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CONTACTS

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REFERENCES & LINKS

• Saleh G, Al-Abcha A, Chaaban K, Adi MZ, Tweet M, Collins JD, Alkhouli M, Gulati R. Concomitant Takotsubo Cardiomyopathy and Spontaneous Coronary Artery Dissection: Exploring the Role of Cardiac Mechanics on Coronary Disruption. JACC Cardiovasc Imaging. 2025 Oct;18(10):1161-1166. doi: 10.1016/j.jcmg.2025.05.020. Epub 2025 Aug 5. PMID: 40758075.
• Baqal O, Karikalan SA, Hasabo EA, Tareen H, Futela P, Qasba RK, Shafqat A, Qasba RK, Hayes SN, Tweet MS, El Masry HZ, Lee KS, Shen WK, Sorajja D. In- hospital and long-term outcomes in spontaneous coronary artery dissection with concurrent cardiac arrest: Systematic review and meta-analysis. Heart Rhythm O2. 2025 Apr 24;6(6):843-853. doi: 10.1016/j.hroo.2025.03.023. PMID: 40717849; PMCID: PMC12287955.
• Morosato M, Gaspardone C, Romagnolo D, Pagnesi M, Baldetti L, Dormio S, Federico F, Scandroglio AM, Chieffo A, Godino C, Margonato A, Adamo M, Metra M, Tchetche D, Dumonteil N, Tweet MS, Saw J, Beneduce A. Left Main Spontaneous Coronary Artery Dissection: Clinical Features, Management, and Outcomes. JACC Cardiovasc Interv. 2025 Apr 28;18(8):975-983. doi: 10.1016/j.jcin.2025.01.427. Epub 2025 Apr 9. PMID: 40208153; PMCID: PMC12290918.
• Tweet MS, Pellikka PA, Gulati R, Gochanour BR, Barrett-O'Keefe Z, Raphael CE, Best PJM, Hayes SN. Coronary Artery Tortuosity and Spontaneous Coronary Artery Dissection: Association With Echocardiography and Global Longitudinal Strain, Fibromuscular Dysplasia, and Outcomes. J Am Soc Echocardiogr. 2024 May;37(5):518-529. doi: 10.1016/j.echo.2024.02.013. Epub 2024 Mar 11. PMID: 38467311; PMCID: PMC11605948.
• Tweet MS, Hayes SN, Grimaldo ABG, Rose CH. Pregnancy After Spontaneous Coronary Artery Dissection: Counseling Patients Who Intend Future Pregnancy. JACC Adv. 2023 Dec;2(10):100714. doi: 10.1016/j.jacadv.2023.100714. Epub 2023 Nov 14. PMID: 38915307; PMCID: PMC11194843.
• Tarabochia AD, Tan NY, Lewis BR, Slusser JP, Hayes SN, Best PJM, Gulati R, Deshmukh AJ, Tweet MS. Association of Spontaneous Coronary Artery Dissection With Atrial Arrhythmias. Am J Cardiol. 2023 Jan 1;186:203-208. doi: 10.1016/j.amjcard.2022.09.032. Epub 2022 Oct 31. PMID: 36328832; PMCID: PMC10403149.
• Murugiah K, Chen L, Dreyer RP, Bouras G, Safdar B, Lu Y, Spatz ES, Gupta A, Khera R, Ng VG, Bueno H, Tweet MS, Spertus JA, Hayes SN, Lansky A, Krumholz HM. Depression and Perceived Stress After Spontaneous Coronary Artery Dissection and Comparison With Other Acute Myocardial Infarction (the VIRGO Experience). Am J Cardiol. 2022 Jun 15;173:33-38. doi: 10.1016/j.amjcard.2022.03.005. Epub 2022 Mar 29. PMID: 35365290; PMCID: PMC9133198.
• Johnson AK, Tweet MS, Rouleau SG, Sadosty AT, Hayes SN, Raukar NP. The presentation of spontaneous coronary artery dissection in the emergency department: Signs and symptoms in an unsuspecting population. Acad Emerg Med. 2022 Apr;29(4):423-428. doi: 10.1111/acem.14426. Epub 2021 Dec 26. PMID: 34897898; PMCID: PMC10403148.
• Murugiah K, Chen L, Dreyer RP, Bouras G, Safdar B, Khera R, Lu Y, Spatz ES, Ng VG, Gupta A, Bueno H, Tweet MS, Spertus JA, Hayes SN, Lansky A, Krumholz HM. Health status outcomes after spontaneous coronary artery dissection and comparison with other acute myocardial infarction: The VIRGO experience. PLoS One. 2022 Mar 23;17(3):e0265624. doi: 10.1371/journal.pone.0265624. PMID: 35320296; PMCID: PMC8942215.
• Adlam D, Tweet MS, Gulati R, Kotecha D, Rao P, Moss AJ, Hayes SN. Spontaneous Coronary Artery Dissection: Pitfalls of Angiographic Diagnosis and an Approach to Ambiguous Cases. JACC Cardiovasc Interv. 2021 Aug 23;14(16):1743-1756. doi: 10.1016/j.jcin.2021.06.027. PMID: 34412792; PMCID: PMC8383825.
• Kok SN, Tweet MS. Recurrent spontaneous coronary artery dissection. Expert Rev Cardiovasc Ther. 2021 Mar;19(3):201-210. doi: 10.1080/14779072.2021.1877538. Epub 2021 Feb 26. PMID: 33455483.
• Campbell KH, Tweet MS. Coronary Disease in Pregnancy: Myocardial Infarction and Spontaneous Coronary Artery Dissection. Clin Obstet Gynecol. 2020 Dec;63(4):852-867. doi: 10.1097/GRF.0000000000000558. PMID: 32701519; PMCID: PMC10767871.
• Tweet MS, Young KA, Best PJM, Hyun M, Gulati R, Rose CH, Hayes SN. Association of Pregnancy With Recurrence of Spontaneous Coronary Artery Dissection Among Women With Prior Coronary Artery Dissection. JAMA Netw Open. 2020 Sep 1;3(9):e2018170. doi: 10.1001/jamanetworkopen.2020. PMID: 32965500; PMCID: PMC7512056.
• Hayes SN, Tweet MS, Adlam D, Kim ESH, Gulati R, Price JE, Rose CH. Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Aug 25;76(8):961-984. doi: 10.1016/j.jacc.2020.05.084. PMID: 32819471.
• Johnson AK, Hayes SN, Sawchuk C, Johnson MP, Best PJ, Gulati R, Tweet MS. Analysis of Posttraumatic Stress Disorder, Depression, Anxiety, and Resiliency Within the Unique Population of Spontaneous Coronary Artery Dissection Survivors. J Am Heart Assoc. 2020 May 5;9(9):e014372. doi: 10.1161/JAHA.119.014372. Epub 2020 Apr 28. PMID: 32342736; PMCID: PMC7428589.
• Tweet MS, Akhtar NJ, Hayes SN, Best PJ, Gulati R, Araoz PA. Spontaneous coronary artery dissection: Acute findings on coronary computed tomography angiography. Eur Heart J Acute Cardiovasc Care. 2019 Aug;8(5):467-475. doi: 10.1177/2048872617753799. Epub 2018 Jan 29. PMID: 29376398; PMCID: PMC6027604.
• Tan NY, Tweet MS. Spontaneous coronary artery dissection: etiology and recurrence. Expert Rev Cardiovasc Ther. 2019 Jul;17(7):497-510. doi: 10.1080/14779072.2019.1635011. Epub 2019 Jul 5. PMID: 31232618.
• Waterbury TM, Tweet MS, Hayes SN, Eleid MF, Bell MR, Lerman A, Singh M, Best PJM, Lewis BR, Rihal CS, Gersh BJ, Gulati R. Early Natural History of Spontaneous Coronary Artery Dissection. Circ Cardiovasc Interv. 2018 Sep;11(9):e006772. doi: 10.1161/CIRCINTERVENTIONS.118. PMID: 30354594.
• Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, Ganesh SK, Gulati R, Lindsay ME, Mieres JH, Naderi S, Shah S, Thaler DE, Tweet MS, Wood MJ; American Heart Association Council on Peripheral Vascular Disease; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Genomic and Precision Medicine; and Stroke Council. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation. 2018 May 8;137(19):e523-e557. doi: 10.1161/CIR.0000000000000564. Epub 2018 Feb 22. PMID: 29472380; PMCID: PMC5957087.
• Tweet MS, Kok SN, Hayes SN. Spontaneous coronary artery dissection in women: What is known and what is yet to be understood. Clin Cardiol. 2018 Feb;41(2):203-210. doi: 10.1002/clc.22909. Epub 2018 Mar 1. PMID: 29493808; PMCID: PMC5953427.
• Tweet MS, Codsi E, Best PJM, Gulati R, Rose CH, Hayes SN. Menstrual Chest Pain in Women With History of Spontaneous Coronary Artery Dissection. J Am Coll Cardiol. 2017 Oct 31;70(18):2308-2309. doi: 10.1016/j.jacc.2017.08.071. PMID: 29073960; PMCID: PMC5957076.
• Lindor RA, Tweet MS, Goyal KA, Lohse CM, Gulati R, Hayes SN, Sadosty AT. Emergency Department Presentation of Patients with Spontaneous Coronary Artery Dissection. J Emerg Med. 2017 Mar;52(3):286-291. doi: 10.1016/j.jemermed.2016.09. Epub 2016 Oct 8. PMID: 27727035.
• Tweet MS, Gulati R, Williamson EE, Vrtiska TJ, Hayes SN. Multimodality Imaging for Spontaneous Coronary Artery Dissection in Women. JACC Cardiovasc Imaging. 2016 Apr;9(4):436-50. doi: 10.1016/j.jcmg.2016.01.009. PMID: 27056163.
• Tweet MS, Gulati R, Hayes SN. What Clinicians Should Know Αbout Spontaneous Coronary Artery Dissection. Mayo Clin Proc. 2015 Aug;90(8):1125-30. doi: 10.1016/j.mayocp.2015.05.010. PMID: 26250728.
• Prasad M, Tweet MS, Hayes SN, Leng S, Liang JJ, Eleid MF, Gulati R, Vrtiska TJ. Prevalence of extracoronary vascular abnormalities and fibromuscular dysplasia in patients with spontaneous coronary artery dissection. Am J Cardiol. 2015 Jun 15;115(12):1672-7. doi: 10.1016/j.amjcard.2015.03.011. Epub 2015 Mar 23. PMID: 25929580.
• Goel K, Tweet M, Olson TM, Maleszewski JJ, Gulati R, Hayes SN. Familial spontaneous coronary artery dissection: evidence for genetic susceptibility. JAMA Intern Med. 2015 May;175(5):821-6. doi: 10.1001/jamainternmed.2014. PMID: 25798899.
• Liang JJ, Prasad M, Tweet MS, Hayes SN, Gulati R, Breen JF, Leng S, Vrtiska TJ. A novel application of CT angiography to detect extracoronary vascular abnormalities in patients with spontaneous coronary artery dissection. J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):189-97. doi: 10.1016/j.jcct.2014.02.001. Epub 2014 Apr 4. PMID: 24939067.
• Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, Gersh BJ, Khambatta S, Best PJ, Rihal CS, Gulati R. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012 Jul 31;126(5):579-88. doi: 10.1161/CIRCULATIONAHA.112. Epub 2012 Jul 16. PMID: 22800851.
• Tweet MS, Gulati R, Aase LA, Hayes SN. Spontaneous coronary artery dissection: a disease-specific, social networking community-initiated study. Mayo Clin Proc. 2011 Sep;86(9):845-50. doi: 10.4065/mcp.2011.0312. PMID: 21878595; PMCID: PMC3257995.

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

TEASER

Specifically, childhood obesity is skyrocketing--1 in 5 children are now above the 95th percentile BMI for age and sex. A recent NEJM article showed Liraglutide (a medication that costs approximately $12,000 per year) was effective in children as young as 6 years old. This is just one example of many where cheap foods, expensive drugs, and band-aid solutions are generating record profits for the most powerful voices at the table. But are we truly acting in the best interests of our patients? What are the unintended consequences of these misaligned incentives? What is our responsibility in all this and where do we start if we want to be part of the solution?

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Swart P, Nijbroek SGLH, Paulus F, Neto AS, Schultz MJ. Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19-Insights From the PRoVENT-COVID Study. Front Med (Lausanne). 2022 Jan 3;8:780005. doi: 10.3389/fmed.2021.780005. PMID: 35300177; PMCID: PMC8923734.
• McNicholas BA, Madotto F, Pham T, Rezoagli E, Masterson CH, Horie S, Bellani G, Brochard L, Laffey JG; LUNG SAFE Investigators and the ESICM Trials Group. Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study. Eur Respir J. 2019 Oct 17;54(4):1900609. doi: 10.1183/13993003.00609-2019. PMID: 31346004.
• Swart P, Deliberato RO, Johnson AEW, Pollard TJ, Bulgarelli L, Pelosi P, de Abreu MG, Schultz MJ, Neto AS. Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts. PLoS One. 2021 Jul 14;16(7):e0253933. doi: 10.1371/journal.pone.0253933. PMID: 34260619; PMCID: PMC8279424.
• Evans, Laura1; Rhodes, Andrew2; Alhazzani, Waleed3; Antonelli, Massimo4; Coopersmith, Craig M.5; French, Craig6; Machado, Flávia R.7; Mcintyre, Lauralyn8; Ostermann, Marlies9; Prescott, Hallie C.10; Schorr, Christa11; Simpson, Steven12; Wiersinga, W. Joost13; Alshamsi, Fayez14; Angus, Derek C.15; Arabi, Yaseen16; Azevedo, Luciano17; Beale, Richard18; Beilman, Gregory19; Belley-Cote, Emilie20; Burry, Lisa21; Cecconi, Maurizio22; Centofanti, John23; Coz Yataco, Angel24; De Waele, Jan25; Dellinger, R. Phillip26; Doi, Kent27; Du, Bin28; Estenssoro, Elisa29; Ferrer, Ricard30; Gomersall, Charles31; Hodgson, Carol32; Hylander Møller, Morten33; Iwashyna, Theodore34; Jacob, Shevin35; Kleinpell, Ruth36; Klompas, Michael37; Koh, Younsuck38; Kumar, Anand39; Kwizera, Arthur40; Lobo, Suzana41; Masur, Henry42; McGloughlin, Steven43; Mehta, Sangeeta44; Mehta, Yatin45; Mer, Mervyn46; Nunnally, Mark47; Oczkowski, Simon48; Osborn, Tiffany49; Papathanassoglou, Elizabeth50; Perner, Anders51; Puskarich, Michael52; Roberts, Jason53; Schweickert, William54; Seckel, Maureen55; Sevransky, Jonathan56; Sprung, Charles L.57; Welte, Tobias58; Zimmerman, Janice59; Levy, Mitchell60. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine 49(11):p e1063-e1143, November 2021. | DOI: 10.1097/CCM.0000000000005337 
• Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, Adhikari NKJ, Amato MBP, Branson R, Brower RG, Ferguson ND, Gajic O, Gattinoni L, Hess D, Mancebo J, Meade MO, McAuley DF, Pesenti A, Ranieri VM, Rubenfeld GD, Rubin E, Seckel M, Slutsky AS, Talmor D, Thompson BT, Wunsch H, Uleryk E, Brozek J, Brochard LJ; American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017 May 1;195(9):1253-1263. doi: 10.1164/rccm.201703-0548ST. Erratum in: Am J Respir Crit Care Med. 2017 Jun 1;195(11):1540. doi: 10.1164/rccm.19511erratum. PMID: 28459336.
• Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B, Aboodi M, Wunsch H, Cecconi M, Koh Y, Chertow DS, Maitland K, Alshamsi F, Belley-Cote E, Greco M, Laundy M, Morgan JS, Kesecioglu J, McGeer A, Mermel L, Mammen MJ, Alexander PE, Arrington A, Centofanti JE, Citerio G, Baw B, Memish ZA, Hammond N, Hayden FG, Evans L, Rhodes A. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020 Jun;48(6):e440-e469. doi: 10.1097/CCM.0000000000004363. PMID: 32224769; PMCID: PMC7176264.
• Wang W, Scharfstein D, Wang C, Daniels C, Needham D, Brower R, NHLBI ARDS Clinical Network. Estimating the Causal Effect of Low Tidal Volume Ventilation on Survival in Patients with Acute Lung Injury. J R Stat Soc Ser C Appl Stat. 2011. PMC: PMC3197806
• Brower RG, Thompson BT, NIH/NHLBI/ARDSNetwork. Tidal volumes in acute respiratory distress syndrome--one size does not fit all. Crit Care Med. 2006.
• Hager DN, Krishman JA, Hayden D, Brower RG, ARDSNet NIH / NHLBI. Tidal Volume Reduction in Patients with acute Lung Injury When Plateau Pressures Are Not High. Am J Resp Crit Care Med. 2005.
• Rubenfeld GD, Cooper C, Carter G, Thompson BT, Hudson LD. Barriers to providing lung protective ventilation to patients with acute lung injury. Crit Care Med. 2004.
• Chatburn RL, El-Khatib M, Mireles-Cabodevila E. A taxonomy for mechanical ventilation: 10 fundamental maxims. Respir Care. 2014 Nov;59(11):1747-63. doi: 10.4187/respcare.03057. Epub 2014 Aug 12. PMID: 25118309.
• Guo L, Wang W, Zhao N, Guo L, Chi C, Hou W, Wu A, Tong H, Wang Y, Wang C, Li E. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis. Crit Care. 2016 Jul 22;20(1):226. doi: 10.1186/s13054-016-1396-0. PMID: 27448995; PMCID: PMC4957383.
• Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB, NIH NHLBI ARDS Network. Comparison of the Sp02/FI02 Ratio and the PaO 2/FI02 in Patients with Acute Lung Injury or ARDS. Chest. 2007.
• Zhang G, Burla MJ, Caesar BB, Falank CR, Kyros P, Zucco VC, Strumilowska A, Cullinane DC, Sheppard FR. Emergency Department SpO2/FiO2 Ratios Correlate with Mechanical Ventilation and Intensive Care Unit Requirements in COVID-19 Patients. West J Emerg Med. 2024 May;25(3):325-331. doi: 10.5811/westjem.17975. PMID: 38801037; PMCID: PMC11112664.

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Teaser: Can we fulfill our oath to “do no harm” if we ignore the harm of racial injustice in medicine? Understanding the historical roots and persistent impact of medical racism isn’t just informative; it is a call to action. This presentation is an opportunity to learn, reflect, and act to become better advocates.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda; @TayMChristian

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @drtaylormonet

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Meisel ZF, Shofer FS, Dolan AR, Goldberg E, Cannuscio CC, Rhodes KV, Perrone J, Hess EP, Rogers M, Bellamkonda V, Bell J, Zyla M, Becker L, McCollum S, Schapira M. Comparing Three Ways to Help Patients with Acute Pain Learn about Opioid Risks — The Life STORRIED Study [Internet]. Washington (DC): Patient-Centered Outcomes Research Institute (PCORI); 2021 Oct. PMID: 39383261.
• Engel-Rebitzer E, Dolan AR, Aronowitz SV, Shofer FS, Nguemeni Tiako MJ, Schapira MM, Perrone J, Hess EP, Rhodes KV, Bellamkonda VR, Cannuscio CC, Goldberg E, Bell J, Rodgers MA, Zyla M, Becker LB, McCollum S, Meisel ZF. Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021 Jul 1;4(7):e2118801. doi: 10.1001/jamanetworkopen.2021.18801. PMID: 34323984; PMCID: PMC8322998.
• Racic M, Roche-Miranda MI, Fatahi G. Twelve tips for implementing and teaching anti-racism curriculum in medical education. Med Teach. 2023 Aug;45(8):816-821. doi: 10.1080/0142159X.2023.2206534. Epub 2023 May 3. PMID: 37134226.
• Sahai A, Corley AMS, Lipps L, Lawton R, DeBlasio D, Klein M. A Locally-Focused Structural Racism Curriculum for Pediatric Primary Care Residents. Acad Pediatr. 2023 Nov-Dec;23(8):1510-1512. doi: 10.1016/j.acap.2023.06.012. Epub 2023 Jun 9. PMID: 37302703.
• Carrera D, Tejeda C, Kakani P, Napolitano J. Addressing Racism in Medical Education: A Longitudinal Antiracism Discussion Curriculum for Medical Students. Med Sci Educ. 2023 Apr 28;33(3):639-643. doi: 10.1007/s40670-023-01788-x. PMID: 37501797; PMCID: PMC10368613.
• Seegmiller Renner AM, Gross JR, Laughlin-Tommaso SK. Paving a Path to Inclusion, Diversity, Anti-Racism, and Equity: A Curriculum Roadmap. Mayo Clin Proc. 2023 Dec;98(12):1755-1762. doi: 10.1016/j.mayocp.2023.08.026. PMID: 38043992.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80. doi: 10.1093/cid/cix669. PMID: 29053792; PMCID: PMC5850553.
• Gore JI, Surawicz C. Severe acute diarrhea. Gastroenterol Clin North Am. 2003 Dec;32(4):1249-67. doi: 10.1016/s0889-8553(03)00100-6. PMID: 14696306; PMCID: PMC7127018.
• Freedman SB, van de Kar NCAJ, Tarr PI. Shiga Toxin–Producing Escherichia coli and the Hemolytic–Uremic Syndrome. The New England Journal of Medicine. 2023;389(15):1402-1414. doi:10.1056/NEJMra2108739.
• Logan C, Beadsworth MB, Beeching NJ. HIV and diarrhoea: what is new? Curr Opin Infect Dis. 2016 Oct;29(5):486-94. doi: 10.1097/QCO.0000000000000305. PMID: 27472290.
• Chassany O, Michaux A, Bergmann JF. Drug-induced diarrhoea. Drug Saf. 2000 Jan;22(1):53-72. doi: 10.2165/00002018-200022010-00005. PMID: 10647976.
• Schiller LR. Secretory diarrhea. Curr Gastroenterol Rep. 1999 Oct;1(5):389-97. doi: 10.1007/s11894-999-0020-8. PMID: 10980977.
• Gong Z, Wang Y. Immune Checkpoint Inhibitor-Mediated Diarrhea and Colitis: A Clinical Review. JCO Oncol Pract. 2020 Aug;16(8):453-461. doi: 10.1200/OP.20.00002. Epub 2020 Jun 25. PMID: 32584703.
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• Expert Panel on Gastrointestinal Imaging; Chang KJ, Marin D, Kim DH, Fowler KJ, Camacho MA, Cash BD, Garcia EM, Hatten BW, Kambadakone AR, Levy AD, Liu PS, Moreno C, Peterson CM, Pietryga JA, Siegel A, Weinstein S, Carucci LR. ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction. J Am Coll Radiol. 2020 May;17(5S):S305-S314. doi: 10.1016/j.jacr.2020.01.025. PMID: 32370974.
• Rami Reddy SR, Cappell MS. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017 Jun;19(6):28. doi: 10.1007/s11894-017-0566-9. PMID: 28439845.
• Modahl L, Digumarthy SR, Rhea JT, Conn AK, Saini S, Lee SI. Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization. J Am Coll Radiol. 2006 Nov;3(11):860-6. doi: 10.1016/j.jacr.2006.05.011. PMID: 17412185.
• Scheirey CD, Fowler KJ, Therrien JA, et al. ACR Appropriateness Criteria Acute Nonlocalized Abdominal Pain. Journal of the American College of Radiology : JACR. 2018;15(11S):S217-S231. doi:10.1016/j.jacr.2018.09.010.
• Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol. 2009 Oct;104(10):2596-604; quiz 2605. doi: 10.1038/ajg.2009.329. Epub 2009 Jun 23. PMID: 19550407.
• Musekiwa A, Volmink J. Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions. Cochrane Database Syst Rev. 2011 Dec 7;2011(12):CD003754. doi: 10.1002/14651858.CD003754.pub3. PMID: 22161381; PMCID: PMC6532622.
• Centers for Disease Control and Prevention (CDC). Scombroid fish poisoning associated with tuna steaks--Louisiana and Tennessee, 2006. MMWR Morb Mortal Wkly Rep. 2007 Aug 17;56(32):817-9. PMID: 17703171.
• Résière D, Florentin J, Mehdaoui H, Mahi Z, Gueye P, Hommel D, Pujo J, NKontcho F, Portecop P, Nevière R, Kallel H, Mégarbane B. Clinical Characteristics of Ciguatera Poisoning in Martinique, French West Indies-A Case Series. Toxins (Basel). 2022 Aug 3;14(8):535. doi: 10.3390/toxins14080535. PMID: 36006197; PMCID: PMC9415704.
• Centers for Disease Control and Prevention (CDC). Ciguatera fish poisoning--Texas, 1998, and South Carolina, 2004. MMWR Morb Mortal Wkly Rep. 2006 Sep 1;55(34):935-7. PMID: 16943762.
• Thyroid Inferno EM Blog: https://emblog.mayo.edu/2014/11/01/thyroid-inferno/ 
• Lazzerini M, Wanzira H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2016 Dec 20;12(12):CD005436. doi: 10.1002/14651858.CD005436.pub5. PMID: 27996088; PMCID: PMC5450879.
• Dhingra U, Kisenge R, Sudfeld CR, Dhingra P, Somji S, Dutta A, Bakari M, Deb S, Devi P, Liu E, Chauhan A, Kumar J, Semwal OP, Aboud S, Bahl R, Ashorn P, Simon J, Duggan CP, Sazawal S, Manji K. Lower-Dose Zinc for Childhood Diarrhea - A Randomized, Multicenter Trial. N Engl J Med. 2020 Sep 24;383(13):1231-1241. doi: 10.1056/NEJMoa1915905. PMID: 32966722; PMCID: PMC7466932.
• Dalfa RA, El Aish KIA, El Raai M, El Gazaly N, Shatat A. Oral zinc supplementation for children with acute diarrhoea: a quasi-experimental study. Lancet. 2018 Feb 21;391 Suppl 2:S36. doi: 10.1016/S0140-6736(18)30402-1. Epub 2018 Feb 21. PMID: 29553435.

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Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

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CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

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REFERENCES & LINKS

• Kim Y, Bae SC, Song YS. Exploring the potential of telehealth in-flight medical emergencies. Digit Health. 2025 Mar 13;11:20552076251326666. doi: 10.1177/20552076251326666. PMID: 40093698; PMCID: PMC11907535.
• Hawati SM, Binobaid F, Alsaeigh A, Alameer W, Al Ajmi AM, Alghamdi MK, Alqarni AA, Al-Harthi SN, Almelaifi A, Al Shehri AA. Assessing Emergency Medicine, Family Medicine, and ICU Doctors' Knowledge, Confidence, and Attitude in Managing In-Flight Medical Emergencies in the Kingdom of Saudi Arabia Hospitals: A Cross-Sectional Study. Cureus. 2025 Feb 1;17(2):e78359. doi: 10.7759/cureus.78359. PMID: 40046350; PMCID: PMC11880637.
• Hu JS, Smith JK. In-flight Medical Emergencies. Am Fam Physician. 2021 May 1;103(9):547-552. PMID: 33929167.
• Martin-Gill C, Doyle TJ, Yealy DM. In-Flight Medical Emergencies: A Review. JAMA. 2018 Dec 25;320(24):2580-2590. doi: 10.1001/jama.2018.19842. PMID: 30575886.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

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CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

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Email - AlwaysOnEM@gmail.com

RELATED READING

• Clark A, Amanti C, Sheng AY. Supervision of Advanced Practice Providers. Emerg Med Clin North Am. 2020 May;38(2):353-361. doi: 10.1016/j.emc.2020.02.007. PMID: 32336330.
• Rainer R, Bambach K. Navigating Supervision of Advanced Practice Providers. Emerg Med Clin North Am. 2025 Feb;43(1):131-138. doi: 10.1016/j.emc.2024.05.030. Epub 2024 Aug 1. PMID: 39515936.
• Lowery B, Scott E, Swanson M. Nurse practitioner perceptions of the impact of physician oversight on quality and safety of nurse practitioner practice. J Am Assoc Nurse Pract. 2016 Aug;28(8):436-45. doi: 10.1002/2327-6924.12336. Epub 2015 Dec 29. PMID: 26712306.
• Haslam-Larmer L, Krassikova A, Wojtowicz E, Vellani S, Feldman S, Katz P, Robert B, Heer C, Martin-Misener R, May K, McGilton KS. Nurse Practitioner and Physician Collaboration in the Long-Term Care Setting: Secondary Analysis of a Scoping Review. J Am Med Dir Assoc. 2025 Feb;26(2):105418. doi: 10.1016/j.jamda.2024.105418. Epub 2024 Dec 27. PMID: 39701552.
• McGilton KS, Haslam-Larmer L, Wills A, Krassikova A, Babineau J, Robert B, Heer C, McAiney C, Dobell G, Bethell J, Kay K, Keatings M, Kaasalainen S, Feldman S, Sidani S, Martin-Misener R. Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatr. 2023 Feb 16;23(1):98. doi: 10.1186/s12877-023-03798-1. PMID: 36797669; PMCID: PMC9934505.
• Guidelines Regarding the Role of Physician Assistants and Nurse Practitioners in the Emergency Department. American College of Emergency Physicians Policy Statement Approved June 2023. 

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REFERENCES & LINKS & ADDITIONAL READING 

• Childs DD, Lalwani N, Craven T, Arif H, Morgan M, Anderson M, Fulcher A. A meta-analysis of the performance of ultrasound, hepatobiliary scintigraphy, CT and MRI in the diagnosis of acute cholecystitis. Abdom Radiol (NY). 2024 Feb;49(2):384-398. doi: 10.1007/s00261-023-04059-w. Epub 2023 Nov 20. PMID: 37982832.
• de Oliveira GS, Torri GB, Gandolfi FE, Dias AB, Tse JR, Francisco MZ, Hochhegger B, Altmayer S. Computed tomography versus ultrasound for the diagnosis of acute cholecystitis: a systematic review and meta-analysis. Eur Radiol. 2024 Nov;34(11):6967-6979. doi: 10.1007/s00330-024-10783-8. Epub 2024 May 17. PMID: 38758253.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

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Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @KatrinaJoyAugustin

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Lichtenstein DA, Meziere GA. Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure. Chest 2008; 134:117-125
• Walsh MH, Smyth LM, Desy JR, Fischer EA, Goffi A, Li N, Lee M, St-Pierre J, Ma IWY. Lung Ultrasound: A Comparison of image interpretation accuracy between curvillinear and phased array transducers. Australia J Ultrasound Med, 26:150-156
• Alzahrani H, Woo MY, Johnson C, Pageau P, Millington S, Thiruganasambandamoorthy V. Can severe aortic stenosis be identified by emergency physicians when interpreting a simplified two-view echocardiogram obtained by trained echocardiographers? Crit Ultrasound J. 2015 Apr 18;7:5. doi: 10.1186/s13089-015-0022-8. PMID: 25932319; PMCID: PMC4409610.
• Furukawa A, Abe Y, Morizane A, Miyaji T, Hosogi S, Ito H. Simple echocardiographic scoring in screening aortic stenosis with focused cardiac ultrasonography in the emergency department. J Cardiol. 2021 Jun;77(6):613-619. doi: 10.1016/j.jjcc.2020.12.006. Epub 2020 Dec 29. PMID: 33386216.
• Lin J, Drapkin J, Likourezos A, Giakoumatos E, Schachter M, Sarkis JP, Moskovits M, Haines L, Dickman E. Emergency physician bedside echocardiographic identification of left ventricular diastolic dysfunction. American Journal of Emergency medicine 
• Ehrman RR, Russell FM, Ansari AH, Margeta B, Clary JM, Christian E, Cosby KS, Bailitz J. Can emergency physicians diagnose and correctly classify diastolic dysfunction using bedside echocardiography? Am J Emerg Med. 2015 Sep;33(9):1178-83. doi: 10.1016/j.ajem.2015.05.013. Epub 2015 May 21. PMID: 26058890.2021;44:20-25
• Del Rios M, Colla J, Kotini-Shah P, Briller J, Gerber B, Prendergast H. Emergency physician use of tissue Doppler bedside echocardiography in detecting diastolic dysfunction: an exploratory study. Crit Ultrasound J. 2018 Jan 25;10(1):4. doi: 10.1186/s13089-018-0084-5. PMID: 29372430; PMCID: PMC5785451.
• Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Böhm M, Ebelt H, Schneider S, Werdan K, Schuler G; Intraaortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) trial investigators. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013 Nov 16;382(9905):1638-45. doi: 10.1016/S0140-6736(13)61783-3. Epub 2013 Sep 3. PMID: 24011548.
• Aksoy O, Yousefzai R, Singh D, Agarwal S, O'Brien B, Griffin BP, Kapadia SR, Tuzcu ME, Penn MS, Nissen SE, Menon V. Cardiogenic shock in the setting of severe aortic stenosis: role of intra-aortic balloon pump support. Heart. 2011 May;97(10):838-43. doi: 10.1136/hrt.2010.206367. Epub 2010 Oct 20. PMID: 20962337.
• Karatolios K, Chatzis G, Luesebrink U, Markus B, Ahrens H, Tousoulis D, Schieffer B. Impella support following emergency percutaneous balloon aortic valvuloplasty in patients with severe aortic valve stenosis and cardiogenic shock. Hellenic J Cardiol. 2019 May-Jun;60(3):178-181. doi: 10.1016/j.hjc.2018.02.008. Epub 2018 Mar 21. PMID: 29571667.
• Gottlieb M, Long B, Koyfman A. Evaluation and Management of Aortic Stenosis for the Emergency Clinician: An Evidence-Based Review of the Literature. J Emerg Med. 2018 Jul;55(1):34-41. doi: 10.1016/j.jemermed.2018.01.026. Epub 2018 Mar 7. PMID: 29525246.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

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Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• 2013 British Journal of Surgery - C-W Yu, Systematic reivew and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein, and white blood cell count for suspected acute appendicitis

In this second part, we talk through mimics of abuse, second victim syndrome related to caring for children of abuse, some aspects of neglect, and more. 

CONTACTS

x- @AlwaysonEM; @VenkBellamkonda

YouTube - @AlwaysonEM; @VenkBellamkonda

Instagram - @AlwaysonEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysonEM@gmail.com

REFERENCES

1. Sugar NF, Taylor JA, Feldman KW. Bruises in infants and toddlers: those who don't cruise rarely bruise. Puget Sound Pediatric Research Network. Arch Pediatr Adolesc Med. 1999 Apr; 153(4):399-403

In this first part, we talk through the approach to sharing the concern that you have with the family, keys to the physical examination, the role of additional testing such as serum, urine, and radiograph. 

CONTACTS

x- @AlwaysonEM; @VenkBellamkonda

YouTube - @AlwaysonEM; @VenkBellamkonda

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Email - AlwaysonEM@gmail.com

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Tosh PK, Schafer JM, Harvieux TP, Hall BL. Medical Supply Shortages - We are part of the problem...and solution. Mayo Clin Proc. 2023 Dec; 98(12):1763-1766Associated Press. (2024, October 1). US port strike: Over 45,000 dockworkers from Maine to Texas hit picket lines. AP News. Retrieved from https://apnews.com/article/port-strike-ila-dockworkers-begins-e5468e760f46a64e4322d1702beb1f72[1](https://apnews.com/article/port-strike-ila-dockworkers-begins-e5468e760f46a64e4322d1702beb1f72).
• Harris, R. (2018, March 31). Why did sterile salt water become the IV fluid of choice? NPR. Retrieved from https://www.npr.org/sections/health-shots/2018/03/31/597666140/why-did-sterile-salt-water-become-the-iv-fluid-of-choice[1](https://www.mybib.com/tools/apa-citation-generator).

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda;

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

LinkedIn - Sarayna McGuire

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Pompeii LA, Schoenfisch AL, Lipscomb HJ, Dement JM, Smith CD, Upadhyaya M. Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six U.S. hospitals. Am J Ind Med. 2015 Nov;58(11):1194-204
• McGuire SS, Finley JL, Gazley BF, Mullan AF, Clements CM. The team is not okay: Violence in emergency departments across disciplines in a health system. West J Emerg Med. 2023 Feb 1;24(2):169-177
• Speroni KG, Fitch T, Dawson E, Dugan L, Atherton M. Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. J Emerg Nurs. 2014 May;40(3):218-28
• McGuire SS, Mullan AF, Clements CM. Unheard victims: multidisciplinary incidence and reporting of violence in an emergency department. West J Emerg Med. 2021 May 7;22(3):702-709

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda; @SamitShahMD

YouTube - @AlwaysOnEM; @VenkBellamkonda

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Email - AlwaysOnEM@gmail.com

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

LEARN MORE ABOUT RESIDENCY:

• https://youtu.be/gCQ0zimhhhY?si=NpsyTruGM9N_UpVM
• https://college.mayo.edu/academics/residencies-and-fellowships/emergency-medicine-residency-minnesota/

REFERENCES:

• Williams T, Mortada R, Porter S. Diagnosis and Treatment of Polycystic Ovary Syndrome. Am Fam Physician. 2016;94(2):106-113
• Rutz M, Boulger C. Early Pregnancy. Sonoguide - American College of Emergency Physicians. Accessed 8/20/2024 (https://www.acep.org/sonoguide/basic/early-pregnancy) 
• Rodgers SK, et al. A lexicon for first-trimester US: Society of radiologists in ultrasound consensus conference recommendations. Radiology. 2024; 312(2):e240122
• Kreisel K, Flagg EW, Torrone E. Trends in pelic inflammatory disease emergnecy department visits, United STates, 2006-2013. Am J Obstet Gynecol 2018;218:117e1-e10
• Adhikari S, Blaivas M, Lyon M. Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. JEM 2008. 34(4):429-433
• Mohseni M, Simon LV, Sheele JM. Epidemiologic and clinical characteristics of tubo-ovarian abscess, hydrosalpinx, pyosalpinx, and oophoritis in emergency department patients. Cureus. 2020;12(11):e11647
• CDC sexually transmitted infections treatment guidelines, 2021 - Pelvic Inflammatory Disease (PID) accessed 8-20-24
• Linden JA. et al. Is the pelvic examination still crucial in patients presenting to the emergency department with vaginal bleeding or abdominal pain when an intrauterine pregnancy is identified on ultrasonography? A randomized tli. Annals of Emerg Med 2017(70):825-834
• Stein JC, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: A Meta-Analysis. Annals of Emerg Med. 2010;56:674-683
• Robertson JJ, Long B, Koyfman A. Emergency Medicine Myths: Ectopic pregnancy, evaluation, risk factors, and presentation. JEM. 2017(53)6819-828
• Brown J, Fleming R, Aristizabal J, Rocksolana G. Does pelvic exam in the emergency department add useful information? West J Emerg Med. 2011;12(2):208-212
• Lee R, Dupuis C, Chen B, Smith A, Kim YH. Diagnosing ectopic pregnancy in the emergency setting. Ultrasonography. 2018;37:78-87
•  

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda; @KenMilne4234

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

TikTok - @Dr_Venk

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Skeptics guide to emergency medicine: https://thesgem.com/ 
• Ken Milne’s Youtube video of his presentation: https://youtu.be/f18FmFci-BI?si=jqJ-53HMLTI-uwLy
• Herbert L Fred M.D. (1998) Old-Fashioned Doctors, Hospital Practice, 33:12, 15-15, DOI: 10.1080/21548331.1998.11443787

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

RESOURCES FOR PRACTICE:

• MDCALC for anesthetic dose calculation: https://www.mdcalc.com/calc/10205/local-anesthetic-dosing-calculator 
• Safe Local app for anesthetic dose calculation: https://apps.apple.com/us/app/safelocal/id1440999841 
• New York School of Regional Anesthesia: https://www.nysora.com/filter-topics/ 
• Highland County Emergency Medicine Website: https://highlandultrasound.com/ 
• ASRA - American Society of Regional Anesthesia - Checklist for treatment of LAST: https://www.asra.com/news-publications/asra-updates/blog-landing/guidelines/2020/11/01/checklist-for-treatment-of-local-anesthetic-systemic-toxicity 

REFERENCES:

1. American College of Emergency Physicians Policy Statements: Ultrasound-Guided Nerve Blocks, published April 2021. Document accessed June 20, 2024 via: https://www.acep.org/patient-care/policy-statements/ultrasound-guided-nerve-blocks
2. American College of Emergency Physicians Policy Statements: Guideline for ultrasound transducer cleaning and disinfection, approved April 2021. Document accessed June 20, 2024 via: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.acep.org/siteassets/new-pdfs/policy-statements/guideline-for-ultrasound-transducer-cleaning-and-disinfection.pdf 
3. Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement. J Ultrasound Med. 2020; online before print. https://doi.org/10.1002/jum.15653 
4. Ramesh S, Ayyan SM, Rath DP,Sadanandan DM. Efficacy and safety of ultrasound-guidederector spinae plane block compared to sham procedure inadult patients with rib fractures presenting to the emergencydepartment: A randomized controlled trial. Acad Emerg Med.2024;31:316-325. doi:10.1111/acem.14820
5. New York School of Regional Anesthesia: Ultrasound-guided fascia iliaca nerve block. Accessed June 21, 2024 via: https://www.nysora.com/techniques/lower-extremity/ultrasound-guided-fascia-iliaca-block/ 
6. Downs T, Jacquet J, Disch J, Kolodychuk N, Talmage L, Krizo J, Simon EL, Meehan A, Stenberg R. Large Scale implementation of fascia iliaca compartment blocks in an emergency department. West J Emerg Med. 2023 May 3;24(3):384-389
7. Makkar JK, Singh NP, Bhatia N, Samra T, Singh PM. Fascia iliaca block for hip fractures in the emergency department: meta-analysis with trial sequential analysis. Am J Emerg Med. 2021 Dec:50:654-660
8. Rukerd MRZ, Erfaniparsa L, Movahedi M, et al. Ultrasound-guided femoral nerve block versus fascia iliaca compartment block for femoral fractures in emergency department: a randomized controlled trial. Acute Med Surg. 2024 Mar 6;11(1):e936
9. Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013 Jun;20(6):584-91
10. Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, Benger J. Randomised trial of the fascia iliaca block versus the 3-in-1 block for femoral neck fractures in the emergency department. Emerg Med J. 2015;32:685-689
11. Schulte SS, Fernandez I, Van Tienderen R, Reich MS, Adler A, Nguyen MP. Impact of the fascia iliaca block on pain, opioid consumption, and ambulation for patients with hip fractures: a prospective, randomized study. J Orthop Trauma. 2020 Oct;34(10):533-538

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Heaton HA, Campbell RL, Thompson KM, Sadosty AT. In support of the medical apology: the nonlegal arguments. Journal of Emergency Medicine 2016. 51(5)605-609
• Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and Physicians’ attitudes regarding the disclosure of medical errors. JAMA 2003;289:1001-7
• Carlson JN, et al. Provider and Practice Factors associated with emergency physicians being named in a malpractice claim. Ann Emerg Med. 2018;71:157-164
• Sachs. Malpractice claims: It’s a crapshoot-Time to stop the self-blame and ask different questions. Ann Emerg Med. 2018;71(2):165-167
• Weinstock & Jolliff.  High-Risk Medicolegal Conditions in Pediatric Emergency Medicine. Emerg Med Clin N Am. 39(2021) 479-491
• Selbst, et al. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers.  Pediatr. Emerg Care. 2005 Mar;21(3):165-9
• Wong, et al. Emergency Department and Urgent Care Malpractice Claims 2001-2015. West JEM. 2021. 22(2): 333-8

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES

• Gopinath B, et al. Nebulized vs IV Tranexamic Acid for Hemoptysis - A pilot randomized controlled trial. Chest 2023;163(5):1176-1184
• Wand O, Guber E, Guber A, Epstein Schochet G, Israeli-Shani L, Shitrit D. Inhaled Tranexamic Acid for Hempotysis Treatment: A randomized controlled trial. Chest 2018;154(6):1379
• Ibrahim WH. Massive Hemoptysis:The definition should be revised. Eur Respir J. 2008 Oct;32(4):1131-2

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

interventions are key, what patients are most likely to suffer a bad outcome and more.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Ingason AB, et al. Warfarin is associated with higher rates of epistaxis compared to direct oral anticoagulants: a nationwide propensity score-weighted study. J Intern Med. 2022 Sep;292(3):501-511
• Thomg JF, et al. A prospective comparative study to examine the effects of oral diazepam on blood pressure and anxiety levels in patients with acute epistaxis. Journal of Laryng & Otol. 2007. (121)124-129
• Terakura M et al. Relationship between blood pressure and persistent epistaxis at the emergency department: a retrospective study. J Am Soc Hypertens. 2012 Jul(4):291-295
• Lee CJ, et al. Evaluation of the relationship between blood pressure control and epistaxis resource after achieving effective hemostasis in the emergency department. J Acute Med. 2020 mar 1;10(1)27-39

Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. We review the PROCESS, PROMISE, and ARISE trials and provide pragmatic approach to your septic patients. 

So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes.

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

Intravascular volume assessment

• Azadian M, Win S, Abdipour A, et al. Mortality benefit from the passive leg raise maneuver in guiding resuscitation of septic shock patients: A systematic review and meta-analysis of randomized trials. J Intensive Care Med. 2022 May;37(5):611-617
• Spiliotaki E, Saranteas T, Moschovaki N, et al. Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: a critical analysis review. J Clin Ultrasound. 2022 Jun;50(5):733-744

Chest radiography paper referenced

• Poku JK, Bellamkonda-Athmaram VR, Bellolio F, Nestler DM, Stiell IG, Hess EP. Failure of prospective validation and derivation of a refined clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome. Acad Emerg Med. 2012 Sep;19(9):E1004-10

Albumin

• Caironi P, Tognoni G, Masson S, Fumagalli R, Presenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L, ALBIOS Study Investigators. Albumin Replacement in patients with severe sepsis or septic shock. NEJM. 2014;370(15):1412
• Xu JY, Chen QH, Xie JF, Pan C, Liu SQ, Huang LW, Yang CS, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB. Comparison of the effects of albumin and cyrstalloid on mortality in adult patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials. Crit Care. 2014;18(6):702
• Jiang L, Jiang S, Zhang M, Zheng Z, Ma Y. Albumin versus other fluids for fluid resuscitation in patients with sepsis: A meta-analysis. PloS One. 2014;9(12):e114666

Unbundling studies

• ProCESS Trial: ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, PIke F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC. A randomized trial of protocol based care for early septic shock. NEJM  2014;370(18):1683
• ProMISE Trial: Mouncey PR, Osborn ™, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM, ProMISe Trial Investigators. Trial of early, goal directed resuscitation for septic shock. NEJM 2015;372(14):1301
• ARISE Trial: ARISE investigators, ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, WEbb SA, Williams P. Goal-directed resuscitation for patients with early septic shock. NEJM 2014;371(16):1496
• Angus DC, Barnato AE, Bell D, Bellomo R, Chong CR, Coats TJ, Davies A, Delaney A, Harrison DA, Holdgate A, Howe B, Huang DT, Iwashyna T, Kellum JA, Peake SL, Pike F, Reade MC, Rowan KM, Singer M, Webb SA, Weissfeld LA, Yealy DM, Young JD. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS, and ProMISE investigators. Intensive Care Med. 2015 SEp;41(9):1549-60
• PRISM Investigators. Early Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis. NEJM 2017
• Lu Y, Zhang H, Teng F, Xia WJ, SUn GX, Wen AQ. Early goal-directed therapy in severe sepsis and septic shock: A meta-analysis and Trial sequential analysis of randomized controlled trials. J Intensive Care Med. 2018;33(5):296

Vitamin C

• Sevransky JE, et al. Effect of vitamin C, thiamine, and hydrocortisone on ventilator- and vasopressor-free days in patients with sepsis: The VICTAS randomized clinical trial. JAMA. 2021 Feb 23;325(8):742-750

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

SOFA Score:

• Vincent JL, MOreno R, Takala J, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction / failure. On Behalf of the working group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10
• Vincent JL, de Mendonca A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction / failure in intensive care units: results of a multicenter, prospective study. Working group on ‘sepsis-related problems’ of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-1800
• Ferreira FL, Bota DP, Bross A, Merlot C, Vincent JL. Serial evaluation of the SOFA score to predict outcomes in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8
• Cardenas-Turanzas M, Ensor J, Wakefield C, Zhang K, Wallace SK, Price KJ, Nates JL. Cross-validation of a sequential organ failure assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care. 2012 Dec;27(6):673-80

qSOFA score

• Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762-774
• Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and SEptic Shock (Sepsis-3). JAMA. 2016;315(8):775-787
• Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 Criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA. 2017;317(3):301-308
• Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290-300

Comparing Prognostic scores

• Henning DJ, Puskarich MA, Self WH, Howell MD, Donnino MW, Yealy DM, Jones AE, Shapiro NI. An Emergency Department validation of the SEP-3 Sepsis and Septic Shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med. 2017 Oct;70(4):544-552

IDSA concern

• Rhee C, Chiotos K, Cosgrove SE, Heil EL, Kadri SS, Kalil AC, Gilbert DN, Masur H, Septimus EJ, Sweeney DA, Strich JR, Winslow DL, Klompas M. Infectious diseases society of america position paper: Recommended revisions to the National Severe Sepsis and Septic Shock early management bundle (SEP-1) Sepsis Quality Measure. Clin Infect Dis. 2021 Feb 16;72(4):541-552

About Barcelona Declaration

• Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care. 2003;7:1-2

1- hour surviving sepsis bundle guidance

• Freund Y, Khoury A, Mockel M, et al. European Society of Emergency Medicine position paper on the 1-hour sepsis bundle of the Surviving Sepsis Campaign: expression of concern. Eur J Emerg Med. 2019 Aug;26(4):232-233

Early Goal Directed Therapy

• Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM. 2001 Nov 8;345(19):1368-77

SEP - 1 Quality Measure

• National Quality Forum Measure submission and evaluation worksheet 5.0 for NQF #0500 Severe Sepsis and Septic Shock: Management Bundle, last updated Date: Oct 05, 2012. Website link Accessed 01-31-2024: https://www.qualityforum.org/Projects/i-m/Infectious_Disease_Endorsement_Maintenance_2012/0500.aspx 
• National Quality Forum: NQF Revises Sepsis Measure. Website link accessed 01-31-2024: https://www.qualityforum.org/NQF_Revises_Sepsis_Measure.aspx 
• Faust JS, Weingart SD. The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1 - the early management bundle for severe sepsis / septic shock. Emerg Med Clin N Am. 2017; 35:219-231

Affordable care act

• Patient Protection and Affordable Care Act, Public Law 148, U.S. Statutes at Large 124 (2010):119-1024. Website link accessed 01-31-2024: https://www.govinfo.gov/app/details/STATUTE-124/STATUTE-124-Pg119/summary. 

Fluids for sepsis in concerning populations

• Pence M, Tran QK, Shesser R, Payette C, Pourmand A. Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis. Am J Emerg Med. 2022 May:55:157-166
• Zadeh AV, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis. Am J Emerg Med. 2023 Nov:73:34-39

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Heckenberg SG, et al. Clinical features, outcome and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore) 2008. 87(4):185
• Brechot N, Hajage D, et al. Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study. Lancet 2020. 396(10250)545-552
• Ling RR, Ramanathan K, et al. Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: a systematic review and meta-analysis with individual participant data meta-regression analysis. Crit Care 2021. Jul 14;25(1):246

WANT TO WORK AT MAYO?

EM Physicians: https://jobs.mayoclinic.org/emergencymedicine

EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs  

Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine

EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice

All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Nickerson TP, Zielinski MD, Jenkins DH, Schiller HJ. The Mayo Clinic Experience with Morel-Lavallee lesions: Establishment of a practice management guideline. J Trauma Acute Care Surg. 2012. Vol 76, Number 2 493-497
• Demetriades D, Chan LS, Velmahos G, Berne TV, Cornwell III EE, Belzberg H, Asensio JA, Murray J, Berne J, Shoemaker W. TRISS methodology in trauma: the need for alternatives. British Journal of Surgery 1998, 85,379-384
• Meyer DM, Jessen ME, Grayburn PA. Use of echocardiography to detect occult cardiac injury after penetrating thoracic trauma: A prospective study. J Trauma. 1995 Nov;39(5):902-7

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES

ARHQ report and responses:

• December 2022, AHRQ (Agency for Healthcare Research and Quality) released a systematic review on diagnostic error in the ED. https://effectivehealthcare.ahrq.gov/sites/default/files/related_files/cer-258-diagnostic-errors.pdf
• Letter from many ED organizations: Multi-Organizational Letter Regarding AHRQ Report on Diagnostic Errors in the Emergency Department December 14, 2022
• Published critical appraisal of report: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121120/pdf/ms120_p0114.pdf
• JAMA commentary Feb 2023 “Misdiagnosis in the ED: Time for a System Solution” Misdiagnosis in the Emergency Department: Time for a System Solution | Health Care Safety | JAMA

Recovering from error:

• ARHQ summary on recovery after error Second Victims: Support for Clinicians Involved in Errors and Adverse Events | PSNet
• ARHQ Commentary – after error:How Do Providers Recover From Errors? | PSNet
• Clinician Peer Support Program after adverse events – implementation Supporting Clinicians after Adverse Events: Development of a Clinician Peer Support Program - PMC
• Scott SD, Hirschinger LE, Cox KR, McCoig M, Hahn-Cover K, Epperly KM, Phillips EC, Hall LW. Caring for our own: deploying a systemwide second victim rapid response team. Jt Comm J Qual Patient Saf. 2010 May;36(5):233-40. Caring for our own: deploying a systemwide second victim rapid response team

General resources on Diagnostic Error:

• Schiff JAMA Network Open 2021Characteristics of Disease-Specific and Generic Diagnostic Pitfalls: A Qualitative Study | Health Policy | JAMA Network Open
• Monteiro et al. 2020 Review “The enduring myth of generalisable skills.” https://asmepublications.onlinelibrary.wiley.com/doi/full/10.1111/medu.13872
• Book – Improving Diagnosis in Health Care (chapter 9) The Path to Improve Diagnosis and Reduce Diagnostic Error

Cognitive biases:

• MDs were asked to reflect on a serious error and given some education on cognitive biases: Watari, T.; Tokuda, Y.; Amano, Y.; Onigata, K.; Kanda, H. Cognitive Bias and Diagnostic Errors among Physicians in Japan: A Self Reflection Survey. Int. J. Environ. Res. Public Health 2022, 19, 4645. Cognitive Bias and Diagnostic Errors among Physicians in Japan: A Self-Reflection Survey
• Anchoring Bias and strategies for overcoming: Anchoring Bias With Critical Implications | PSNet
• "Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance: Albulescu P, Macsinga I, Rusu A, Sulea C, Bodnaru A, et al. (2022) "Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance. PLOS ONE 17(8): e0272460. "Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance | PLOS ONE

Better teams in EM:

• Purdy E, Borchert L, El-Bitar A et al “Psychological safety and Emergency Medicine team performance: a mixed methods review.” EM Australasia 2023;35:456-465 Psychological safety and emergency department team performance: A mixed‐methods study - Purdy
• Ottawa M+M rounds framework: Enhancing the Quality of Morbidity and Mortality Rounds: The Ottawa M&M Model - Calder - 2014 - Academic Emergency Medicine - Wiley Online Library

Selected references for artificial intelligence in medicine:

• AI chatbot in JAMA Internal Medicine Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum | Health Informatics | JAMA Internal Medicine
• AI in Health Care NEJM podcast Is Medicine Ready for AI? — ITT Episode 6 | NEJM
• AI clinical prediction (systematic review 2022) Artificial Intelligence for the Prediction of In-Hospital Clinical Deterioration: A Systematic Review - PMC
• Lee P, Bubeck S, Petro J. Benefits, limits and risks of GPT-4 as an AI chatbot for medicine. NEJM 2023;388:1233-1239 Benefits, Limits, and Risks of GPT-4 as an AI Chatbot for Medicine | NEJM

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods Jr CR. Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics. 2021 Aug;148(2):e2021052228
• Powell EC, Mahajan PV, Roosevelt G, Hoyle Jr JD, Gattu R, Cruz AT, Rogers AJ, Atabaki S, Jaffe DM, Casper TC, Ramilo O, Kuppermann N. Epidemiology of bacteremia in febrile infants aged 60 days and younger. Ann Emerg Med. 2018 Feb;71(2):211-216
• Mahajan P, Browne LR, Levine DA, Cohen DM, Gattu R, Linaki JG, Anders J, Borgialli D, Vitale M, Dayan PS, Casper TC, Ramilo O, Kuppermann N. Risk of bacterial coinfections in febrile infants 60 days and younger with documented viral infections. J Pediatr. 2018 Dec:203:86-91.e2

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

YouTube - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Gierula J, et al. Prospective evaluation and long-term follow up of patients referred to secondary care based upon natriuretic peptide levels in primary care. European Heart Journal – Quality of Care and Clinical Outcomes. 2019. 5, 218-224
• Bay M, et al. NT-proBNP: A new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function. Heart. 2003. 89,150-154
• Dockree S, et al. Pregnancy reference intervals for BNP and NT-pro BNP – changes in natriuretic peptides related to pregnancy. Journal of Endocrine society. 2021. 5(7)1-9
• Mueller C, et al. Heart failure association of the European society of cardiology practical guidance on the use of natriuretic peptide concentrations. European Journal of Heart Failure. 2019. 21, 715-731
• Ravichandran J, et al. High-sensitivity cardiac troponin I levels in normal and hypertensive pregnany. American J of Medicine. 2019. 132,362-366
• High sensitivity troponin T and I among pregnant women in the US – the National Health and Nutrition Examination Survey. JAMA Cardiology. 2023. 8(4)406-408
• Tweet MS, et al. Spontenaoues Cardic Artey Dissection associated with pregnancy. Journal of the American College of Cardiology. 2017. 70,426-435
• Baggish AL, et al. The differential diagnosis of an elevated amino-terminal Pro-B-Type Natriuretic Peptide level. Am J Cardiol. 2008. 101,43A-48A
• Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute Respiratory Failure – the Blue Protocol. Chest. 2008. 134,117-125
• Smit MR, et al. Comparison of linear and sector array probe for handheld lung ultrasound in invasively ventilated ICU patients. Ultrasound in Med & Biol. 2020. 46(12)3249-3256
• Haller EP, Nestler DM, Campbell RL, Bellamkond VA. Point-of-care ultrasound findings of acute pulmonary embolism: McConnell sign in the emergency medicine. JEM. 2014. 47(1)e19-e24
• Halpern DG, et al. Use of medication for cardiovascular disease during pregnancy:JACC State of the Art Review. J Am Coll Cardiol. 2019. Feb, 73(4)457-476
• Loyanga-Rendon RY, et al. Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. 2014. Circ Heart Failure. 7,300-309
• Adedinsewo DA, et al. Detecting cardiomyopathies in pregnancy and the postpartum period with an electrocardiogram-based deep learning model. European Heart Journal – Digital Health. 2021. 2,586-596
• Zieleskiewicz L., et al. Lung ultrasound-guided management of acute breathlessness during pregnancy. Anesthesia. 2013. 68,97-101
• Balaceanu A. B-type natriuretic peptides in pregnant women with normal heart or cardiac disorders. Medical Hypotheses. 2018. 121,149-151

CONTACTS

Youtube -https://www.youtube.com/@AlwaysonEM 

X - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

X - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

RECOMMENDATION:

• Dieulafoy lesion video from New England Journal of Medicine: https://youtu.be/tzJQDen1nug?si=zOmywZ1VN3VvA004 

REFERENCES:

• Drescher MJ, Stapleton S, Britstone Z, Fried J, Smally AJ. A call for reconsideration of the use of fecal occult blood testing in emergency medicine. Journal of Emerg Med. 2020. 58(1)54-58
• Mathews BK, Ratcliffe T, Sehgal R, Abraham JM, Monash B. Fecal Occult Blood testing in hospitalized patients with upper gastrointestinal bleeding. Journal of Hospital Medicine. 2017. 12(7)567-569
• Harewood GC, McConnell JP, Harrington JJ, Mahoney DW, Ahlquist DA. Detection of occult upper gastrointestinal bleeding: performance in fecal occult blood tests. Mayo Clin Proc. 2002 Jan;77(1):23-28
• Blatchford O, et al. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000. Oct 14;356(9238):1318-21
• Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of scotland: case ascertainment study. BMJ 1997. Aug 30;315(7107):510-4
• Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007 Sep;25(7):774-9
• Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917
• Roberts I, Shakur-STill H, Afolabi A, et al. Effects of High-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet 2020. 395(10241):1927-1936
• Aziz M, Haghbin H, Gangwani MK, Weissman S, Patel AR, Randhawa MK, Samikanu LB, Alyousif ZA, Lee-Smith W, Kamal F, Nawras A, Howden CW. Erythromycin improves the quality of esophagogastroduodenoscopy in upper gastrointestinal bleeding: a network meta-analysis. Dig Dis Sci 2023. Apr;68(4):1435-1446
• Abraham NS, Barkun AN, Sauer BG, et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. Am J Gastroenterol 2022;00:1-17
• Vigano GL, Mannucci PM, Lattuada A, Harris A, Remuzzi G. Subcutaneous desmopressin (DDAVP) shortens the bleeding time in uremia. Am J Hematol 1989. May;31(1):32-5
• Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FL, Soares-Weiser K, Uribe M. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev 2010. Sep 8;2010(9):CD002907
• Gao Y, Qian B, Zhang X, Liu H, Han T. Prophylactic antibiotics on patients with cirrhosis and upper gastrointestinal bleeding: A meta-analysis. PLoS One 2022. Dec 22;17(12):e0279496
• Steffen R, Knapp J, Hanggi M, Iten M. Use of the REBOA catheter for uncontrollable upper gastrointestinal bleeding with hemorrhagic shock. Anaesthesiologie 2023. May;72(5):332-337
• Sato M, Kuriyama A. Countering hemorrhagic shock due to duodenal variceal rupture with resuscitative endovascular balloon occlusion of the aorta. Am J Emerg Med 2023. Feb;64:204.e1-204.e3

CONTACTS

X (formerly Twitter) - @AlwaysOnEM; @VenkBellamkonda; @ShannonOMac

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

Society guidelines:

• United States
  • CDC
    • Tickborne diseases of the US
    • Anaplasmosis - information for healthcare providers
    • Babesiosis - resources for healthcare professionals
    • Ehrlichiosis
    • Lyme Disease
    • RMSF
    • A reference manual for healthcare providers 2017
  • American Academy of Pediatrics has several publications on babesiosis, borrelia infections other than Lyme, Ehrlichia, anaplasma, Lyme itself, RMSF
  • Infectious Disease society of America
    • Clinical practice guideline on diagnosis and management of babesiosis 2020
  • Canada
    • Canadian pediatric society 
      • Practice point on Lyme disease in Canada - focus on children 2021
    • Society of OB / Gyn of Canada
      • Committee opinion for management of tick bites and Lyme disease during pregnancy 2020
    • Australia - New Zealand
      • Australian government department of health released An Australian guideline on the diagnosis of overseas - acquired Lyme disease / borreliosis in 2015
    • Japan 
      • choosing wisely Japan - Lyme disease 2018
    • India
      • Department of health research - Indian council of medical research (ICMR) - guidelines for diagnosis and management of rickettsial diseases in India in 2015
    • UK
      • National institute for health and care Excellence (NICE) 
        • quality standards on Lyme disease 2019
        • Guideline on Lyme disease 2018
      • British Infection Association (BIA)

TEASER

There's no place like the Emergency Department. Patients are in pain, scared, and anxious. Staff are distracted, fatigued, frustrated - and sometimes, well, also scared and anxious. How can Emergency Physicians speak to rise above the fray, to best care for patients, lead a team, and ensure that everyone feels heard? Join Dr. Kharmene Sunga as she discusses insights from sources ranging from medicine to business and even child psychology to cut through the proverbial noise.

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

1. Singh NK, Agarwal A, Salazar L, Henkle JQ. Osborn waves in hypothermia induced by baclofen overdose. BMJ Case Rep 2009; 2009.
2. Sullivan R, Hodgman MJ, Kao L, Tormoehlen LM. Baclofen overdose mimicking brain death. Clin Toxicol (Phila) 2012;50:141
3. Alden TD, Lytle RA, Park TS, et al. Intrathecal baclofen withdrawal: a case report and review of the literature. Childs Nerv Syst 2002;18:522

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

1. Wolfsdorf JI, Allgrove J, Craig M, et al. Hyperglycemic crises in pediatric patients with diabetes; a consensus statement from the International Society for Pediatric and Adolescent Diabetes. Pediatr Diabetes. 2014;15(S20):154-179.
2. Neu A, Hofer SE, Karges B, et al. Ketoacidosis at diabetes onset is still frequent in children and adolescents. Diabetes Care. 2009;32:1647-1648. doi: 10.2337/dc09-0553. Epub 2009 Jun 23. PMID: 19549730.
3. Kuppermann N, Ghetti S, Schunk JE, et al. Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis. N Engl J Med. 2018;378:2275-2287
4. Long B. Lentz S, Koyfman A, Gottlieb M. Euglycemic diabetic ketoacidosis: etiologies, evaluation and management. Am J Emerg Med. 2021 Jun;44:157-160
5. Glaser N, Barnett P, McCaslin I. Risk factors for cerebral edema in children with diabetic ketoacidosis: The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001;344:264-269.
6. Soto-Rivera CL, Asaro LA, Agus MSD, DeCourcey DD. Suspected cerebral edema in diabetic ketoacidosis: Is there still a role for head CT in treatment decisions? Pediatr Crit Care Med. 2017 Mar;18(3):207-212
7. Wilkinson K, Sanghamitra S, Nair P, Sanchez J, Ambati S. Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA. J Pediatr Endocrinol Metab. 2022 Sep 29;35(10):1257-1263

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

1. Kaeley et al. The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Research & Therapy. 2020;22:1
2. Horton SC, Tan AL, Wakefield RJ, et al. Ultrasound-detectable grey scale synovitis predicts future fulfillment of the 2010 ACR/EULAR RA classification criteria in patients with new onset undifferentiated arthritis. RMD Open 2017;3:e000394
3. https://youtu.be/7YqGIl6Oqbk - industry sponsored video on POCUS for rheumatoid arthritis. I recommend jumping to the 20 minute mark and watch this area for examples of ultrasounds and the use of the grey scale evaluation for synovitis.

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda; @McGregorMD

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Dr. McGregor’s website: www.alysonmcgregormd.com

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

Articles she references throughout are listed below in chronological order.

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda; @LauraBurke20

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

• Li G, Lau JT, McCarthy M, Schull MJ, Vermeulen M, Kelen GD. Emergency Department Utilization in the United States and Ontario, Canada. Acad Emerg Med June 2007, Vol 14, No. 6
• Papanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018;319(10):1024-1039
• Papanicolas I, Woskie LR, Orlander D, Orav EJ, Jha AK. The Relationship between health spending and social spending in high-income countries: How does the US compare? Health Aff (Millwood). 2019 Sep;38(9):1567-1575
• Zhou RA, Baicker K, Taubman S, Finkelstein AN. The uninsured do not use the emergency department more – they use other care less. Health Affairs (Millwood). 2017 Dec;36(12):2115-2122
• Smulowitz PB, Lipton R, Wharam JF, Adelman L, Weiner SG, Burke L, Baugh CW, Schuur JD, Liu SH, McGrath ME, Liu B, Sayah A, Burke MC, Pope JH, Landon BE. Emergency department utilization after the implementation of Massachussetts health reform. Annals of Emergency Medicine. 2011 Sep;58(3):225-234
• Singer AJ, Thode HC, Pines JM. US Emergency Department visits and hospital discharges among uninsured patients before and after implementation of the Affordable Care Act. JAMA Network Open. 2019 Apr 5;2(4):e192662
• Brook, Robert H., Emmett B. Keeler, Kathleen N. Lohr, Joseph P. Newhouse, John E. Ware, William H. Rogers, Allyson Ross Davies, Cathy D. Sherbourne, George A. Goldberg, Patricia Camp, Caren Kamberg, Arleen Leibowitz, Joan Keesey, and David Reboussin, The Health Insurance Experiment: A Classic RAND Study Speaks to the Current Health Care Reform Debate. Santa Monica, CA: RAND Corporation, 2006. https://www.rand.org/pubs/research_briefs/RB9174.html.
• Vogel JA, Rising KL, Jones J, Bowden ML, Ginde AA, Havranek EP. Reasons patients choose the emergency department over primary care: A qualitative metasynthesis. J Gen Intern Med. 2019 Nov; 34(11):2610-2619
• Chou SC, Gondi S, Baker O, Venkatesh AK, Schuur JD. Analysis of a commercial insurance policy to deny coverage for emergency department visits with nonemergent diagnoses. JAMA network Open. 2018 Oct 5;1(6):e183731
• Raven MC, Lowe RA, Maselli J, Hsia RY. Comparison of presenting complaint vs discharge diagnosis for identifying nonemergency emergency department visits. JAMA. 2013 Mar 20;309(11):1145-53
• Arnetz BB, Goetz C, vanSchagen J, Baer W, Smith S, Arnetz JE. Patient-reported factors associated with avoidance of in-person care during the COVID-19 pandemic: Results from a national survey. PLoS One. 2022 Aug 5;17(8):e0272609
• Sharma M, Lioutas VA, Madsen T, Clark J, O’Sullivan J, Elkind MSV, Willey JZ, Marshall RS, Selim MH, Greer D, Tirschwell DL, Burton T, Boehme A, Aparicio HJ. Decline in stroke alerts and hospitalisations during the COVID-19 pandemic. Stroke Vascular Neurology. 2020 Dec;5(4):403-405
• Bradley CJ, Neumark D, Walker LS. The effect of primary care visits on other health care utilization: A randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia. J Health Economics. 2018 Nov;62:121-133
• Peikes D, Dale S, Ghosh A, Taylor EF, Swankoski K, O’Malley AS, Day TJ, Duda N, Singh P, Anglin G, Sessums LL, Brown RS. The comprehensive primary care initiative: effects on spending, quality, patients and physicians. Health Affairs (Millwood). 2018 Jun;37(6):890-899
• Song Z, Gondi S. Will increasing primary care spending alone save money? JAMA. 2019 Oct 8;322(14)1349-1350
• Weinik RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs (millwood). 2010 Sep;29(9):1630-6
• Wang B, Mehrotra A, Friedman AB. Urgent care centers deter some emergency department visits but, on net, increase spending. Health Affairs (Millwood). 2021 Apr;40(4):587-595
• Pitts SR, Pines JM, Handrigan MT, Kellermann AL. National trends in emergency department occupancy, 2001-2008:effect of inpatient admissions versus emergency department practice intensity. Annals of Emergency Medicine. 2012 Dec;60(6):679-686
• Burke LG, Wild RC, Orav EJ, Hsia RY. Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? An observational study among US Medicare beneficiaries. BMJ Open. 2018 Jan 30;8(1):e019357
• Schuur JD, Venkatesh AK. The growing role of emergency departments in hospital admissions. NEJM. 2012 Aug 2;367(5):391-3
• Chou SC, Baker O, Schuur JD. Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey. Western Journal of Emergency Medicine. 2020 Feb 21;21(2):209-216
• Janke AT, Gettel C, Vacirca RK, Lin MP, Kocher KE, Venkatesh AK. Trends in treat and release emergency care visits with high-intensity billing in the US, 2006-19. Health Affairs (Millwood). 2022 Dec;41(12)1772-1780
• Gani F, Canner JK, Pawlik TM. Assessing coding practices for gastrointestinal surgery over time in the United States. Surgery. 2018 Sep;164(3):530-538
• Schonberger RB, Dutton RP, Dai F. Is there evidence for systematic upcoding of ASA physical status coincident with payer incentives? A regression discontinuity analysis of the national anesthesia clinical outcomes registry. Anesthesia Analgesia. 2016 Jan;122(1):243-50
• Rajkumar CA, Suh WM, Francis DP. Upcoding of clinical information to meet appropriate use criteria for percutaneous coronary intervention. Circulation: Cardiovascular Quality and Outcomes. 2019 Mar;12(3):e005025
• Smulowitz PB, Honigman L, Landon BE. A novel approach to identifying targets for cost reduction in the emergency department. Annals of Emergency Medicine. 2013 Mar;61(3):293-300
• Burke LG, Burke RC, Epstein SK, Orav EJ, Jha AK. Trends in costs of care for Medicare beneficiaries treated in the emergency department from 2011 to 2016. JAMA Network Open. 2020 Aug 3;3(8):e208229
• Tsai TC, Greaves F, Zheng J, Orav EJ, Zinner MJ, Jha AK. Better patient care at high-quality hospitals may save medicare money and bolster episode-based payment models. Health Affairs (Millwood). 2016 Sep 1;35(9):1681-9
• Lin MP, Baker O, Richardson LD, Schuur JD. Trends in emergency department visits and admission rates among US acute care hospitals. JAMA Intern Med. 2018 Dec 1;178(12):1708-1710
• Pomerantz A, Burke R, Friedman A, Burke L, Wolfe R, Smulowitz P. The influence of Medicare for all on reimbursement for emergency care treat-and-release visits. Annals of Emergency Medicine. 2020 Oct;76(4):454-458
• Obermeyer Z, Cohn B, Wilson M, Jena AB, Cutler DM. Early death after discharge from emergency departments: analysis of national US insurance claims data. BMJ. 2017 Feb 1;356:j239
• Burke LG, Epstein SK, Burke RC, Orav EJ, Jha AK. Trends in mortality for medicaire beneficiaries treated in the emergency department from 2009 to 2016. JAMA Internal Medicine. 2020 Jan 1;180(1):80-88
• Marco CA, Courtney DM, Ling LJ, Salsberg E, Reisdorff EJ, Gallahue FE, Suter RE, Muelleman R, Chappell B, Evans DD, Vafaie N, Richwine C. The emergency medicine physician workforce: projections for 2030. Annals of Emergency Medicine. 2021 Dec;78(6):726-737
• Paul Genberg. The Value of Being a Generalist. Forbes. June 3, 2021

CONTACTS

Twitter - @AlwaysOnEM; @VenkBellamkonda; @KreuterMD

Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @KreuterMD

Email - AlwaysOnEM@gmail.com

REFERENCES & LINKS

1. Lab medicine rounds podcast link: https://news.mayocliniclabs.com/homepage/podcasts-2/lab-medicine-rounds/
2. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, plaeteles, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma – the PROPPR Randomized Clinical Trial. JAMA. 2015; 313(5):471-482
3. Holcomb JB, Del Junco DJ, Fox EE, et al. The prospective observational multicenter major trauma transfusion (PROMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013 Feb;148(2):127-136
4. J-Y Borg et al. FEIBA in the treatment of acquired hemophilia A: results from the prospective multicentre French ‘FEIBA dans l’hemophilie A acquise’ (FEIBHAC) registry. Haemophilia. 2015 May;21(3):330-337
5. Sharp G, Young CJ. Point of care viscoelastic assay devices (rotational thromboelastometry and thromboelastography): a primer or surgeons. Anz J Surg. 2019 Apr;89(4):291-295
6. Hospital Liaison Committee for Jehovah’s Witnesses: https://www.jw.org/en/medical-library/strategies-downloads/hospital-liaison-committees-jehovahs-witnesses/

Summary

The United States immigration system is exceedingly complex and results in barriers to care for structurally vulnerable immigrant populations. Immigration status alone is a social determinant of health with historical, economic, social and political implications related to healthcare 'access'. As a result, the emergency department may be one of the most reliable and safe points of entry into the health system for immigrant populations, as 'access' to routine care may seem unattainable. EM physicians are well positioned to provide high quality and structurally competent care to immigrant populations seeking care in the ED, as well as facilitating community-academic partnerships to address external barriers to care. Doctor Zeidan will provide an overview of the US immigration system, how it impacts health seeking behaviors, and discuss strategies and considerations for care delivery for immigrant populations.

Objectives: 1) Explore the structure and context of the US immigration system and how this impacts the health of immigrants 2) Discuss the barriers to care faced by immigrants that impact health seeking behaviors (both inside and outside of the hospital) 3) Consider the role of EM physicians in supporting the health rights of immigrants on shift and beyond the hospital

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @Amyjwal

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @Abhishek_mbbs

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

Upon conclusion of this activity participants should be able to:

- List the five traits of exceptional individuals

- Discuss strategies to improve care for geriatric patients in the ED

- Recognize ways to grow your impact through scholarship

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @LizGoldbergMD

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @LizGoldbergMD

EMAIL - AlwaysOnEM@gmail.com

Pain is the most common reason for people to seek care in the Emergency Department. The current laws and regulations have significantly affected ED Clinician’s ability to provide effective, efficient and safe pain relief by worsening opiophobia, by repurposing non-analgesic medications for pain control and by proliferation of dangerous drug-drug combinations. This talks is set to discuss the current state of ED analgesia when it comes to acute pain management with a primary focus on what works and what does not.

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @PainFreeED

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

Contacts

TWITTER - @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

References

1. Rosenbaum S, Wilkerson RG, Winters ME, Vilke GM, Wu MYC. Clinical Practice Statement: What is the Emergency Department Management of Patients with Angioedema Secondary to an ACE-Inhibitor? J Emerg Med. 2021 Jul;61(1):105-112 [from the American Academy of Emergency Medicine] https://pubmed.ncbi.nlm.nih.gov/34006418/
2. Moellman JJ, Bernstein JA, et al. A consensus parameter for the evaluation and management of angioedema in the emergency department. Acad Emerg Med. 2014 Apr;21(4):469-84 [from the American College of Allergy, Asthma & Immunology (ACAAI) and the Society for Academic Emergency Medicine (SAEM)] https://pubmed.ncbi.nlm.nih.gov/24730413/
3. Carrillo-Martin I, Gonzalez-Estrada A, Funni SA, Sandefur BJ, Jeffery MM, Campbell RL. Angioedema - related emergency department visits in the United States: Epidemiology and time trends, 2006-2015. J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2442-2444. https://pubmed.ncbi.nlm.nih.gov/32302784/
4. Ishoo E, Shah UK, Grillone GA, Stram JR, Fuleihan NS. Predicting airway risk in angioedema: staging system based on presentation. Otolaryngol Head Neck Surg. 1999 Sep;121(3):263-8 https://pubmed.ncbi.nlm.nih.gov/10471868/
5. Arthur J, Caro D, Topp S, Chadwick S, Driver B, Henson M, Norse A, Spencer H, Godwin SA, Guirgis F. Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema. Am J Emerg Med. 2022 Oct 19;63:44-49 https://pubmed.ncbi.nlm.nih.gov/36327748/
6. Sandefur BJ, Liu XW, Kaji AH, Campbell RL, Driver BE, Walls RM, Carlson JN, Brown CA. Emergency Department Intubations in Patients with Angioedema: A Report from the National Emergency Airway Registry. J Emerg Med. 2021 Nov;61(5):481-488 https://pubmed.ncbi.nlm.nih.gov/34479750/
7. Sandefur BJ, Oliveira Silva L, Lohse CM, Goyal KA, Barbara DW, Castaneda-Guarderas A, Liu XW, Campbell RL. Clinical features and outcomes associated with angioedema in the emergency department. West J Emerg Med. 2019 Aug 6;20(5):760-769 https://pubmed.ncbi.nlm.nih.gov/31539333/

Additional Resources

1. Wilkerson RG, Moellman JJ. Hereditary Angioedema. Emerg Med Clin North Am. 2022 Feb;40(1):99-118 https://pubmed.ncbi.nlm.nih.gov/34782094/
2. Wilkerson RG, Winters ME. Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema. Emerg Med Clin North Am. 2022 Feb;40(1):79-98 https://pubmed.ncbi.nlm.nih.gov/34782093/

He will be discussing the movement toward careful and kind care he calls the Patient Revolution. This movement seeks to turn away from industrialized healthcare – a form of healthcare in which the care of patients is a means to an end, in which patients are processed, and in which cruelty happens routinely and care by happy accident. He challenges us to turn toward careful and kind care. Careful care is unhurried, evidence-based, safe, and sensible. It is responsive to the needs and situation of this patient rather than patients like this. Careful care, as he describes, requires that clinicians see patients in high definition, notice their problems in their biology and biography, and respond with compassion and competence by co-creating plans of care that make intellectual, emotional and practical sense to each patient. Kind care recognizes each patient as a fellow human, one of us rather than one of them. It calls for minimizing the demands healthcare makes on patients’ scarce time, energy, and attention which patients rather use to fulfill their obligations, pursue their loves, and flourish. Based on solidarity and love, health care must support the work of people who come together to give and receive care. Beyond healthcare, we need to advocate for common care and for the care of our environment. He is challenging us to create a movement for care.

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda; @VMontori

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

References:

1. Why we revolt, authored by Dr. Victor Montori, published October 2017

2. www.PatientRevolution.org, organization cofounded by Dr. Victor Montori

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

He discusses the experience at UW conceiving, designing, and implementing a program, which incorporates a machine-learning algorithm for real-time calculation of fall risk for all older adults who visit the ED. The talk will include the rationale for using automation to improve public health referrals from the ED, techniques used to create the intervention, and issues surrounding the design and governance of similar interventions.

TWITTER @BPatterson; @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM @AlwaysOnEM

EMAIL AlwaysOnEM@Gmail.com

Contacts:

TWITTER - @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

EMAIL - AlwaysOnEM@gmail.com

References:

1. Brown DJ, Brugger H, Boyd J, Paal P. Accidental Hypothermia. N Engl J Med. 2012 Nov 15, 367(20):1930-8

2. Paal P, Brown DJ, Brugger H, Boyd J. In hypothermic major trauma patients the appropriate hospital for damage control and rewarming may be life saving. Injury. 2013 Nov;44(11):1665

3. Wanscher M, et al. Outcome of accidental hypothermia with or without circulatory arrest experience from the Danish Praesto Fjord boating accident. Resuscitation. 2012 Sep;83(9):1078-84

When it comes to shock, we have developed a blood pressure addiction. Our propensity for a laser-like focus on blood pressure frequently hobbles our ability to promptly diagnose and optimally manage shock patients. This lecture aims to facilitate a more naunced approach to shock through an expanded mental model of shock pathophysiology combined with an iterative hypothesis testing strategy for clinical problem solving

TWITTER @SaraCrager; @AlwaysOnEM; @VenkBellamkonda

INSTAGRAM @AlwaysOnEM

EMAIL AlwaysOnEM@Gmail.com

TWITTER: @AlwaysOnEM; @VenkBellamkonda; @CLeeBennett

INSTAGRAM: @Always On EM; @Venk_like_vancomycin; @ASFinch

GMAIL: AlwaysOnEM@gmail.com

References:

1. Bennett CL, et al. National Study of the Emergency Physician Workforce, 2020. Annals of Emerg Med. Dec 2020

2. Marco CA, et al. The Emergency Medicine Physician Workforce: Projections for 2030. Annals of Emerg Med. Dec 2021

Contacts:

@AlwaysOnEM - TWITTER

AlwaysOnEM@gmail.com

@VenkBellamkonda - TWITTER

References:

1. Thornhill JP, et al. Monkeypox Virus Infection in Humans across 16 countries - April-June 2022. N Engl J Med. 2022 Jul 21. doi: 10.1056/NEJMoa2207323. Online ahead of print.

2. WHO Director-General's statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox - 23 July 2022; read July 24, 2022; weblink: https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022  

3. Second meeting of the International Health Regulations (2005)(IHR) Emergency Committee regarding the multi-country outbreak of monkeypox - 23 July 2022; read July 24, 2022; weblink: https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox 

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Check out a summary on the Mayo Clinic EM Blog