ACEP SA Replay

What does leadership look like in emergency medicine? Based on the inspirational best-seller by Susan Cain, this presentation will take a close look at introverted and extroverted leadership in emergency medicine. The presenters will discuss and debate different types of leadership. They will speak to emotional intelligence, self-awareness and genuine leadership focusing on expectations of the ED and the hospital community. Find out who you are as a leader and recognize the beauty of different types of leadership.

What really happens to the patient who presents to the ED night after night? How can emergency medicine help the system coordinate care so as to prevent further ED visits and hospital admissions? The speaker will share innovative and proven strategies that will help you identify super-utilizers and create a coordinated discharge plan to prevent further recidivism.

Empathy is defined as the ability to understand the feelings and perspective of another person. There are numerous studies that have examined the science and art of empathy. Empathy has been proven to increase patient satisfaction and provider satisfaction. There are practical and simple techniques to increase empathetic behaviors even the chaotic setting of an ED. The audience will be able to apply these techniques easily on their next clinical shift for patient-centered bedside communication.

Join a panel of speakers in a “20 by 20” tour through the hottest topics in pediatric trauma. Clinical pearls and how to avoid pitfalls will be discussed during this non-stop course.

The identification and treatment of pediatric orthopedic injuries is an extremely difficult aspect of working in an ED due to the often paucity of radiological findings and relatively rarity of the conditions encountered. Yet we can’t miss these injuries. The speaker review the latest in pediatric orthopedics so that making that diagnosis will be a “snap”.

How much information should be presented to a patient prior to allowing them to leave the ED against medical advice? How should we assess the competence of a patient to make such a decision? When can the EP forcibly treat a patient? These questions, and others, will be explored in this course addressing the ethical, legal and public health complexities of patients who refuse medical care.

Trauma in 2015! Trauma management has been considered cook-book medicine, but there is still ongoing research to support changes in the management of patients. A review of this year’s top articles will be presented, with insight as to how to modify your standard of practice.

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). This is not a new concept but has been re-visited with advances in technology from the field of endovascular surgery. REBOA has the potential to positively influence outcome in the leading cause of death in trauma - uncontrolled hemorrhage. Balloon occlusion can be utilized proactively and without the need to resort to a highly invasive resuscitative thoracotomy. Come learn about REBOA and see how it may be useful in trauma management in the future.

Emergency medicine is a high risk specialty. Certain clinical entities, however, are predictable sources of bad outcomes and associated medical malpractice claims and lawsuits. The speaker will review common areas associated with risk in EM, reviewing the pitfalls of misdiagnosis and strategies to reduce risk to the patient and the provider. Medical malpractice cases will be utilized to illustrate key concepts.

Whether dealing with your teenager or the patient you see on your next shift, you have recognized that so much of communication is based in not what we say but how we say it. Whether it is simple thing like the way we dress to the more nuanced ways we focus our attention when we speak to patients, nonverbal communication is key to recognizing when a patient needs a bit more TLC, while being cognizant of your own nonverbal habits can radically change the way patients perceive you. Mindful communication strategies involving more than just what comes out of your mouth can greatly enhance your relationship with your patients and interactions with co-workers.

Over the past several years, there has been an explosion in the use of various social media platforms, podcasts, and various websites devoted to Emergency Medicine. The term FOAM, or free open access medical education, is used to broadly categorize these resources, which for the most part are available to all providers. While certain providers may be able to seamlessly integrate this growing body of information into their daily practice, many providers may be unfamiliar with or uncomfortable accessing and implementing this new world of information. In this course we hope to familiarize novice users with the world of FOAM. We hope to highlight various resources that provide easy access to these resources. In addition we hope to illustrate the overlap that is developing between FOAM and traditional CME for providers. Finally we hope to address the unique pitfalls and challenges that can occur when providers attempt transfer knowledge from online into clinical practice.

The literature on concussion has grown exponentially over the past decade. CTE (chronic traumatic encephalopathy), brain remodeling, return to play guidelines, and the connection of concussion to other diseases (e.g. ALS) are only beginning to be understood. Whether working in the ED or on the sidelines the Emergency Physician should be aware of literature based information on this controversial topic.

Confusion about cardiac arrest management and recent recommendations? Are there different interpretations of the guidelines and approaches to cardiac arrest care? This course is a friendly (and possibly not so friendly), high-level, dialogue of the major management strategies in the patient with cardiac arrest in the ED. The various issues discussed will include the importance of chest compressions and what CPR technique to employ, early defibrillation, airway management (when and if it is needed), the use of cardioactive (the "code drugs") medications, early post-resuscitative care, and factors influencing the decision to terminate resuscitative efforts.

Calling back patients has improves patient care, satisfaction, and safety. The speaker will discuss the use of post-discharge callbacks as a method to improve the patient experience and quality of care. Challenging questions will be addressed such as “how to handle the upset patient?” or “what can I leave on the voicemail?” Examples of scripting to address these areas will be utilized and ideally audience interaction can generate ideas, solutions to common questions. Finally, methods to obtain buy in, to track calls, and to promote compliance will be addressed.

During this interactive course, the speaker will review emergency medicine charts and discuss how wording factors into lawsuits. You will learn how specific charting can help avoid getting sued and/or win the case if there is litigation.

Patients with chronic abdominal disorders such as cyclic vomiting syndrome, irritable bowel syndrome, and gastroparesis can be challenging for emergency providers. When are symptom exacerbations indicative of more sinister pathology? What are the current recommendations for successful symptomatic treatment? When should we consider imaging in this population? The speaker will review the keys to successfully managing these patients in the emergency department.

This is a can’t miss life-threatening emergency for any emergency provider. Review the causes, pathophysiology, and treatment for thyroid storm and myxedema coma.

Starting a new job is exciting and full of opportunities. Whether you’re an experienced emergency physician or starting your first job out of residency, opportunities present themselves both in and out of the ED that could land you in hot water or lead to making a bad impression on your colleagues. This speaker will examine what to do and what not to do when starting a new job.

MUDPILES – a familiar pneumonic for the evaluation of the ED patient with a high anion-gap metabolic acidosis. The speaker will review how to apply this pneumonic to the ED patient and when to expand the differential diagnosis beyond MUDPILES.

Over the last two decades, the utilization of CT scan for nephrolithiasis has increased nearly 10 fold without an increase in diagnosis, stone complications or hospitalization rates. Recently clinical decision rule to determine which patients require CT imaging to exclude serious alternative diagnoses was published. Additionally, another recent study compared outcomes in patients with suspected renal colic randomized to either ultrasound or renal CT and found no difference in outcomes, but increased radiation exposure, length of stay, and cost with CT. In this case based interactive discussion the speaker will discuss the historical evidence behind increased CT use, the latest research, and a commonsense approach to the workup of renal colic.

Hyperoxia has been quoted as being independently associated with in-hospital mortality. Can the care we provide in the ED impact the patient’s outcome? Is there a “sweet spot” for oxygen titration? Should our therapy differ for patients status post cardiac arrest versus traumatic brain injured patients? Can we prevent the complications of oxygen toxicity?

"Pneumonia Alert! Did you order antibiotics?” the charge nurse asks you. It seems there is always some new process by which we identify patients with pneumonia, but what really is the current evidence behind the treatment of this common disease? The speaker will focus on the epidemiology of different types of pneumonia, including CAP, HCAP (HealthCare Acquired Pneumonia), HAP (Hospital Acquired Pneumonia), VAP (Ventilator Associated Pneumonia), review the current guidelines for diagnosis and management, and highlight antimicrobial resistance and antibiotic stewardship principles.

Emergency physicians deal with difficult conversations every shift. Whether it is resolving misunderstandings between provider and the patient/family regarding testing and treatment or discussing highly charged topics like “code status,” the ED physician must be expert in this “soft skill.” Using a case-based format with role playing exercises, the speaker will identify areas where ED physicians have difficulty with effective communication. The speaker will lead participants through scenarios where they will be provide scripting tools and key words to help negotiate difficult scenarios and facilitate a mutually agreeable plan.

Thoracic aortic dissection is an uncommon but extremely lethal condition that emergency physicians should be keenly aware of. Aortic dissection has a high mortality rate, and is commonly missed for a number of reasons. This presentation will highlight why the diagnosis is missed and what emergency physicians can do to decrease their miss rates.

It’s unusual to go through a shift without seeing a patient with shortness of breath. Many times the diagnosis is obvious – asthma, COPD, or CHF. But not always. Some patients will present with dyspnea from anemia, or a PE, cardiac tamponade, methemoglobinemia, or acute metabolic acidosis. The speaker will go through a systematic approach to the acutely dyspneic patient, to not miss the case that isn’t so obvious. Not-so-typical cases of dyspnea also will be presented.

High Flow O2 via a heated humidified Nasal Cannula (HFNC) has been reported to be useful in a hypoxic respiratory failure resulting from pneumonia, asthma, congestive heart failure, and pulmonary embolism. Additionally, HFNC effectively delivers a high FiO2 during pre-oxygenation for intubation, DNR/Palliative Care situations, and during invasive procedures such as EGD. In this case based discussion, the speaker will discuss the evidence behind and actual set up of HFNC, as well as common uses in the ED.

Diabetic ketoacidosis and hyperosmolar syndrome are the most common life-threatening complications of the growing epidemic of diabetes in the US. Timely recognition is essential to initiating appropriate management in the ED. Careful attention to fluid administration, electrolyte replacement, and insulin therapy is essential to reducing hospital length of stay and complications. During this case-based interactive discussion, the speaker will review cases of diabetic emergencies. Important similarities and differences in pathophysiology and management will be reviewed. Best evidence will be summarized in practical strategies to bring back to your ED.

Empathy is defined as the ability to understand the feelings and perspective of another person. There are numerous studies that have examined the science and art of empathy. Empathy has been proven to increase patient satisfaction and provider satisfaction. There are practical and simple techniques to increase empathetic behaviors even the chaotic setting of an ED. The audience will be able to apply these techniques easily on their next clinical shift for patient-centered bedside communication.

How does the expert clinician manage to sort through a sea of seemingly vague and disconnected complaints to pick up that rare but critically-ill patient whose condition is potentially devastating if missed? What clues do astute physicians hone in on and why? What tipped them off? Our patients don’t read the textbook ahead of time and rarely volunteer the key pieces of information needed to come up with the tough diagnosis. Test your skills as the presenter works through challenging cases. Will you sort out the clues and make the right call?