Researching Osteopathic Emergency Medicine Programs

This post was peer reviewed.
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Author: Muhammad Alghanem, MSIV
Medical Student
Midwestern University - Chicago College of Osteopathic Medicine

If you’re an osteopathic medical student interested in emergency medicine, you may be wondering where to find information specific to osteopathic residency programs. Some general facts, such as the universal four year length of the residency curriculum, may be common knowledge even to those just starting to explore their interest in emergency medicine. However, more program specific information may be harder to come by.[1] Taking the initiative to learn about the resources and opportunities available to you can help you prepare for the application process. In this post, you’ll find some basic insights into researching osteopathic emergency medicine programs.

Tox Talks: Drug Induced Noncardiogenic Pulmonary Edema

Author: Ashley Grigsby, DO, Indiana University

Noncardiogenic pulmonary edema (NCPE) is a clinical entity consisting of alveolar fluid accumulation without evidence of cardiac cause.[1] Although there are many non-toxicologic causes of NCPE, both opiate overdose and salicylate toxicity are known to cause NCPE and should be part of one's differential diagnoses.

Opiate overdose induced NCPE was first recognized by William Osler in 1880.[2] It can occur with any opioid, including heroin and methadone. Although the pathophysiology of this phenomenon is not yet completely understood, it is believed that both direct drug toxicity and hypoxia induced alveolar permeability play a role in the development of pulmonary edema.[1,2] New users and males are more at risk to develop NCPE than other opiate users. Symptoms become clinically apparent within 24 hours of use, but usually manifest within four hours.[2,3] Treatment for NCPE in these patients is mostly supportive. In one case series, approximately 33% of patients required mechanical ventilation; fortunately, most are able to be extubated within 24 hours as the effects are short lasting.[1] Naloxone may be beneficial in these patients to reverse the opioid toxicity. Patients who present with respiratory failure from opiate overdose should be observed for development of pulmonary edema, even if reversed with naloxone.[2]

Interviewing Tips for Emergency Medicine Residency Positions

Via Flickr - Creative Commons

Authors:
Andrew W. Phillips, MD MEd
Gregory Wanner, DO PA-C

This is not peer reviewed … This is not evidence based … This is based on nothing more than our own meandering experiences that we thought may be helpful at this time of year. We invite comments below the post from everyone — students, residents, and attendings. Share your recommendations and experiences.

1) Research the program ahead of time.
Not just for 10-15 minutes, but for 2-3 hours. Know the programs leadership by their faces. Know the faculty you would seek as mentors based on their posted biographies. When you receive your interview schedule upon arrival, try to step aside during down time and look up information about your interviewers. Most interviewers know what is on their program’s website — so should you.

2) Contact medical school alumni who went into emergency medicine.
Get to know them if you don’t already. You never know what a good word from the inside can do when trying to get an interview or on the wait list. They can also give you a candid perspective on programs and their experiences.

Determining Brain Death: Updated Guidelines and Ancillary Testing

This post was peer reviewed.
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Author: Sean Weaver, DO MPH
Emergency Medicine Resident
University of Nevada, School of Medicine

The following blog post appeared initially at www.lasvegasemr.com/foam-blog and is reproduced with the permission of the author.



Introduction
Last week we reviewed the original 1995 criteria for declaring brain death. This week we are reviewing updated standards as outlined by the American Academy of Neurologists (AAN). Also, this post reviews some of the ancillary tests that EM physicians may be asked to order in order to evaluate for possible brain death.

Updated Evidence-Based Guideline: Determining Brain Death in Adults[1]
In 2010 the American Academy of Neurology published an evidence-based review of the original 1995 guidelines on determining brain death. They reviewed the existing literature and sought to answer five questions listed below. This is a brief summary of their conclusions.

Determining Brain Death: Legal Definition and Original Guidelines

This post was peer reviewed.
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Author: Sean Weaver, DO MPH
Emergency Medicine Resident
University of Nevada, School of Medicine

The following blog post appeared initially at www.lasvegasemr.com/foam-blog and is reproduced with the permission of the author.  

 
Introduction
Brain death accounts for 1-2% of all deaths in the United States.[1] Patients will present to your emergency department clinically brain dead. While neurologists, neurosurgeons and intensivists may have more experience in determining brain death, all physicians have the legal authority to determine brain death.[2] As emergency physicians we need to know how to properly evaluate these patients, assess their level of brain function, guide their disposition, and prepare their family or loved ones for the eventual outcome.

Increasing the Paper Speed in Narrow-Complex Tachycardia

Normal paper speed (25mm/s)

Authors: Destinee DeLemos, MD
Nathan Haas, MD
University of Michigan Department of Emergency Medicine





Narrow complex tachycardia often presents a diagnostic and therapeutic dilemma, and one simple trick can help in the correct identification of the underlying rhythm. With increasing heart rates, it becomes quite challenging for the emergency physician to distinguish between sinus tachycardia, paroxysmal supraventricular tachycardia (pSVT), atrial fibrillation and atrial flutter. If the underlying rhythm is not pSVT, an unnecessary adenosine trial can prove quite unpleasant for both the patient and physician.

Increased paper speed (50mm/s)
Images Courtesy of Amal Mattu, MD FAAEM

Standard 12-lead EKGs are printed at 25mm/second. By simply doubling the paper speed to 50mm/second, the printed rhythm strip appears widened and exaggerated, which can aid in identifying finer details of the EKG. The images in this post demonstrate previously hidden flutter waves becoming more apparent at an increased paper speed.