EM 2019 LLSA Reading List

Brief Resolved Unexplained Events (BRUE)

Tieder JS, Bonkowsky JL, Etzel RA, Franklin WH, Gremse DA, Herman B, et al.; Subcommittee on Apparent Life-Threatening Events. Clinical practice guideline: brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants: executive summary [published erratum appears in Pediatrics May 2016, 137(5): pii: e e20161488]. Pediatrics 2016 May;137(5): pii: e20160591.

The term BRUE defines an event occurring in an infant younger than ___________________.
The four components of a BRUE include: Cyanosis or ___________________; absent, decreased, or ___________________ breathing; marked change in ___________________; and altered level of responsiveness.

Burnout

Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2017 Jan;92(1):129-46.

Studies demonstrate that ___________________% of US physicians are experiencing professional burnout.
Name at least three things an organization can do to promote physician wellness:

___________________

Emergency Delivery

Gupta AG, Adler MD. Management of an unexpected delivery in the emergency department. Clin Ped Emerg Med 2016 Jun;17(2):89-98.

According to the article, the three most important issues to address upon delivery of the neonate in the emergency department include ___________________, ___________________, and ___________________.
Recent data have demonstrated that ___________________ is now recommended for both term and preterm infants who do not require resuscitation at birth.

Hyperemesis Gravidarum

McParlin C, O'Donnell A, Robson SC, Beyer F, Moloney E, Bryant A, et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review. JAMA 2016 Oct;316(13):1392-1401.

For moderate symptoms of hyperemesis gravidarum, metoclopramide, ___________________, and ___________________ have been found to be effective therapy.
For mild symptoms of hyperemesis gravidarum, over-the-counter medications such as ___________________ and ___________________ can be used as first-line agents.

Inhalation Injury

Sheridan RL. Fire-related inhalation injury. N Engl J Med 2016 Aug;375(5):464-9.

___________________ is associated with a persistent acidosis despite an otherwise successful resuscitation.
If a high carboxyhemoglobin level is documented, or if substantial carbon monoxide exposure is suspected, the standard treatment is ___________________ for 6 hours.

Mechanical Ventilation

Weingart SD. Managing initial mechanical ventilation in the emergency department. Ann Emer Med 2016 Nov;68(5):614-7.

___________________ pressure on a ventilator represents a combination of alveolar pressure and large airway and ventilator equipment resistance.
The best ventilator strategy in the patient with obstructive pulmonary disease is to ___________________.

Mesenteric Ischemia

Clair DG, Beach JM. Mesenteric ischemia. N Engl J Med 2016 Mar;374(10):959-68.

Computed tomographic angiography (CTA) has become the recommended method of imaging for the diagnosis of visceral ischemic syndromes and has ___________________% accuracy.
___________________ therapy should be initiated as soon as possible in patients who have acute ischemia or an exacerbation of chronic ischemia.

Migraine

Friedman BW. Managing migraine. Ann Emerg Med 2017 Feb;69(2):202-7.

While three classes of medications can be administered as first-line therapy for treating acute migraine headaches, good clinical evidence has emerged to support the use of ___________________ as monotherapy for acute migraine.

Pediatric Nontraumatic Hip Pathology

Neville DN, Zuckerbraun N. Pediatric nontraumatic hip pathology. Clin Ped Emerg Med 2016 Mar;17(1):13-28.

___________________ is the most common diagnosis in children with nontraumatic hip complaints.

Pulmonary Embolism

Long B, Koyfman A. Current controversies in thrombolytic use in acute pulmonary embolism. J Emerg Med 2016 Jul;51(1):37-44.

Submassive pulmonary embolism (PE) accounts for about ___________________% of all PE, with up to a ___________________% in-hospital mortality.
When considering thrombolytic therapy for submassive PE, it is ideal to utilize ___________________ as a communication technique when discussing the risks and benefits with the patient.

Seizures

Gavvala JR, Schuele SU. New-onset seizure in adults and adolescents: a review. JAMA 2016 Dec;316(24):2657-68.

In patients with new-onset seizures seen in the ED, CT scans may miss certain lesions, such as ___________________.
There is an approximately ___________________% chance of a seizure recurrence within 5 years following new-onset seizure in adults.

TIA

American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Suspected Transient Ischemic Attack; Lo BM, Carpenter CR, Hatten BW, Wright BJ, Brown MD. Clinical policy: critical issues in the evaluation of adult patients with suspected transient ischemic attack in the emergency department. Ann Emerg Med 2016 Sep;68(3):354-70.

In adult patients with suspected transient ischemic attack (TIA) without high-risk conditions, a rapid ED based diagnostic protocol may be used to evaluate patients. Name the high-risk conditions for TIA.
          ___________________

         ___________________

          ___________________

          ___________________

          ___________________
In adults with suspected TIA, ___________________ may be used to exclude carotid stenosis because it has accuracy similar to that of MRA and CTA.

Brief Resolved Unexplained Events (BRUE)

The term BRUE defines an event occurring in an infant younger than 1 year.
The four components of a BRUE include: Cyanosis or pallor; absent, decreased, or irregular breathing; marked change in tone; and altered level of responsiveness.

Burnout

Studies demonstrate that 50% of US physicians are experiencing professional burnout.
Name at least three things an organization can do to promote physician wellness:

Acknowledge and assess the problem

Harness the power of leadership

Develop and implement targeted work unit interventions

Cultivate community

Use rewards and incentives wisely

Align values and strengthen culture

Promote flexibility and work-life integration

Provide resources to promote resilience and self-care

Facilitate and fund organizational science

Emergency Delivery

According to the article, the three most important issues to address upon delivery of the neonate in the emergency department include term gestation, good tone, and breathing or crying.
Recent data have demonstrated that delayed umbilical cord clamping is now recommended for both term and preterm infants who do not require resuscitation at birth.

Hyperemesis Gravidarum

For moderate symptoms of hyperemesis gravidarum, metoclopramide, ondansetron, and promethazine have been found to be effective therapy.
For mild symptoms of hyperemesis gravidarum, over-the-counter medications such as ginger and vitamin B6 can be used as first-line agents.

Inhalation Injury

Cyanide poisoning is associated with a persistent acidosis despite an otherwise successful resuscitation.
If a high carboxyhemoglobin level is documented, or if substantial carbon monoxide exposure is suspected, the standard treatment is 100% normobaric oxygen for 6 hours.

Mechanical Ventilation

Peak pressure on a ventilator represents a combination of alveolar pressure and large airway and ventilator equipment resistance.
The best ventilator strategy in the patient with obstructive pulmonary disease is to avoid intubation altogether.

Mesenteric Ischemia

Computed tomographic angiography (CTA) has become the recommended method of imaging for the diagnosis of visceral ischemic syndromes and has 95 to 100% accuracy.
Heparin therapy should be initiated as soon as possible in patients who have acute ischemia or an exacerbation of chronic ischemia.

Migraine

While three classes of medications can be administered as first-line therapy for treating acute migraine headaches, good clinical evidence has emerged to support the use of antidopaminergics as monotherapy for acute migraine.

Pediatric Nontraumatic Hip Pathology

Transient synovitis is the most common diagnosis in children with nontraumatic hip complaints.

Pulmonary Embolism

Submassive pulmonary embolism (PE) accounts for about 20% of all PE, with up to a 5% in-hospital mortality.
When considering thrombolytic therapy for submassive PE, it is ideal to utilize shared decision making as a communication technique when discussing the risks and benefits with the patient.

Seizures

In patients with new-onset seizures seen in the ED, CT scans may miss certain lesions, such as low-grade gliomas.
There is an approximately 35% chance of a seizure recurrence within 5 years following new-onset seizure in adults.

TIA

In adult patients with suspected transient ischemic attack (TIA) without high-risk conditions, a rapid ED based diagnostic protocol may be used to evaluate patients. Name the high-risk conditions for TIA.
          Abnormal head CT scan

         Suspected embolic source, e.g., atrial fibrillation, cardiomyopathy, valvular disease

          Known carotid stenosis

          Previous large stroke

          Crescendo TIA
In adults with suspected TIA, carotid ultrasound may be used to exclude carotid stenosis because it has accuracy similar to that of MRA and CTA.