
NEONATAL MENINGITIS WELLNESS SKEPTICS' GUIDE Big Disease Encouraging Hydrocortisone in a Tiny Host Resilience and Sepsis SEE PAGE 8 SEE PAGE 15 SEE PAGE 14 MARCH 2017 Volume 36 Number 3 FACEBOOK/ACEPFAN TWITTER/ACEPNOW ACEPNOW.COM PLUS THE NEW SURVIVING SOUND ADVICE OPIOID-SPARING TECHNIQUE FOR PATIENTS WITH RIB SEPSIS FRACTURES ILLUSTRATION:CHRIS WHISSEN; PHOTOS: SHUTTERSTOCK.COM SEE PAGE 12 RECOMMENDATIONS HIGHLIGHTS FROM THE LATEST GUIDELINES BUZZARRE A new continuing medical education feature of ACEP Now by TIFFANY M. OSBORN, MD, MPH BEE STING LOG ON TO http://www.acep.org/ Cura te ipsum: ACEPeCME/ CEP endorsed the latest iteration of the Surviv- TO COMPLETE THE Doctor, heal thy uvula ACTIVITY AND EARN ing Sepsis Campaign (SSC) guidelines, totaling FREE AMA PRA by GREGORY PODOLEJ, MD CATEGORY 1 CREDIT. 67 pages with 93 statements on early manage- A 1,2 ment and 655 references. An important note: Guide- was supposed to be a nice refreshing lines should be a counselor, not a jailer. Guidelines IT run along a country road. provide a framework for direction and standardization On my return loop, about a mile from my EM CASES where possible but require clinical context for house, I felt an insect fly into my mouth. I FIXING individual patients. This summary includes immediately coughed it out and was a lit- HYPONATREMIA items specifically pertinent to emergency tle surprised when I saw that it was not WHILE AVOIDING medicine and is not intended to be all- just a regular house fly—it had some yel- CATASTROPHE inclusive. low stripes on it. Nonetheless, I was having SEE PAGE 11 a good run and didn’t feel like stopping to DEFINITIONS take a better look. “Even if it was a bee or a All the data informing guideline devel- wasp,” I thought to myself as I kept running, opment were based on the established “thank God I’m not allergic.” definitions, not Sepsis-3. The Sepsis-3 and Literally 30 seconds later, I started to feel FIND IT ONLINE established definitions were modified for the intense pain in the back of my throat, much For more clinical stories and like a sore throat from hell. Granted, even practice trends, plus commentary and opinion pieces, go to: CONTINUED on page 6 though I am more out of shape now than I www.acepnow.com SHUTTERSTOCK.COM used to be, it started feeling like it was get- ting harder to breathe. A few scenarios started running through my head: 1. If my throat closes, at least I’ll be by a bigger road soon and somebody will see me. 2. I wonder how long the paramedics will MEET take to get to my rural house. 3. I’m not that far from home. I know I have a scalpel, a bougie, and an endotra- cheal tube somewhere. EDIE I managed to get home and took a cur- PAGE 4 sory look at the back of my throat. My pos- terior pharynx was quite erythematous, but most noticeably, my uvula was the size of CONTINUED on page 10 2017 Course Topics Updated & Revised Topics! n Acute and Chronic Back Pain in the ED n BRUE in Low Risk Infants: AAP Guidelines n SEPSIS, SOFA, So What? n Sore Throat: 2017 Sate-of-the-Art n Imaging in Chest Trauma n Myths in Emergency Medicine n Poisoning / Overdose 2017 28 State-of-the-Art Topics Focused on Clinical Questions n ED-Related “Choosing Wisely” - Part 1 Four 90-Minute Faculty Panels Literature-Derived Evidence n ED-Related “Choosing Wisely” - Part 2 Seasoned Clinical Faculty Top Dates & Destinations n Gastrointestinal Pearls n ACLS Literature Update - Part 1 n ACLS Literature Update - Part 2 n Unusual Antibiotic Side Effects n The Dilemma of PE Overdiagnosis n The Challenges of Physician Variability n Assessing Suicide Risk n TIAs in the ED Course Has Passed Course Has Passed n Clinician Burnout: 2017 Update Key West, Florida Cancún, Mexico Vail, Colorado n Getting to Know Tranexamic Acid Feb. 27 - March 3, 2017 March 6 - 10, 2017 March 20 - 24, 2017 n Management of CPR Survival - Part 1 n Management of CPR Survival - Part 2 n SAH Ongoing Diagnostic Challenges n Minor Head Trauma: Special Cases n Ongoing Challenge of Managing Pediatric UTI n Steroids: Uses and Misuses in EM n Topics in COPD 2017: Is Anything New? Scottsdale, Arizona Orlando, Florida San Francisco, California n Visual Diagnosis Challenges - Part 1 March 23 - 26, 2017 April 12 - 15, 2017 April 20 - 23, 2017 n Visual Diagnosis Challenges - Part 2 n Important Recent EM Literature - Part 1* n Important Recent EM Literature - Part 2* n Diagnostic and Therapeutic Controversies* n Challenging ED Scenarios* *Topics listed with an asterisk (*) are 90-minute faculty panel New Orleans, Louisiana Hilton Head, South Carolina San Diego, California discussions; all other topics are 30 minutes. April 27 - 30, 2017 May 10 - 13, 2017 June 1 - 4, 2017 Experience the Course Enjoyed by Over 45,000 Nashville, Tennessee New York, New York Girdwood, Alaska of Your Colleagues! June 14 - 17, 2017 June 22 - 25, 2017 June 26 - 30, 2017 Take Advantage of Early Bird For Complete Details and to Register, Registration Visit www. or and Discounted EMAcourse.com Hotel Rates! Call 800-458-4779 (9:00am-4:30pm ET, M-F) Jointly Sponsored by THE CENTER FOR MEDICAL EDUCATION MARCH 2017 Volume 36 Number 3 ACEPNOW.COM EDITORIAL STAFF MEDICAL EDITOR-IN-CHIEF EDITOR Kevin Klauer, DO, EJD, FACEP Dawn Antoline-Wang [email protected] [email protected] Time Saving Features. ART DIRECTOR Chris Whissen Streamlined Asynchronous Learning. [email protected] My Residency Learning ACEP STAFF Robust, peer-reviewed content Portal is a customized, EXECUTIVE DIRECTOR DIRECTOR, MEMBER Dean Wilkerson, JD, MBA, CAE COMMUNICATIONS AND personalized, single entry point World-renowned EM educators [email protected] MARKETING Nancy Calaway, CAE for high-quality, EM on-demand Over 875 hours of course selections ASSOCIATE EXECUTIVE DIRECTOR, [email protected] education. It offers robust, peer- MEMBERSHIP AND EDUCATION Downloadable course reporting DIVISION COMMUNICATIONS MANAGER reviewed content presented Robert Heard, MBA, CAE Noa Gavin Time savings for Program Directors [email protected] [email protected] by world-renowned educators Unlimited Support in Emergency Medicine, and PUBLISHING STAFF boasts over 875 hours of Meets the six requirements for EXECUTIVE EDITOR/ ASSOCIATE DIRECTOR, Individualized Interactive Instruction (III) PUBLISHER ADVERTISING SALES course selections. Lisa Dionne-Lento Steve Jezzard [email protected] [email protected] You’ll have 12 months of unlimited access ADVERTISING STAFF for your Residents (and up to 10 DISPLAY ADVERTISING CLASSIFIED ADVERTISING residency faculty) — a wealth of Dean Mather or Kelly Miller Kevin Dunn Cynthia Kucera knowledge, all for one low fee. [email protected] [email protected] [email protected] (856) 768-9360 Cunningham and Associates (201) 767-4170 1-50 Residents $495 EDITORIAL ADVISORY BOARD Personalized Dashboard 51 or more $995 James G. Adams, MD, FACEP Ricardo Martinez, MD, FACEP James J. Augustine, MD, FACEP Howard K. Mell, MD, MPH, FACEP Richard M. Cantor, MD, FACEP Mark S. Rosenberg, DO, MBA, FACEP Helps your residency program reach its education goals. L. Anthony Cirillo, MD, FACEP Sandra M. Schneider, MD, FACEP Marco Coppola, DO, FACEP Jeremiah Schuur, MD, MHS, FACEP Jordan Celeste, MD David M. Siegel, MD, JD, FACEP Meets all six requirements Jeremy Samuel Faust, MD, MS, MA Michael D. Smith, MD, MBA, FACEP Jonathan M. Glauser, MD, MBA, FACEP Robert C. Solomon, MD, FACEP for Individualized Interactive Instruction (III). Michael A. Granovsky, MD, FACEP Annalise Sorrentino, MD, FACEP Sarah Hoper, MD, JD Jennifer L’Hommedieu Stankus, MD, JD Ensures faculty oversight Linda L. Lawrence, MD, FACEP Peter Viccellio, MD, FACEP review the courses in advance, then assign them to your Frank LoVecchio, DO, FACEP Rade B. Vukmir, MD, JD, FACEP Residents based on their needs. Monitor their performance Catherine A. Marco, MD, FACEP Scott D. Weingart, MD, FACEP on an admin dashboard INFORMATION FOR SUBSCRIBERS Measures performance Subscriptions are free for members of ACEP and SEMPA. Free access is also available online at www. with post-tests and evaluations acepnow.com. Paid subscriptions are available to all others for $262/year individual. To initiate a paid subscription, email [email protected] or call (800) 835-6770. ACEP Now (ISSN: 2333-259X print; 2333-2603 digital) is published monthly on behalf of the American College of Emergency Physicians Brings you and your Residents together by Wiley Subscription Services, Inc., a Wiley Company, 111 River Street, Hoboken, NJ 07030-5774. Periodical postage paid at Hoboken, NJ, and additional offices. 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