Fever in Returning Traveler - Resident Journal Review

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Authors: Megan Donohue, MD MPH; Phil Magidson, MD MPH; Erica Bates, MD; Adeolu Ogunbodede, MD; Mark Sutherland, MD; Akilesh Honasoge, MD
Editors: Michael C. Bond, MD FAAEM and Kelly Maurelus, MD FAAEM
Originally Published: Common Sense November/December 2016

With increasing frequency of international travel, EMPs often find themselves caring for travelers who return ill. According to the International Society of Travel Medicine global surveillance network, fever was the chief complaint in approximately one third of ill travelers. The care of these patients may be challenging given the broad differential diagnosis that must be considered, including many illnesses that are uncommon in the US. This article provides a review of the literature on the epidemiology of febrile illness in the returning traveler and offers an approach to the initial evaluation, management, and diagnosis.

Tox Talks: A Case of (Very) Long QT

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Author: Ashley Grigsby, DO
Indiana Univeristy
AAEM/RSA Social Media Committee

Case
A 42-year-old female presented to the emergency department with her husband for new episodes of apnea that had been occurring over the last few days. She currently felt well and review of systems was negative except for possible jerking movements that had been occurring prior to the apneic episodes. She had no history of seizures. Past medical history included untreated Graves’ disease. She was not on any prescription medications. Physical exam was unremarkable, including a normal neurologic exam. Laboratory evaluation was significant only for hypokalemia of 2.9 mEq/L, ionized calcium of 1.1 mg/dL, and low thyroid stimulating hormone (TSH). Electrocardiogram (EKG) was obtained and is shown below.

The patient’s QTc was greater than 700 msec on initial EKG and QRS was widened at 126 msec. On further questioning, the patient admitted to taking 160 mg of loperamide daily to treat her opioid addiction. She was admitted to the intensive care unit (ICU) for cardiac monitoring, electrolytes were aggressively replaced, and loperamide was held. Her QTc decreased from greater than 700 msec to 520 msec and she was discharged home in good condition.

How to Be an Effective Leader in the ED

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Author: Meaghan Mercer, DO
2013/2014 AAEM/RSA President
Originally Published: Common Sense November/December 2013

Leadership is creating a way for people to contribute to making something happen, developing an environment that allows cohesion and a drive toward a common goal. Leadership affects our lives on a constant basis and our role in the hierarchy changes as we shift from one environment to another: parent, boss, teacher, mentor. Leadership is a skill and learned behavior that becomes second nature over time and is important to cultivate, especially when working in the emergency department. In the ED we orchestrate the movement and flow of patients, staff, and resources, in a delicate yet chaotic balance. As we progress through residency, we gain the leadership skills to manage all the pieces until we unconsciously and fluidly become leaders in the field.

Putting the Focus Back on Diagnosis

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Author: Leana S. Wen, MD MSc
AAME/RSA 2010 Resident Editor
Originally Published: Common Sense September/October 2010

Last week, Jerry got the scare of his life. Jerry is a 48-year old mechanic who is in good health. His parents are healthy, and he recently got a “clean bill of health” during his annual check-up. Over the weekend, he helped his brother move across town. Monday morning, he woke with tightness in his chest. He described it as a “spasm” and thought that he might have pulled something while he was lifting the sleeper sofa. But someone in his neighborhood had a heart attack recently, and Jerry’s wife persuaded him to go to the ED to get it checked out.

Getting the Most Out of Residency

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Author: Meaghan Mercer, DO
2014-2015 RSA President
Originally Published: Common Sense September/October 2014

As I enter my third year of residency, the end of training is becoming more of a reality every day. I have received many pearls of wisdom along my path from medical students to residents to soon-to-be-attendings. With less than a year to go, I remind myself every day that I should make the most of each day of my education — and I hope you will do the same. A huge thank you to the members of AAEM/RSA, who really have been with me all the way. Reflecting on these past few years, I want to share some advice that has helped me succeed.

Haney Mallemat on Technology’s Role in EM Education and Training

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Author: Ali Farzad, MD, AAEM/RSA Publications Committee Chair
Author: Linda J. Kesselring, MS, ELS, Copyeditor
Originally published: Common Sense July/August 2013

This article marks the last of a series that has aimed to highlight how you can use simple technology to make your learning more efficient and effective. In previous interviews with leaders in emergency medicine (EM) education — Drs. Mel Herbert, Amal Mattu, and Scott Weingart — we learned the value using free websites, blogs, podcasts, and ECG videos to stay current with medical information and save more lives. Continuing that theme, I recently had the pleasure of interviewing Haney Mallemat, MD FAAEM (@criticalcarenow), an EM/IM-trained critical care specialist who works in the adult emergency department at the University of Maryland Medical Center as well as the critical care ICUs in the R Adams Cowley Shock Trauma Center in Baltimore, Maryland.

A Real Case of Broken Heart: Takotsubo Cardiomyopathy

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Image Credit: Flickr

Author: Alexandria Gregory, MS3

Saint Louis University School of Medicine

AAEM/RSA Social Media Committee 

Author: Eric Goedecke, DO  

Milford Regional Medical Center

Overview
An 80-year-old female with a history of chronic obstructive pulmonary disease (COPD), high cholesterol, and hypertension presented to the emergency department (ED) with a two-day history of shortness of breath. She also reported mild left-sided chest pain, but had no cough, fever, or calf pain. She had no history of deep vein thrombosis (DVT) or pulmonary embolism (PE), though she recently traveled from Massachusetts to Florida via airplane, and returned on the day her symptoms began. The patient had quit smoking over ten years prior to her presentation in the ED. She had been using her inhalers, prescribed for COPD, frequently with minimal improvement.

Board Review: Rabies Exposure

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Author: Alexandria Gregory, MS-3
Saint Louis University School of Medicine
AAEM/RSA Social Media Committee

A 16-year old male presents to the emergency department (ED) after a potential exposure to a bat while sleeping in a barn. He believes his friend may have been bitten by the bat, but did not have any known contact with the bat himself. The bat could not be found after the incident. The patient has not noticed any skin changes and has no other physical complaints.