ResidentOfficial Publication of the Emergency Medicine Residents’ Association June/July 2021 VOL 48 / ISSUE 3 Managing Envenomations How to Sustain a Career: Peer Support Guide to ABEM Certi ication We Help Healers SCP Reach New Heights Health Meet Your Medical Career Dream Team SCP Health Step Right Up, Residents! As you’re transitioning from residency to begin your career, our team is here to create a tailored environment for you that fosters growth and delivers rewarding daily work experiences. Explore clinical careers at scp-health.com/explore TOGETHER, WE HEAL Welcome to a New Academic Year! uly marks a turning point each year, as new interns arrive in programs throughout Jthe country, newly graduated residents launch the next phase of their careers, and medical students take the next steps in their journey to residency. DO YOU KNOW HOW EMRA CAN HELP? Resources for Interns Resources for PGY2+ Resources for Students All EM programs will receive EMRA residents members receive the EMRA shows up for medical students Intern Kits this summer with nearly 10-pound EMRA Resident Kit upon interested in this specialty. From resources that offer immediate first joining EMRA. It is packed with clinical new advising content every month to backup for those first nerve-wracking resources for every rotation — some you’ll opportunities for leadership and growth, shifts. The high-yield EMRA Intern need only rarely (but prove to be clutch), and EMRA student membership is high-yield. Kit is sent for free to all EM interns some you’ll use every single shift (EMRA Plus, our online resources are unparalleled: (membership not required) and Antibiotic Guide, anyone?). Plus, check out: • EMRA Match for Clerkships: https:// includes: • EMRA Match for Fellowship: https:// webapps.emra.org/utils/spa/match#/ • Basics of Emergency Medicine, webapps.emra.org/utils/spa/match#/ search/map (click C for clerkships in the 4th ed. (newly updated this year!) search/map (click F for fellowships in the upper left corner) upper left corner) • EMRA Match for Residency: https:// • Basics of EM: Pediatrics, 3rd ed. • EMRA Fellowship Guide: https://www.emra. webapps.emra.org/utils/spa/match#/ (newly updated this year!) org/books/fellowship-guide-book/i-title search/map • EMRA Trauma Guide • PGY2 resources: https://www.emra.org/ • EMRA and CORD Student Advising Plus, log in at emra.org to resident/pgy2 Guide: https://www.emra.org/books/ find resources specific for interns: • PGY3+ resources: https://www.emra.org/ msadvisingguide/msag https://www.emra.org/resident/pgy1 resident/pgy3 • EMRA resources for every year of your medical school journey: https:// Resources for Fellows and Alumni www.emra.org/student/msi (log in as a You remain one of our #EMRAFamily, long after you’ve surpassed your member to view) residency years. Fellows and alumni receive their own tailored EMRA Member kits upon joining after residency. Resources for All Check www.emra.org often, as we Plus, check out: constantly add new content (podcasts, • EMRA Match for Jobs: https://webapps.emra.org/utils/spa/match#/search/map vlogs, Hangouts, free publications, open- (click J for Jobs in the upper left corner) access EM Resident online, and more). • EMRA Career Resources: https://www.emra.org/residents-fellows/career-planning Plus, refer often to these critical resources: From EMRA Match for Jobs to podcast content to contract negotiation tips and • EMRA Wellness Guide: https://www.emra. CV prep, we’ve got you covered. org/books/emra-wellness-guide/cover • Log in to get your Fellow-specific content here: https://www.emra.org/emra- • Emergency Medicine Advocacy fellow Handbook: https://www.emra.org/books/ • Alumni, log in and visit: https://www.emra.org/alumni advocacy-handbook/advhbook Welcome to this new stage of your career! We’re glad you’re here, and it’s our privilege to journey with you. ¬ June/July 2021 | EM Resident 1 TABLE OF CONTENTS Looking Beyond Patient Outcomes in EDITORIAL STAFF 4 the Uncertainty 36 ED Observation Units LEADERSHIP for Syncope EDITOR-IN-CHIEF Priyanka Lauber, DO Micro-Communities ADMIN & OPS Lehigh Valley Health Network 6 of Practice to Maintain EMRA as the MVP EDITORS 38 HEALTH POLICY, OP-ED Resilience During Times Erich Burton, DO of Uncertainty Why EM Physicians Should Greenville Health System CAREER DEVELOPMENT, 39 Care About Health Literacy Marc Cassone, DO WELLNESS, COVID-19 SOCIAL EM Shiprock, NM Residents’ Guide 25 Under 45 Brian Sumner, MD 8 to ABEM Certification 41 AWARDS Mount Sinai Morningside-West BOARD CERTIFICATION EMRA at ACEP21 Devan Pandya, MD Managing Envenomation UC Riverside 42 EMRA EVENTS 10 TOXICOLOGY EMRA 20-in-6; Gabrielle Ransford, MD Pericardial Effusion East Virginia Medical School 43 Case-Con 15 TOXICOLOGY EMRA EVENTS Sarah Ring, MD An Unexpected Icahn SOM at Mount Sinai EMRA MedWAR; 18 Electrical Injury Samuel Southgate, MD, MA 44 EMRA Resident SIMWars TRAUMA Regions Hospital EMRA EVENTS A Case of Excipient EMRA Job & MSC Editor Luke Wohlford 20 Lung Disease 45 Fellowship Fair TOXICOLOGY University of Arizona EMRA EVENTS College of Medicine–Phoenix Shockingly Dangerous EMRA Residency Fair; 22 Hypokalemia ECG Faculty Editor 46 Virtual Medical Jeremy Berberian, MD CARDIOLOGY Student Forum ChristianaCare Juvenile Ovarian Cancer EMRA EVENTS 24 and the Importance PEM Fellowship Editor News & Notes Emine Tunc, MD of POCUS in the ED 47 EMRA RELEASE 6 NEW PUBS; University of Washington US, PEDIATRICS ABEM VIRTUAL EXAM DATES Complications Seen Toxicology Faculty Editor The Hidden Curriculum David J. Vearrier, MD, MPH, FACMT, 25 in Pediatric Sickle Cell 48 HEART OF EM FAACT, FAAEM Disease Patients University of Mississippi PEDIATRICS, HEMATOLOGY, Lessons in Vulnerability PAIN MANAGEMENT 49 HEART OF EM Be Wary of the Bruise Regarding “Failure 50 of Follow-Up: Scrotal EM Resident (ISSN 2377-438X) is the bi-monthly 28 PEDIATRICS magazine of the Emergency Medicine Residents’ Hernia Case Illustrates Association (EMRA). The opinions herein are One Bad Hand of Poker Healthcare Disparities” 30 TRAUMA those of the authors and not of EMRA or any LETTER TO EDITOR institutions, organizations, or federal agencies. A Case of Overwhelming ECG Challenge EMRA encourages readers to inform themselves 32 fully about all issues presented. Post-splenectomy Infection 51 CARDIOLOGY EM Resident INFECTIOUS DISEASE reserves the right to edit all material and does Board Review Questions not guarantee publication. EM Use of Sphenopalatine 53 PEER ASSISTANCE 34 Ganglion Block for © Copyright 2021 Migraine Headaches Emergency Medicine Residents’ Association PAIN MANAGEMENT WHY I’M AN OWNER At Vituity, I get to be a part of something bigger “ than myself. As an academic leader, I teach new physicians and aspiring leaders how to make a difference in healthcare.” Lori Winston, MD, FACEP Vituity Partner & Director of Academic Affairs | Visalia, CA Vituity has always been 100% owned by its physicians, and you join as a Partner from Day 1. Learn more about Vituity’s Fellowships in Administration, Clinical Education & Simulation, EMS, and Ultrasound. vituity.com/fellowships Now hiring in: Arizona, California, Illinois, Indiana, Kansas, Missouri, Minnesota, Nevada, New Jersey, Oregon, South Carolina, Texas, Washington, and Wisconsin. June/July 2021 | EM Resident 3 Vituity® is a registered trademark of CEP America, LLC. © CEP America, LLC, All Rights Reserved. LEADERSHIP Looking Beyond the Uncertainty RJ Sontag, MD I called a stroke alert and spoke to a workforce (acep.org/workforce). I see the EMRA President neurologist. I looked her in the eyes as impact of this when I look in the eyes of Mid Ohio Emergency Services I described the patient’s presentation, EMRA members who have already felt @RJSontagMD and she agreed the presentation made the pressures of these changing workforce he first thing I notice about a patient diagnosis difficult. I breathed a sigh of trends. We have the opportunity to look Tare their eyes. Are they open or shut? relief, realizing I was not alone in my this challenge in the eyes and make a Are they bloodshot? Are they avoiding eye uncertainty. I was beginning to build decision: We can sit back and wait contact? When we look in someone’s eyes, what would become strong relationships to see how it unfolds, or we can emergency physicians get an immediate with our consultants. lean in to our uncertainty and sense of what we will encounter as our Later in the year, as the winter look for solutions. Now is the time to time together unfolds. Not only do we set in and the pandemic worsened, a have difficult conversations, including begin to gather pertinent information nurse pulled me into a room. He looked conversations about our own residency for our physical exam, but we also see concerned and explained that his patient training models and about the impact of the emotions underlying their chief arrived in respiratory distress, and she business interests and other providers on complaints. As I reflect on my time as was not responding to the BiPAP EMS our training and practice. EMRA’s recent EMRA president and on my first year as a had provided. I called for respiratory Workforce Town Hall showed that our brand-new attending, I also wonder what therapy to join us, and I looked in my members are ready to have these difficult people saw when they looked in my eyes. patient’s eyes. I saw fatigue, and I knew conversations. Did my very first patient see any she needed immediate help. Between Whether I am with patients as their uncertainty? His chief complaint was shallow breaths and coughing fits, she doctor, with consultants as their partner, dizziness, and his symptoms were shared that her partner recently died or with you as EMRA’s president, I see vague. I looked in his eyes, searching from COVID-19, and she wondered if she it as my job to look a person in the eyes for nystagmus or any other clues I could would survive.