February audio is posted

This month’s Annals audio, a look at the national report card on EM, is now posted and available. Highlights:

-The American College of Emergency Physicians has released their comprehensive national and state-by-state report cards on the status of emergency medicine in the United States. We do a brief summary and review.

-The new College clinical policy on procedural sedation and analgesia.

Email any time at annalsaudio@acep.org, and download the audio to get the goods and stay up to date.


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By Bruce D Janiak, MD, FACEP

A 40-something female came into our ED with some confusion, low BP, and tachycardia. EKG and labs were normal, but she continued to deteriorate despite appropriate treatments. The cardiology fellow was with me when she arrested, and despite ACLS protocol, we were unsuccessful in our resuscitative efforts. She was pronounced dead.

As the cardiology fellow and I were discussing her case outside of the room, the monitor began to show a spontaneous rhythm. She regained a pulse and BP and was admitted. Later that day she arrested again and after unsuccessful efforts was pronounced dead (again)!

Then she revisited her Lazerus process and spontaneously recovered.

Some two weeks later she came to the ED to see me saying “Dr Janiak, thanks for your efforts. I could hear you guys talking about me during the whole resuscitative process”

(Yes, this really happened!)


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Annals audio, Jan 2014 is here

Sorry for delays, sometimes we get all technical…. But the January audio is here! Highlights:

-Cricothyrotomy techniques: a comparison
-Two hand versus one hand BVM ventilation, which one works best?
-Can looking at the RV with bedside ultrasound help diagnose PE?
-Surviving sepsis: an update
-Lit review: can febrile neutropenics go home?
-Late bleeding after crotalid envenomation: how often?

…and more!
Check out the audio, and email any time annalsaudio@acep.org.

David & Ashley

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Be An Official ACEP Central Line Blogger

When something interesting happens in the ED, you tell friends about it.

When a clinical study or great article comes out, you discuss it with other emergency physicians. Why not tell this work-related stuff to 33,000 people who know you best? Say it right here on The Central Line blog. The Central Line is ACEP’s official blog, and to get your blog posted, send your thoughts to this email address.

Once you become a regular, we’ll offer up the keys to the store and let you post directly. Get started!

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2014 EM Report Card Released

Jon Mark Hirshon, MD, MPH, PhD, FACEP

By Jon Mark Hirshon, MD, MPH, PhD, FACEP
Report Card Task Force Chair

With the release of the 2014 ACEP Report Card on Emergency Medicine, the nation learns how well each state supports emergency medicine and your emergency department.

The nation received an overall grade of D+.

ACEP has produced Report Cards in 2006 and 2009 to evaluate the overall emergency care environment both nationally and on a state by state basis. This is not a report on the emergency care delivered in any specific hospital or by any individual physician, but rather an evaluation of how well the country supports emergency care.

The 2014 Report Card is based on 136 objective measures in five areas:

  • Access to Emergency Care (30%)
  • Quality & Patient Safety (20%)
  • Medical Liability (20%)
  • Public Health & Injury Prevention (15%)
  • Disaster Preparedness (15%)

It reflects the most recent data available from high-quality sources such as the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Centers for Medicare & Medicaid Services, and the American Medical Association. Additionally, two surveys were sent to state health officials to gather data for which no reliable, comparable state-by-state sources were available. These data elements were then combined to create the components of the Report Card.

Since 2006, ACEP chapters have used the Report Cards to help with the establishment of new emergency medicine residency programs, support the funding of a statewide trauma system, to help with the enactment of liability protection for federally mandated EMTALA related care, and to increase awareness of emergency medicine issues among state and national lawmakers. We plan to use the 2014 Report Card to educate policymakers and the public about the pivotal role of emergency medicine, help change the conversation from preventing “expensive” emergency visits to protecting access to emergency care, and use communications tools to achieve the national and state recommendations of the Report Card in order to improve the emergency care environment.

To access the most current state by state information, including state and national grades, and to be able to compare the 2014 Report Card with the previous Report Card, please visit: http://www.emreportcard.org/

-Jon Mark Hirshon, MD, MPH, PhD, FACEP
Report Card Task Force Chair
Dr. Hirshon is Board Certified in both Emergency Medicine and Preventive Medicine and has authored approximately 75 articles and chapters on various topics, including the development of public health surveillance systems in emergency departments and placing emergency care on the global health agenda. He has a doctorate in epidemiology and is a federally funded researcher and teacher with specific interest in improving access to acute care and in developing emergency departments as sites for surveillance and hypothesis driven research in public health.


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Annals Q&A With Dr. Jeremy Brown, Director of the Office of Emergency Care Research

Dr. Jeremy Brown

Dr. Jeremy Brown is the director of the newly created Office of Emergency Care Research (OECR) at the National Institutes of Health (NIH). He trained as an emergency physician in Boston, and prior to joining the NIH he worked in the Department of Emergency Medicine at the George Washington University (GW) in Washington, DC. While at GW, he founded the emergency department (ED) HIV screening program and was the recipient of 3 NIH grants that focused on a new therapy for renal colic. He continues to teach at GW on the practice of clinical research, as well as teaching a course on science and religion. He is the author of more than 30 peer-reviewed articles and 3 books, including 2 textbooks of emergency medicine, all published by Oxford University Press. Annals News & Perspective editor Truman J. “TJ” Milling Jr., MD, interviewed Dr. Brown in his Bethesda, MD, office, on the importance of the OECR and how he plans to use his new position to coordinate and grow emergency research within the NIH. His comments have been edited for clarity.
Read the Q and A here

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ABEM Loses Power, Extends MOC Deadlines

Editor’s Note: Power distributions from an ice storm have impacted business at the American Board of Emergency Medicine, and they have asked ACEP to help spread the word about their special circumstances.

A significant ice storm on Dec. 22 caused power and communication outages with the ABEM headquarters. These disruptions are continuing while the utility companies actively work on restoring dependable service. Please be advised that intermittent disruptions are possible during the next several days. ABEM apologizes for any inconveniences physicians may have encountered in trying to reach its office or website services.

All December 31, 2013, deadlines for completing MOC activities and PQRS MOC Additional Incentive Payment requirements have been extended to January 10, 2014, 11:59 p.m., EST.

Holiday Hours
The ABEM office will be closed from Dec. 25, 2013, through Jan. 1, 2014.

However, contingent upon the restoration of the power and communication outages the ABEM office is currently experiencing due to the ice storm, staff will be available on December 26, 27, 30, and 31 from 8:30 a.m. to 4:30 p.m. EST to provide assistance with ABEM MOC requirements.

Questions about your ABEM MOC requirements can be sent to MOC@abem.org, or you can call 517.332.4800 for assistance during the times noted.


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ACEP Member Dr. Donna Carden of Florida Awarded PCORI Research Funding

The University of Florida’s Dr. Donna Carden has been approved for PCORI funding for her research, “An Emergency Department-to-Home Intervention to Improve Quality of Life and Reduce Hospital Use.” Dr. Carden will lead one of 82 research projects approved for PCORI funding to help answer the question: “How can clinicians and the care delivery systems they work in help patients make the best decisions about their health and healthcare.”

Dr. Carden: “The transition from the emergency department (ED) to home can create patient confusion and anxiety and lead to a cycle of repeated, costly and preventable ED visits and hospital admissions, especially for older patients with chronic health problems. There is an urgent need, therefore, for more patient-centered management of patients discharged from the ED. Our research team (patients, caregivers, Area Agency on Aging staff, physicians, health-system managers, researchers) proposed the following question: Compared to usual, post-ED care, can an intervention deployed after an ED visit that links chronically ill patients with community-based social- and medical-support improve quality of life and reduce the need for additional ED visits and unnecessary hospital admissions? We expect the proposed community-based intervention to have a positive impact on patient-reported quality of life and to reduce the likelihood of return ED visits and hospital admissions. The knowledge gained from this work has the potential to contribute to a broader understanding of how post-ED transition interventions can be tailored to reduce healthcare disparities for vulnerable populations, improve healthcare quality and reduce healthcare costs.”

By providing support and funding to pilot-test the proposed, community-based intervention, Dr. Carden said that ACEP and EMF contributed substantially to the success of this PCORI application.

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Bat In The Sack


By Constance Doyle, MD, FACEP

She came in with a chief complaint of “needs rabies shot”

Her story: She said she was placing clothes in the washer when something bit her on the hand.  She looked to see if her cat was in the washer and seeing that she was not, slammed the lid and ran the wash twice to be sure that whatever animal it was dead.

Then carefully looking through the clothes while putting the clothes in the dryer, she found a limp and dead bat which she fished out with kitchen dishwashing gloves.  At that point, she pulled a paper sack out of her handbag and set it on the counter.  We went on with the physical and discussion of rabies testing and vaccine, when I noticed the bag was slowly moving in and out like something was breathing and the sack was rattling.  I had visions of the creature getting out and flying all over the ER, being a nightmare to catch, exposing both staff and other patients as well as becoming a liability for the hospital.  The normal bat containers, empty paint cans were in storage, and I knew that someone would have to go to the locker and get one taking at least 15 minutes.   I needed a container now.  I ran next door to the trauma room and grabbed a large suction canister and lid and put the sack in it.  Now to humanely be sure that the bat was not a threat, we found a bottle of alcohol and poured it in through the suction hose connection.  At least it could die in an alcohol stupor.  The bag stopped moving and the paint canister arrived and the whole canister fit inside without opening it and off to the health department.

You just can’t make this stuff up!

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December Annals Audio posted

The December audio issue of Annals of EM is now posted and available. Highlights include:

-New onset atrial fibrillation — should we anticoagulate in the ED?
-Atrial fibrillation in the ED: trends in Canada
-Review: High sensitivity troponins
-Capnography to diagnose PE: meta-analysis
-Observation is associated with less imaging for pediatric minor head injury
-Pediatric magnet ingestions
-Review: reversing warfarin in the ED

Email us at annalsaudio@acep.org, any time.


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