ResidentOfficial Publication of the Emergency Medicine Residents’ Association April/May 2014 EM VOL 41 / ISSUE 2 In the Field Pre-hospital medicine EMS, backboards, hypothermia and more Will your salary cover your student loans? student loans? cover your My Kaywa QR-Code http://erdocsalary.com/ Will your salary http://kaywa.me/P7V6O Scan the QR code or go to erdocsalary.com Download the Kaywa QR Code Reader (App Store &Android Market) and scan your code! (800) 726-3627 x3668 CONTENTS 18 A Reflection on Mental Health and EM Kyra D. Reed, MD Among our colleagues, we can reinforce the importance of mental health issues, keeping in mind the rate of serious outcomes, including suicide. 2 1 1 2 3 CT 1 21 5 MA 2 CT 15 11 2 1 1 NJ 4 1 8 12 7 Two Roads, 1 MD 9 9 1 2 DE 1 1 8 1 DC 1 2 1 2 1 1 15 5 1 4 1 2 5 One Destination 4 1 3 3 1 1 2 24 1 1 1 2 Osteopathic BACKBOARDS 3 11 2 Emergency Medicine Number of AOA Programs 5 2 Do They Really Have Your Back? Number of ACGME Programs Puerto Rico Christina L. Tupe, MD and Jose V. Nable, MD, NRP Zach Jarou, MSIV and Bradley Davis, OMS3 Spinal immobilization has long been standard practice for 20 The single accreditation system will ensure quality, pre-hospital trauma patients, but this practice is being re-evaluated. consistent training and increased access to fellowships. 3 PRESIDENT’S MESSAGE 33 EMRA EVENTS AT SAEM 5 LEGISLATIVE ADVISOR 34 RESIDENT LIFE 7 ACADEMIC AFFAIRS 36 PROCEDURAL GUIDANCE 8 INTERNATIONAL EM 39 EM PEDIATRICS 11 RRC-EM UPDATE 41 CLINICAL CASE 12 WILDERNESS MEDICINE 43 CLINICAL CASE 16 VICE-SPEAKER REPORT 45 EMPOWER 17 CLINICAL CASE 48 EM REFLECTIONS 18 PSYCHIATRY 51 BOARD REVIEW QUESTIONS 20 MEDICAL STUDENT LIFE 52 PEDIATRIC PEARLS 22 EMERGENCY MEDICAL SERVICES 53 RISK MANAGEMENT PITFALLS 28 FIRST PERSON 28 54 REFERENCES/RESOURCES 30 CRITICAL CARE 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 While most of you will have graduated and moved into practice by the time all these changes take place, it is important to remain Jordan Celeste, MD EMRA President informed about the current challenges of our professional pathway Brown University and the future direction of our field. Providence, RI uring my year as EMRA President, one of my goals has been to highlight the true value of membership. Going beyond our outstanding in-house publications, even going beyond free EM:Rap and other member benefits, EMRA does Dsomething more – we develop leaders. The EMpower initiative has been showcasing past members who found EMRA to be a launching pad for the rest of their careers (check out page 45 for more!). While we help to create leaders, in this issue I’d like to focus on how EMRA develops physician advocates. I’m sure you’ve all been told before that as physicians, you are natural advocates. It’s true – each and every day you speak for your patients to ensure that they get the resources and care that they need. Beyond that, though, EMRA develops emergency physician advocates using resources that you just can’t get anywhere else. EMRA Health Policy Committee EMRA Advocacy ACEP 9-11 Legislative Action and Legislative Advisor Handbook Network EMRA has a Legislative Advisor on its board of In its third edition, the EMRA EMRA also enjoys a tremendous working directors who keeps the entire membership Advocacy Handbook has relationship with ACEP and, as a result, informed about general concepts within evolved into the go-to resource our members benefit from multiple health policy, as well as hot topics such as health for students and residents other resources and opportunities in care reform and GME funding. The Legislative interested in emergency the world of health policy and advocacy. Advisor provides guidance for the board regarding medicine health policy. It is All members should sign up for the 911 these issues, and often serves as a liaison to external being used across the country Legislative Action Network. It’s free and groups with shared interests. Moreover, he or to augment traditional EM easy, and provides updates about events she serves as the liaison to the EMRA Health curricula, and to inspire in DC pertinent to emergency medicine. Policy Committee. readers to become more Beyond just providing information, it involved at the local, state, allows emergency medicine to maximize As a longstanding member group, the EMRA Health and national level. So vital is its voice to legislators. Member com muni­­ Policy Committee is extremely engaged and active. this information that EMRA ca­­tions often contain a link that contacts Committee members keep members informed has made it available on your legislator with a pre-formed advocacy through articles in EM Resident, as well as via their EMRA.org as a downloadable, message that you can customize as you see Facebook feed. They also maintain a cache of health FREE e-book. fit. Free, easy, powerful. policy resources on the website. continued on page 4 Log-in and More Information become a RESOURCES FOUND ON EMRA.ORG RESOURCES FOUND ON ACEP.ORG physician • EMRA Health Policy Committee • 9-11 Legislative Action Network advocate • EMRA Legislative Advisor position description • Leadership and Advocacy Conference • Free downloadable EMRA Advocacy Handbook information today! • EMRA-ACEP Mini-Fellowship in Washington April/May 2014 | EM Resident 3 PRESIDENT’S MESSAGE ACEP Leadership and Advocacy Conference Every spring, ACEP puts on the Leadership and Advocacy Conference in Washington, EMRA develops D.C. where EMRA has the great pleasure of providing programming on the first day. Here you can learn about the basics of health policy, and then delve much deeper on emergency select topics and hear from distinguished speakers and guests. This conference provides phenomenal opportunities to network, not only with your physician colleagues within emergency medicine, but also with your legislators and their staff on Capitol Hill. After learning about health policy issues and advocacy advocates messages, you visit your state legislators’ offices to speak about these issues, providing data, but also telling patient stories. This year’s conference is right around the corner, using resources May 18-21 at the Omni Shoreham. that you just EMRA-ACEP Health Policy Mini-Fellowship For residents and young physicians inter ested in taking an even bigger step into the can’t get realm of health policy, EMRA and ACEP offer the mini-fellowship. This month-long experience places you in the center of the action in the ACEP Washington, anywhere else. D.C. office. Here, you gain hands-on experience on Capitol Hill and customize your time to meet your particular goal – whether that be lobbying, regulations, policy, or anywhere else your interest lies.