As emergency physicians fought while caring for patients. and palliative medicine is increasing in for our place in the house of medicine, the But how can these individuals be popularity among EM graduates, and expectations for the care we deliver in the identified quickly and efficiently in the many residency programs have recruited ED grew exponentially. fast-paced world of EM? emergency physicians with this background In the modern era, emergency The ACEP Palliative Medicine section for the exact purpose of emphasizing this physicians maintain an ever-increasing has created a toolkit2 that can be used to importance skill set on shift. scope of practice that often extends far rapidly screen patients for potential benefit For EM residents interested in beyond the initial resuscitation and from palliative care resources. Designed to pursuing fellowship training in palliative diagnosis of life-threatening pathology. function as a quick check list, the criteria care and hospice medicine, ABEM offers With current trends toward increased include diagnosis of a non-survivable subspecialty certification to graduates of boarding times in EDs across the country, illness and any one of 5 additional ACGME-accredited Hospice and Palliative emergency care has become a complex and elements. These can be summarized to Medicine fellowships. While there are multi-stage event that extends hours past provider-estimated life expectancy of less currently 10 specialties including EM the initial evaluation. than 12 months (or anticipated death prior that offer subspecialty training in this At its most basic definition, palliative to adulthood, for children), multiple ED discipline, the American Board of Internal care is the term given to describe the visits for the same condition in the past Medicine (ABIM) creates the subspecialty medical care provided for patients several months, uncontrolled symptoms certification exam that is currently held with serious illnesses. In a typical (eg pain, dyspnea), functional decline, every 2 years.3 shift, this definition might apply to any and complex care requiring increasing At the interface of the initial number of patients receiving care in our support. While this tool is intended for use resuscitation and ultimate disposition crowded EDs. While the word palliative in patients who already carry the diagnosis of critically ill patients in the ED lies a immediately calls to mind the idea of a of a non-survivable illness, it also serves dynamic period during which emergency patient in extremis, this represents just one as a helpful reminder to identify high-risk physicians are the sole providers of the many instances in which palliative features of other critically ill patients who communicating life-changing diagnoses care interventions have been shown to may benefit from palliative care services. and prognoses to patients and their improve the quality of life for patients.1 During EM training, there is ample loved ones. It is during this time that The Model of the Clinical Practice opportunity to develop skill in palliative this essential skill set of our craft can of Emergency Medicine (EM Model) care. While routine EM practice provides provide the key resources, support, and is produced by the American Board significant experience, there are multiple comfort needed during devastating disease of Emergency Medicine (ABEM) and ways to hone palliative care skills outside of processes. Just as we strive to perfect the serves as a content blueprint for ABEM the ED. During ICU blocks, interaction and art and science of resuscitation, so too examinations. The EM Model clearly collaboration with palliative care specialists should we strive to provide high-quality identifies end-of-life and palliative care is a common occurrence and can provide palliative care. ¬ References available online. October/November 2018 | EM Resident 1 TABLE OF CONTENTS EDITORIAL STAFF Categories EDITOR-IN-CHIEF Tommy Eales, DO Indiana University COVER STORY DEPUTY EDITOR 7 Implicit Bias Brian Fromm, MD Thomas Jefferson University and ED Overcrowding EDITORIAL TEAM Whitney Johnson, MD It’s clear that overcrowding UCSF-Fresno impacts the quality of care in an ED. But does it also Jeremy Lacocque, DO Midwestern University/CCOM affect the equality of care? Leah McDonald, MD NYU/Bellevue Medical Center 5 PRESIDENT’S MESSAGE 16 TOXICOLOGY Clark Owyang, MD What Can We Accomplish Tackling Stanford Critical Care Medicine Fellow in Our Next 45 Years? Valproate Overdose Jayram Pai, MD Mount Sinai Yagnaram Ravichandran, MBBS, MD, FAAP CARDIOLOGY/PEDIATRICS Children’s Hospital of Michigan 18 The Pediatric ECG and Long QT Syndrome Danny VanValkinburgh, MD CRITICAL CARE University of Tennessee 10 College of Medicine Doubling Down on Re-Expansion ECG Editor Pulmonary Edema Jeremy Berberian, MD Treatment Approach Christiana Care Health System and Ventilator Management MSC Editor TOXICOLOGY Morgan Bobb 20 Bleach University of Iowa Carver RISK MANAGEMENT College of Medicine Ingestion 12 Falls in the To Scope or Emergency Not to Scope? Department EM Resident (ISSN 2377-438X) is the bi- An Investigation NEPHROLOGY monthly magazine of the Emergency Medicine 22 Residents’ Association (EMRA). The opinions Catching Up with herein are those of the authors and not of CRITICAL CARE ALERT Contrast-Induced EMRA or any institutions, organizations, or 14 Balanced Crystalloids Nephropathy federal agencies. EMRA encourages readers versus Saline in Critically Ill to inform themselves fully about all issues presented. EM Resident reserves the right Adults (the SMART trial) SPORTS MEDICINE to edit all material and does not guarantee 23 Emergency publication. PEDIATRICS Management © Copyright 2018 15 When You Hear Hooves, of Heat-Related Emergency Medicine Residents’ Association Consider a Zebra Illness 2 EMRA | emra.org • emresident.org UPCOMING EVENTS Oct. 13–16: ABEM Fall Oral Certification SPORTS MEDICINE ECG CHALLENGE Exam 26 Berlin Concussion 39 Nov. 30: NRMP standard registration deadline Summary and Nov. 30: CORD Abstract submissions due Active Rehabilitation Regional Meeting funding for Concussion Dec. 15: Management applications due Jan. 1: Medical Student Council applications due INTERNATIONAL MEDICINE VISUAL DIAGNOSIS Jan. 10: Committee chair-elect applications due 28 Small Bowel Obstruction What’s Jan. 15: EMRA Spring Awards Secondary to the Diagnosis? nominations due Ascariasis Infection Jan. 30: NRMP rank order list entry opens An Alarming @ noon ET Finding in the Feb. 20: NRMP rank order lists due Remote Territory March 11-14: SOAP of Eastern NRMP Match Day Honduras March 15: March 31–April 3: CORD Academic FINANCIAL Assembly/EMRA Spring Meeting MEDICAL STUDENTS 42 EM’s Own Emergency: @ Hyatt Regency Seattle 30 Unraveling the Mystery Financial Education of Dizziness in the ED First Thursday of every month 45 PRACTICE ENVIRONMENT A Guide for the Student Clerkship Locums Life TRAUMA So Many 32 The Use of Low Titer Choices Group O Whole Blood in Emergency Medicine EMRA-FIED PROGRAMS EMRA-Cast: Listen at your convenience PREHOSPITAL & DISASTER 46 34 Emerging Prehospital Protocols ADVERTISE WITH US PRINT AND ONLINE MARKETING These Programs Rock! OPPORTUNITIES AVAILABLE Contact Cynthia Kucera | 201-767-4170 [email protected] NEWS & NOTES Download EM Resident Media Kit The More You Know 47 Do You Love Your Program emra.org/advertise Leaders?; National MEDICAL EDUCATION Leadership Opportunities; Be sure to check EMResident.org Annals of Emergency for exclusive online content! 36 Understanding EMS Medicine and more Provider Education Want to improve your CV? and How to Participate Write for EM Resident! as a Resident BOARD REVIEW Submit online at emresident.org. More Than a Powerpoint 49 Questions from PEER October/November 2018 | EM Resident 3 EmBassador Travel Team Seeking the Best and Brightest EM Physicians Enjoy the flexibility to live where you want and practice where you are needed. EMBASSADOR
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