ResidentOfficial Publication of the Emergency Medicine Residents’ Association June/July 2018 VOL 45 / ISSUE 3 First Shift of Residency Examining the DAWN and DEFUSE 3 Trials Simplified Approach to TEG and ROTEM Modern Trends in Blast Injuries 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] Letter from the Editor ENOUGH IS ENOUGH Tommy Eales, DO Editor-in-Chief, EM Resident Indiana University @tommyeales Editor’s Note: Gun violence continues to have a dramatic impact on our society, and the EMRA Representative Council is discussing the topic to form EMRA’s official stance. This letter reflects my opinions. “Time of death — 2:31 am.” rate of gun-related deaths among ugliness and even accept it as unchangeable, 1 stared at the lifeless child in front of industrialized countries. Every year, the insurmountable. Yet, there are some things me — the focal point of a quiet, well- number of Americans who will die from that should never be normalized. disciplined trauma resuscitation. There gunshot wounds rivals the number of those The next time you hold a parent’s hand I who die from sepsis.2 Perhaps a striking while confirming the worst possible news, were blank faces around the room. And for statistic to some, this should come as no here’s my advice. a moment, absolute silence. surprise to those of us working in crowded Apologize. Then, from beyond the curtain, a slow, EDs across the country. Apologize that our society normalizes piercing cry. Despite the media attention and public gun violence to the extent that no action I carefully removed my blood-stained outcry associated with the violent deaths of will be taken to address the systemic flaws gloves and gown, pausing to ensure that young children, the sobering reality is that that contributed to her child’s death. my scrubs bore no evidence of the grisly the majority of gunshot-wound fatalities Apologize that our professional scene that just enfolded. I washed my in America occur in adults and are self- organizations have failed to reverse the hands and took a deep breath. As I stepped inflicted.2 These stories will never make caustic legislation preventing us from out of the resuscitation bay, I came face- the evening news. If only we could do a collecting and analyzing the data we need to-face with the patient’s mother. Words better job of identifying those at risk and to create evidence-based guidelines to fight cannot capture her desperate, glassy stare intervening earlier, perhaps these deaths gun violence across the country. as her eyes met mine. might one day be preventable. Apologize that emergency medical and Before I could even speak, she knew. Embarrassingly, we have dangerously surgical staff have become immune to the In the moments that followed, we limited data pertaining to gun violence. emotions associated with gun violence and shared a simple discussion that would This is critical information we need to save death. change her life forever. I explained that lives. Talking to my patient’s mother her child had suffered a gunshot wound Compared with other leading causes that night, I told her that we had done to the chest that caused her heart to stop of death, gun violence was associated everything in our power to save her child. beating just prior to reaching the hospital. with less funding and fewer publications But what about my next patient? Have Without divulging too many details than predicted based on mortality rate, I done everything in my power to prevent about the exhaustive measures that were with approximately 1.6% of the funding others from becoming victims of gun attempted to revive her upon arrival to the and 4.5% of the volume of publications violence? ED, I assured the grief-stricken mother predicted by a regression analysis As the frontline of the healthcare that every effort was made to save her incorporating the leading causes of death system, gun violence is our problem. It baby. “I’m sorry,” I concluded. “She died.” reported by the CDC between 2004- is our responsibility to stand up and take Not 20 minutes later, I was back at 2014.3 While the reasoning for this is ownership of this. Short of that, we are my workstation and catching up on charts multifactorial, the major driving force is the doing an injustice to our patients. Every during a rare lull in the steady onslaught of gun lobby — a collection of various groups time we quietly go back to work after new arrivals. working tirelessly to restrict federal funding another young person’s violent death, we Gun violence has become so routine in for researchers investigating gun violence. make it easier for this to remain the status the ED that not even the gruesome death Life in the ED is unpredictable. We quo. As physicians, it is our duty to speak up of a young child can interrupt the daily routinely come face-to-face with the for those who cannot speak for themselves. grind. struggles of our communities. Over time, I speak for my deceased patients when I In fact, the U.S. now has the highest there is a tendency to normalize the say that enough is enough. ¬ References available online. June/July 2018 | EM Resident 1 TABLE OF CONTENTS EDITORIAL STAFF Categories EDITOR-IN-CHIEF Tommy Eales, DO COVER STORY Indiana University 14 Welcome to DEPUTY EDITOR Brian Fromm, MD Emergency Thomas Jefferson University Medicine Blake Baker, MD, MPH, completed his first EDITORIAL TEAM shift as a physician on the night of a mass Jeremy Lacocque, DO shooting in Dallas. How can this year’s interns Midwestern University/CCOM prepare for their own first shifts — and first month of residency? Megan Cobb, MD On the cover: Blake Baker is beginning his final year of residency at UT Southwestern, University of Maryland rotating at Parkland Health & Hospital System. Jayram Pai, MD Mount Sinai PRESIDENT’S MESSAGE COVER STORY SUPPLEMENT 5 #EMRAatCORD18 16 How Did You Survive Leah McDonald, MD the First Month NYU/Bellevue Medical Center of Residency? Karen Bowers, MD, MS, MEd Emory University Event WELLNESS Recap 18 Whitney Johnson, MD Emotional Intelligence UCSF-Fresno in the Emergency Department Danny VanValkinburgh, MD ACGME RC-EM UPDATE University of Tennessee College of Medicine 6 ACGME Review Committee for ECG Editor Emergency Medicine Jeremy Berberian, MD Updates Christiana Care Health System WELLNESS 20 Applying Cognitive Load LEADERSHIP REPORT MSC Editor Theory to Emergency Morgan Bobb 8 Introducing EMRA’s Medicine Handoffs University of Iowa Carver New Administration & College of Medicine Operations Committee CRITICAL CARE EM Resident (ISSN 2377-438X) is the bi- 10 Examining DAWN monthly magazine of the Emergency Medicine and DEFUSE 3 Residents’ Association (EMRA). The opinions herein are those of the authors and not of Endovascular Therapy EMRA or any institutions, organizations, or Option for Late-Presenting federal agencies. EMRA encourages readers Ischemic Stroke Patients TRAUMA to inform themselves fully about all issues 22 Modern presented. EM Resident reserves the right AIRWAY Trends to edit all material and does not guarantee publication. 13 Delayed Sequence in Blast © Copyright 2018 Intubation Injuries Emergency Medicine Residents’ Association Basics for Residents 2 EMRA | emra.org • emresident.org UPCOMING EVENTS June 15: 20 in 6 Resident Lecture Entries PREHOSPITAL CARE INFECTIOUS DISEASE Due 24 34 June 19-22: Resuscitation 2018 — discount Cervical Collar Tamiflu for EMRA members! Baltimore, MD To Use or July 15: Fall Award Application Due Not to Use? Aug. 5: EM Resident Articles Due Aug. 18: EMRA Board Nominations Due TRAUMA Aug. 18: Fall Resolutions Due 37 A Simplified Treatment- Sept. 15: 2019 Main Registry Match opens @ Noon EDST Friend or Foe? Based Approach to TEG and ROTEM Sept. 28-Oct. 4: EMRA Events at ACEP18, San Diego PULMONARY DISORDERS Sept. 30: EMRA Residency Program Fair PREHOSPITAL 25 Super Bowl-induced 40 @ ACEP18 Spontaneous Rescue Oct. 1: EMRA Job & Fellowship Fair @ ACEP18 Pneumomediastinum Task Force Oct. 13-16: ABEM Fall Oral Certification Exam Super-Fan Oct. 5: EM Resident Articles Due Life Nov. 30: NRMP standard registration deadline RESEARCH Jan. 30: NRMP rank order list entry opens @ Noon ET 42 How to Get Published Feb. 20: NRMP rank order lists due PROCEDURE/CRITICAL CARE 26 The Use of the Angiocatheter in Central Line Insertion Paper Hack 101 First Thursday of every month MEDICAL STUDENTS EMRA-Cast: 44 Required Clerkships Listen Setting the at your Foundation convenience CRITICAL CARE for a Career 28 in Emergency Hepatic Medicine Syndromes ADVERTISE WITH US EM POWER PRINT AND ONLINE MARKETING 46 Jo Linder, MD, OPPORTUNITIES AVAILABLE ORTHOPEDICS FACEP Contact Cynthia Kucera | 201-767-4170 30 Posterior Sternoclavicular [email protected] Joint Dislocation Download EM Resident Media Kit ECG CHALLENGE 47 emra.org/advertise Be sure to check EMResident.org Recanting Impressions for exclusive online content! 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