Posts (139)

6 days ago · How to best identify patients that have a high likelihood of dying in one year?

Author: Caitlin Loprinzi-Brauer, MD @cloprinzi

To determine who should have goals of care discussions, encourage advanced care planning and consider palliative medicine consultation

 

Cardiopulmonary resuscitation (CPR) is the only medical intervention that does not need consent to be preformed. In medicine all patients are assumed to be a full code and undergo CPR and most times intubation (insertion of a breathing tube), unless otherwise documented. For many having all interventions preformed in attempt to save their life is what they want and what would be recommended by most medical professionals. As patients age or have a decline in their health secondary to medical comorbidities, many patients do not want aggressive heroic measures taken, particularly in times of critical illness. Also, as people age and medial comorbidities increase, the likelihood of survival following cardiac arrest decreases.

Value-based decision-making is about eliciting a patient’s values and goals in order to guide treatment; however, patients are not always empowered or able to communicate their wishes. Advance healthcare directives (AHD) can help patients communicate their wishes regarding their care and can guide conversations with surrogate decision-makers when the patient lacks capacity for such discussions. Understanding patients’ goals and values is especially important in the case of critically ill patients presenting to the emergency department (ED) who would receive life-sustaining treatments unless this is not what the patient wants.

 

We externally validated and derived a clinical prediction tool previously created by an ED group in Australia (Richardson P et al. https://www.ncbi.nlm.nih.gov/pubmed/25062815). We identified patients likely to die within one-year;, as these patients ideally should have advanced care planning (i.e. completed an advanced directive or similar document) including their code status documented (ie, Do not resuscitate or Do not intubate).

The PREDICT screening tool is composed by six variables that are easy to collect within a clinical ED visit and is easy to utilize in the fast-paced environment of the ED. Each criterion is assigned different points as seen in the table below:

PREDICT criteria and score

Feature Points
Referral to palliative care team for a non-cancer diagnosis 12
Current residence in nursing home 3
Department of intensive care unit (ICU) admission with multi-organ failure 10
Current diagnosis of cancer 10
2 medical admissions in the past year 3
Age at ED visit in years
   55-65 1
   66-75 2
   76 3

 

In our study, we applied the PREDICT tool to 927 patients older than 55 years of age presenting to the ED. A fourth of them (26%) were deceased at one year. Patients from the deceased group were older, had a higher PREDICT score, had an increased number of comorbidities, were more likely to live in a nursing home, and were more likely to have an AHD on file. Of the 147 patients with PREDICT scores ≥13, 55% were deceased at one year. The AUC of the PREDICT score was 0.717, sensitivity 33% and specificity was 90% to predict 1-year mortality. High specificity is preferred in this scenario, however a table with different sensitivity and specificity and ROC curves depending on the PREDICT score cutoff used are presented in the full article.

 

We further refined the clinical prediction tool to improve the original PREDICT criteria, and the PREDICT minus ICU admission with multiorgan failure (modified PREDICT) appeared to have a diagnostic test accuracy performance similar to the original PREDICT score. We selected this as the preferred model, as the variable of ICU admission with multiorgan failure is not always available at the time of assessment in the ED, was the hardest one to extract from the records, and will make the model easier to apply earlier in the course of an ED visit. By removing the ICU admission variable, this clinical tool, could result in earlier calculation of the PREDICT score during an ED visit. This time could be used for initiating conversations regarding AHD and, if appropriate, allow placement of palliative care consultation before inpatient admission.

 

PREDICT and modified PREDICT have advantages over other prognostic indices. Other indices require a patient be assessed for factors not regularly gathered in the context of a brief clinical encounter in the ED setting, require the use of the complex non-cancer hospice guidelines that may not be familiar to those who work outside of hospice and palliative medicine, incorporate laboratory values that may not be available or up-to-date, cannot be applied until the patient has final disposition from the ED, or cannot be applied to patients until they are dismissed from the hospital. PREDICT and modified PREDICT use data commonly available in the medical record or that are clinically relevant to an ED physician and are generally collected within the confines of a clinical encounter in the ED. Further, either PREDICT score could be discussed directly with the patient and their caregivers while they are in the ED and, thus, AHD, goals-of-care discussions and, when applicable, the need for palliative care consultation can be identified earlier and, possibly, initiated before the patient is admitted to the hospital.

Link to the paper

 

Reference

  • Moman RN, Loprinzi Brauer CE, Kelsey KM, Havyer RD, Lohse CM, Bellolio MF. PREDICTing Mortality in the Emergency Department: External Validation and Derivation of a Clinical Prediction Tool. Acad Emerg Med. 2017 Jul;24(7):822-831. doi: 10.1111/acem.13197. Epub 2017 May 29. PubMed PMID: 2840162

Sat, Jul 15 7:39am · Apneic Oxygenation actually works (for some things)

 

Author: Lucas Silva (@lucasojesilva12)

 

In the last few years, the use of apneic oxygenation has been recommended by experts for management of high-risk airway situations, including emergency intubations in the ED (1), and for patients at risk for difficult laryngoscopy and intubation in the operating room (2).

The relative simplicity and safety of this intervention and the potential to turn intubation in a safer procedure, with higher success rates and fewer complications, led to a rapid and widespread use of the concept and to its even being considered by some as standard of care despite relatively scarce evidence to support its use (1). Recently, ICU-based studies have shown conflicting results on the effectiveness of apneic oxygenation using different approaches (3-8).

To evaluate the current evidence, we performed a systematic review and meta-analysis on the use of apneic oxygenation during emergency intubation (ED or ICU intubations), looking at outcomes as hypoxemia, first-pass success, and lowest oxygen saturation.  

Here the link to the paper (open access!):

http://www.annemergmed.com/article/S0196-0644(17)30582-6/fulltext

 

After a comprehensive literature search, including 4 large databases, we found 1,386 studies for review. After screening the titles and abstracts and removing duplicates, we identified 77 potentially relevant studies. After full-text review, a total of 14 studies met the inclusion criteria: 6 ICU studies, 6 ED studies, and 2 mixed ED and ICU studies. The included studies involved 2,023 participants, with 1,168 patients receiving apneic oxygenation during intubation and 855 not receiving it. Eight studies including 982 patients receiving apneic oxygenation and 855 not receiving it, underwent meta-analysis.

In this study, we found that the use of apneic oxygenation during emergency intubation appears to be associated with increased peri-intubation oxygen saturation and first-pass success rates, as well as decreased incidence of hypoxemia in patients intubated in the ED or ICU. The use of apneic oxygenation was associated with a decrease in ICU length of stay, but there was no difference in duration of mechanical ventilation and ICU mortality. We found no reports of adverse events related to the use of apneic oxygenation, despite different approaches and settings.

 

Main findings:

  • Hypoxemia (SpO2 < 93%)
    • Meta-analysis of 8 studies, 1837 patients;
    • Odds ratio (OR) 0.66; 95% confidence interval (CI) 0.52 to 0.84.
  • First-Pass Success (success on the first attempt of laryngoscopy)
    • Meta-analysis of 6 studies, 1658 patients;
    • OR 1.59; 95% CI 1.04 to 2.44.
  • Lowest Oxygen Saturation Peri-Intubation
    • Meta-analysis of 6 studies, 1043 patients;
    • Weighted Mean Difference +2.2%; 95% CI 0.8% to 3.6%.

 

Limitations regarding our study, however, have to be acknowledged. The major limitation relates to the quality of included studies, which warrants a moderate to low level of certainty in the estimates. Another important limitation is the different approaches used to apneic oxygenation in terms of preoxygenation and other peri-intubation variables and co-interventions. The different methods of preoxygenation between groups could affect the likelihood of developing hypoxemia during the apneic period; therefore, the effect of apneic oxygenation was not isolated in some of the included studies. The maintenance of airway patency during apneic oxygenation was not described in most of the studies, and that might affect the quality of this intervention. The clinical heterogeneity of patients intubated in the ED and ICU in regard to their cardiorespiratory baseline status is also an important factor to be considered, and which approach is better among the spectrum of sickness in patients requiring emergency intubation still has to be evaluated by future studies.

In summary, in our meta-analysis apneic oxygenation was associated with increased peri-intubation SpO2, decreased hypoxemia, and increased first-pass intubation success.

 

Bottom-line: The current body of evidence supports the role of apneic oxygenation as an important adjunct for emergency airway management.

 

FULL-ARTICLE: (open access)

 

REFERENCES

  1. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59:165-175.e161.
  2. Berkow L, Hagberg CA, Crowley M. Airway management for induction of general anesthesia. In: Post TWU, Waltham MA, eds. UpToDate.
  3. Besnier E, Guernon K, Bubenheim M, et al. Pre-oxygenation with high-flow nasal cannula oxygen therapy and non-invasive ventilation for intubation in the intensive care unit. Intensive Care Med. 2016;42:1291-1292.
  4. Jaber S, Monnin M, Girard M, et al. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med. 2016;42:1877-1887.
  5. Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med. 2015;43:574-583.
  6. Semler MW, Janz DR, Lentz RJ, et al. Randomized trial of apneic oxygenation during endotracheal intubation of the critically ill. Am J Respir Crit Care Med. 2016;193:273-280.
  7. Simon M, Wachs C, Braune S, et al. High-flow nasal cannula versus bag-valve-mask for preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respir Care. 2016;61:1160-1167.
  8. Vourc’h M, Asfar P, Volteau C, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med. 2015;41:1538-1548.

 

Sat, May 20 7:35pm · Really, how dangerous can it be? Motocross injuries in the emergency department

Author: Lucas Silva (@lucasojesilva12)

Rider in photo: Elisa M. Smith, MD (EM Resident at Mayo Clinic, Rochester, MN)

 

An 18 year-old freshman of the University of Minnesota went back to Wabasha, his hometown, to ride motocross with his high-school friends over the weekend. He was jumping over an obstacle when he suddenly lost control in mid-air and was ejected from his bike, hitting his head and losing his consciousness for 30 seconds. EMS transported him to the emergency department (ED) for evaluation.

In the ED, he reported headache, nausea, and back pain. His GCS was 15 and he had no neurologic deficits on exam.  The emergency providers ordered CTs of the head, neck, chest, abdomen/pelvis with spine reconstructions which revealed a stable lumbar spine fracture. The patient was discharged from the hospital one day later with concussion instructions and outpatient follow-up with the Spine Clinic.

Motocross is a popular that has seen an increasing number of injuries related to the rising on participation (1, 2). Its burden on ED visits, however, has not been well described for adult patients. Motocross has one of the highest incidence rates of injuries compared with other high-impact sports (3) and emergency providers should be aware of the risks associated with this activity, in order to facilitate early recognition and management of injuries in these patients.

In a study of consecutive adult patients presenting to our academic ED with motocross-related injuries over a 6-year period we aimed to describe the rates of head and spine injuries.

We found that adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries and marked levels of morbidity and mortality (Table 1). Among 145 ED visits, 95% of the patients were male and the median age was 25 years.  Almost half of the patients had head and/or spine injuries (67/145, 46.2%).  Almost 93% of patients with head or spine injuries were wearing a helmet at the time of injury.  Among the 43 patients with head injuries, almost 85% were concussions (and over 75% of these were associated with loss of consciousness), 7 were associated with at least 1 head CT abnormality, including skull fracture (n = 2), subdural hematoma (n = 1), subarachnoid hemorrhage (n = 4), intraparenchymal hemorrhage (n = 3), and diffuse axonal injury (n = 3). Approximately 70% of the 46 spinal injuries were acute fractures.  Six patients (4%) had significant persistent neurologic injuries, including:  3 patients with severe TBIs (including 2 with persistent cognitive impairment and 1 in a persistent vegetative state); 2 patients with paraplegia; 1 patient with right upper extremity weakness.  One patient had a minor sensory deficit.  One patient died.

Our findings demonstrate that almost one half of adult ED patients evaluated following motocross accidents had head and/or spine injuries with 4% resulting in significant impairment, and 0.7% died. The long-term functional and economic burden caused by these injuries in these young patients is unknown. Emergency providers and motocross participants should be aware of the high rates of head and spine injuries associated with this sport.  The development of improved safety procedures or equipment may help to mitigate these injuries.

 

Table 1. Emergency Department Visits—Baseline Characteristics and Outcomesa  (used with permission)

  ED Visits
 

Variable

All
(N=145)
Head Injuries (n=43) Spine Injuries (n=46)
Age, y 25 (21-38) 27 (21-40) 25.5 (21-38.5)
Male sex 138 (95.2) 41 (95.3) 43 (93.5)
ED Glasgow coma scaleb      
3 3 (2.1) 3 (7) 2 (4.35)
4-8 2 (1.4) 2 (4.7) 0 (0)
9-14 3 (2.1) 3 (7) 2 (4.35)
15 135 (94.4) 35 (81.3) 42 (91.3)
Head injury (n=43)      
Loss of consciousness 33 (76.8)
Concussion 36 (83.7)
Skull fracture 2 (4.7)
Epidural hematoma 0 (0)
Subdural hematoma 1 (2.3)
Subarachnoid hemorrhage 4 (9.3)
Intraparenchymal hemorrhage 3 (7)
Diffuse axonal injury 3 (7)
Spine injury (n=46)      
Acute spinal fracture 32 (69.6)
Epidural hematoma 4 (8.7)
Acute disc herniation 1 (2.2)
Ligamentous injury 5 (10.9)
Cervical strain 3 (6.5)
Thoracolumbar strain 10 (21.7)
CT imaging      
Head 83 (57.2) 41 (95.3) 36 (78.3)
Any spine 106 (73.1) 41 (95.3) 46 (100)
Cervical spine 105 (72.4) 40 (93) 46 (100)
Lumbar spine 85 (58.6) 33 (76.7) 41 (89.1)
Thoracic spine 61 (42.1) 32 (74.4) 42 (91.3)
ED disposition      
Home 40 (27.6) 7 (16.2) 4 (8.7)
General surgical floor 53 (36.5) 18 (41.9) 19 (41.3)
Intensive care unitc 21 (14.5) 12 (27.9) 12 (26)
Operating room 31 (21.4) 6 (14) 11 (24)
Head or spine intervention or surgery 10 (6.9) 5 (11.6) 8 (17.4)
Persistent neurologic deficit at hospital discharge 7 (4.8) 5 (11.6) 4 (8.7)
Hospital length of stay, d 2 (0-4) 2 (1-5) 3 (1-5)
In-hospital death 1 (0.7) 1 (2.3) 1 (2.2)

Abbreviations: CT, computed tomography; ED, emergency department.

a Data are summarized as number (%) or median (interquartile range).

b Data not available for 2 patients.

c Includes all types of intensive care units at our institution.

 

FULL-ARTICLE:

  • Silva LOJe, Fernanda Bellolio M, Smith EM, et al. Motocross-associated head and spine injuries in adult patients evaluated in an emergency department. The American Journal of Emergency Medicine doi: https://doi.org/10.1016/j.ajem.2017.04.058

 

REFERENCES

  1. Sharma VK, Rango J, Connaughton AJ, et al. The Current State of Head and Neck Injuries in Extreme Sports. Orthopaedic journal of sports medicine 2015;3(1):2325967114564358. doi: 10.1177/2325967114564358 [published Online First: 2015/11/05]
  2. Singh R, Theobald P, Hamad AK, et al. Motocross biking for competition and for recreation: a prospective analysis of 423 injured riders. BMJ Open Sport &amp;amp; Exercise Medicine 2015;1(1)
  3. Gobbi A, Tuy B, Panuncialman I. The incidence of motocross injuries: a 12-year investigation. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2004;12(6):574-80. doi: 10.1007/s00167-004-0510-z [published Online First: 2004/05/11]

 

 

Thu, May 4 9:55am · Anaphylaxis Management

This is a great resource

Wed, Apr 26 11:18am · The Future of Healthcare

This is a video recorded during Mayo Clinic Emergency Grand Rounds presented by Felix Ankel, MD (@felixankel) and Daniel Cabrera, MD (@CabreraERDR) on April 25th 2017.

Healthcare is changing rapidly and the tectonic changes in the way we learn, teach, practice and deliver healthcare are based on a different way to manage knowledge, the close collaboration with artificial intelligence, the ways we create networks and a paradigm change from restricted and episodic healthcare to a continuous unrestricted model.

“The real problem of humanity is the following: we have paleolithic emotions; medieval institutions; and god-like technology”

– E.O. Wilson

Mon, Apr 10 5:10pm · ECMO Rounds: Crash Course

Author: Eric Funk, MD (@efunkEM)

ECMO Rounds: Crash Course

Your patient just got cannulated and started on ECMO. Congratulations! Now what?

The initial steps of starting a patient on ECMO get all the glory, but what about the following minutes, hours and days? At a minimum, you will be responsible for managing the patient until they are transported from the ED to the ICU. ED residents rotating in the ICU may be rounding on these patients on a daily basis. Let’s review the basics information that you will need to gather.

 

Indication

Why were they started on ECMO? This will be fairly obvious because you were there when they got cannulated. Coming from the ED, this is most likely due to refractory cardiac arrest, although other indications exist.

Cannulation sites

Most common sites are femoral artery and vein. Right internal jugular is another common site. Depending on your institution, equipment, patient factors, and provider preference, the patient may be cannulated at other sites as well.

VA or VV

This will be readily apparent based on their cannulation sites. Generally speaking, VA ECMO can assume circulatory and ventilator function, while VV ECMO is unable to provide circulatory function.

Now we are ready to collect some information from the ECMO machinery itself. At our institution we often use the CARDIOHELP System, pictured above. The appearance of the machinery and where to locate the numbers varies by device.

Flow

This is the liters/minute of blood flow that the ECMO circuitry is generating. Recall that a normal cardiac output is 4-8L/min. Some patients have no native flow at all, and rely completely on the ECMO flow. Some patients are still generating low levels of native cardiac flow, and therefore the circuit flow must be balanced against the patient’s native flow. Here is a good explanation of the “mixing cloud” that forms when native flow meets ECMO flow:

 

RPM

This is the pump speed of the ECMO circuit. Changing the RPM has an impact on flow.

Inflow/outflow pressures

These values represent the pressures of the inflow and outflow cannulas. Knowing the difference between these may be helpful. High inflow pressures can cause “suction events”, when the cannula suctions against the inside of the vessel, causing drastic drop in flow.

Sweep and FiO2

Sweep is the setting that controls how much CO2 the ECMO machine removes from the blood. Our system has 2 dials that control sweep; one for larger adjustments and one for fine-tuning. Right next to the sweep control is the oxygen mixer, which controls the FiO2. Obtaining optimal oxygen saturations, PaO2 and pCO2 levels is a balance between the ventilator and the ECMO machinery.

Anticoagulation

Running high volumes of blood through artificial circuitry increases the probability of thromboembolism. Patients must be anticoagulated. This is often done with a heparin or bivalirudin drip, with concomitant monitoring per institutional protocol.

Prophylactic antibiotics

Foreign bodies can be a nidus for infection. Patients may stay on ECMO for weeks or months, and infection is always a concern. Consider starting your patient on empiric antibiotics to help prevent this. Cefazolin and vancomycin are a common combination.

Other information to consider

  1. Ventilator: Not all ECMO patients are on a ventilator, but those who are require balancing ventilator settings with ECMO settings to provide appropriate oxygenation and ventilation.
  2. PA catheter: Select patients may have Swan-Ganz catheters in place, allowing for continuous monitoring of hemodynamic parameters including cardiac index, wedge pressure, pulmonary artery pressures and CVP.

Labs

  1. SVO2 and ABGs can be drawn from both the patient and from the ECMO circuit and compared. This is usually scheduled multiple times per day, with more frequent checks as needed with any change in clinical status. Pay close attention to where the blood gas was drawn as there can be big difference between right and left arms depending on the location of the mixing cloud.
  2. Lactate provides an assessment of global flow

Tue, Apr 4 10:45am · Stick, glue and cone for ear foreign bodies

Author: Jonathan Thornston, M.D.

A 3-year old boy is transferred from an outside facility for ENT consult after failed removal of a foreign body in the left ear. The patient was sedated but the object was unable to be removed with suction or forceps. The patient is in no distress and has an obvious lime green foreign body in the left ear.

 

In this case we knew the extraction would be difficult and conventional maneuvers were unsuccessful with forceps and suction despite sedation.  When typical strategies fail, we have used a novel technique for certain cases that we have had great success although with a limited number of cases. I have personally used this method 3 times and it has worked perfectly each time.

 

The Stick+Glue+Cone Method

  1. Have the patient lie on their side with the affected ear up
  2. Visualize the foreign body with otoscope
  3. Remove the otoscope but leave the speculum in place showing only the foreign body at the end of the speculum. You can use an overhead procedure light or head lamp to help with visualization at this point.
  4. Apply medical glue to the tip of a Q-tip and immediately insert into the speculum making light contact with the foreign body.
  5. Wait 30 seconds and remove the entire apparatus.

 

This method should only be used in certain circumstances. There is a risk of getting medical glue in the ear canal or worsening the impaction by gluing the object in place although this is why we use the speculum to reduce this risk. The patient will need to be able to be calm and not move, again to reduce the risk of glue where you don’t want it. This will work best with smooth objects where you can get the speculum flush on the surface to make a seal.  As always, you should discuss the risks and benefits with the patient. If you or the patient are uncomfortable at all, use an alternative method or consult ENT for removal with a microscope.

Using the Stick+Glue+Cone method above, I was able to remove a green plastic gem from the child’s ear in less than a minute, saving a consultation with ENT. Consider this method when you have a calm patient and an easily visualized foreign body with smooth surfaces.

 

 

We have discussed this technique with the ALiEM team here:

https://www.aliem.com/2015/trick-of-the-trade-ear-foreign-body-removal-with-modified-suction-setup/

and here

Wed, Mar 15 6:28am · Mayo Clinic EM at SAEM 17


WEDNESDAY MAY 17

1:00- 2:30 PM

Oral Presentation

Patients with a history of Heart Failure receive less fluid during sepsis resuscitation  

Ine Oppedal, Bo Madsen, Casey Clements (

 

1:00- 2:30 PM

Oral Presentation

What factors are associated with patient engagement in low-risk ED chest pain patients? A secondary analysis of a multi-center randomized controlled trial.

Craig Tschautscher, Marc Probst, Christine Lohse, Erik Hess

 

1:00- 2:30 PM

Oral Presentation

Effectiveness of a Decision Aid in Vulnerable Populations: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial. 

Rising KL, Hollander JE, Schaffer JT, Kline JA, Torres CA, Diercks DB, Jones R, Owen KP, Meisel ZF, Demers M, Herrin J, Hess EP.

 

1:00- 2:00 PM

Moderated ePoster

Impact of pharmacist bedside tPA admixture for ischemic stroke in the emergency department 
Alicia E. Mattson, Kristin J. Scherber, Sarah L. Clark, Maria I. Rudis.

 

3:00 – 4:00 PM

Moderated ePoster

Epidemiology of Pediatric EMS Transport of a Privately Insured Population

Jana Anderson, Molly Jeffery, Lucas Silva, Erik Hess, M. Fernanda Bellolio

 

3:00 – 4:00 PM

Moderated ePoster

All ED Interruptions are not the same: a study of pattern,

Heather Heaton, Hunter Hawthorne, David Nestler, Tom Hellmich, Varghese, Susan Hallbeck, Mustafa Sir, Kal Pasupathy, Renaldo Blocker

 

4:00 – 5:00 PM

Oral Presentation

Use of Apneic Oxygenation during Endotracheal Intubation: A Systematic Review and Meta-analysis

Lucas Silva, Daniel Cabrera, Patricia Barrionuevo, Rebecca Johnson, Patricia Erwin, M. Hassan Murad, M. Fernanda Bellolio

 

THURSDAY MAY 18

8:30 – 9:30am

Moderated ePoster

Motocross-associated Head and Spine Injuries in the Emergency Department

Lucas Silva, M. Fernanda Bellolio, Elisa Smith, Christine Lohse, Ronna Campbell

 

9:00 – 10:00 AM

Lightning Oral

The effect of two different tourniquet techniques on peripheral IV access success rates

Tobi Kummer, Theresa Tran

 

10:00 – 11:30 AM

Oral Presentation

Opioid Prescribing for Acute Pain in the ED

Molly Jeffery, Fernanda Bellolio, Joe Henk, Nilay Shah, Shelley McLeod, ‎ Bjug Borgundvaag, Erik Hess

 

10:00 – 10:50 AM

Didactic: To Err is Human: Apologizing in the Emergency Department

Annie Sadosty

 

1:00 – 2:00 PM

Oral Presentation

Performance Characteristics of the Modified Sgarbossa Criteria for Diagnosis of Acute Coronary Occlusion in Emergency Department Patients with Ventricular Paced Rhythm and Symptoms of Acute Coronary Syndrome

Kenneth Dodd, Brett Boggust, Jennifer White

 

4:00 – 5:00 PM

Lightning Oral

Older Age is Associated with Less Intensive Emergency Medical System Service Response Among the Elderly

Molly Jeffery, Jana Anderson, Lucas Myers, Lucas Silva, Anu Luke, M. Fernanda Bellolio

 

4:30 – 4:50 PM

Didactic: To bend but not break: the effect of stress in simulation training

Torrey Laack

 

FRIDAY MAY 19

8:00 – 8:20 AM

Didactic: Bringing State-of-the Art Real-Time-Location-System to the ED – Lessons Learned

Heather Heaton, Dave Nestler, Tom Hellmich

 

9:00 – 10:00 AM.

Lightning Oral

PREDICTing mortality in the emergency department: external validation of a clinical prediction tool

Rajat Moman, Caitlin Loprinzi Brauer, Katherine Kelsey, Rachel Havyer, Christine Lohse, M. Fernanda Bellolio

 

10:30 – 11:30

Moderated ePoster

Improved Critical Care Documentation with Triggers and Transparency

Richard Winters

 

11:30 – 11:50

Didactic: Receiving Feedback: Put Yourself In the Driver’s Seat

Jennifer Hess

 

1:00 – 1:50 PM

Didactic: Obtaining an Academic Emergency Medicine Position: A Department Chair’s Perspective

Annie Sadosty

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