Thursday, November 30, 2017

Joint Statement from the Emergency Medicine Community on the Loss of Dr. Kevin Rodgers

November 27, 2017

Contact: Kay Whalen (
Executive Director
Phone: 800-884-2236

Milwaukee, WI - The following joint statement was released today by the American Academy of Emergency Medicine (AAEM), the AAEM Resident and Student Association (AAEM/RSA), the American Board of Emergency Medicine (ABEM), the American College of Emergency Physicians (ACEP), the American College of Osteopathic Emergency Physicians (ACOEP), the Council of Emergency Medicine Residency Directors (CORD), and the Society for Academic Emergency Medicine (SAEM).

The emergency medicine community would like to offer our heartfelt condolences to the family, friends, and colleagues of Dr. Kevin Rodgers.

Sunday, November 26, 2017

Dollars & Sense - Financial Planning for EM Residents

Author: Joel M. Schofer, MD MBA RDMS FAAEM
2014 Secretary-Treasurer, AAEM
2013-2014 President, Virginia AAEM
Commander, U.S. Navy Medical Corps
Originally Published: Common Sense July/August 2014

Dr. Schofer offers some excellent advice below, and his ongoing series on basic personal finance for emergency physicians is shaping up to be one of the best things Common Sense has published under my editorship. I hope all our residents and new attendings read it carefully.

Although I have done more things right than wrong, I have made a few painful financial mistakes in my 55 years. One of the two worst mistakes I made was buying "variable universal" life insurance rather than term insurance — one of the topics Dr. Schofer mentions below. The other was trading in an overseas wine futures market. That ended badly...

There is one other thing I feel compelled to mention. While most families ought to have 3-6 months of income saved for emergencies, as Dr. Schofer says, I believe emergency physicians should have 6-12 months of income saved in a fairly liquid, easily accessible form. Every single emergency physician is virtually guaranteed to lose at least one job unexpectedly, and most of us will lose more than one. Be prepared.

— Common Sense Editor

Thursday, November 23, 2017

Non-Invasive Positive Pressure Ventilation in the Treatment of Acute Respiratory Distress in the Emergency Department

Authors: Theodore J Segarra, Lee Grodin, Taylor Conrad, Ray Beyda, Kelly Maurelus, Michael C. Bond
Originally Published: Common Sense September/October 2017

Over the last decade, non-invasive ventilation (NIV), including both bilevel positive airway pressure (BPAP) and continuous positive airway pressure (CPAP) modes, has become an important tool in the management of ED patients with respiratory distress due to acute pulmonary edema (APE) and chronic obstructive pulmonary disease (COPD) exacerbations. Many studies have shown its utility in successfully reducing the need for intubation and reducing length of stay (LOS) in the ICU. Given these positive results, interest in NIV for patients with undifferentiated respiratory distress has increased but very few studies have compared the outcomes of using NIV for other causes of acute respiratory distress, such as asthma, pneumonia, malignancy, or interstitial lung disease. This review aims to discuss the current literature on the non-standard use of NIV for for other causes of respiratory distress in the emergency setting and to identify potential areas for further research.

Sunday, November 19, 2017

Updates in Pharmacology: Interactions and Adverse Effects of Psychiatric Medications

Authors: Erica Bates, MD; Philip Magidson, MD MPH; Robert Brown, MD; Megan Donohue, MD; Akilesh Honosage, MD
Editors: Michael C Bond, MD FAAEM; Kelly Maurelus, MD FAAEM
Originally Published: Common Sense March/April 2017

Over the past decade, the number of psychiatric medications dispensed has increased dramatically and now annually numbers in the tens of millions. As Emergency Physicians now frequently encounter patients on psychiatric medications, understanding potential complications and potentially life threatening reactions is necessary. This journal review covers common potential side effects, adverse reactions, and drug-drug interactions of various psychiatric medications commonly found in the ED.

Thursday, November 16, 2017

Advancing the Need to Reduce Unnecessary Antibiotic Treatment by Using the Biomarker Procalcitonin

Authors: Raymond Beyda, MD; Jackie Shibata, MD; Lee Grodin, MD; and Theodore Segarra, MD
Editors: Kelly Maurelus, MD FAAEM and Michael C. Bond, MD FAAEM
Originally Published: Common Sense January/February 2017

ED physicians frequently treat and admit patients for infectious diseases. Judicious use of antimicrobial therapy is important in order to avoiding the development of antimicrobial resistance and adverse drug effects. Procalcitonin (PCT) is one of several bbiomarkers which may be useful in decreasing unnecessary antibiotic therapy. Specifically, PCT levels should be low for viral, as opposed to bacterial, infections. Procalcitonin has been studied as both a diagnostic and prognostic marker in various types of systemic and organ-specific infections. The potential for PCT to reduce unnecessary antimicrobial therapy has been shown in several observational and randomized controlled trials performed in outpatient, inpatient, and ICU environments. The most robust evidence is in sepsis and pulmonary infections. Here we review some of the evidence behind the use of PCT in acute infectious disease management.

Sunday, November 12, 2017

Acute Heart Failure

Author: Daniel F. Leiva, DO, MS
Baystate Medical Center

Acute heart failure is a common and potentially life-threatening disorder the emergentologist should know well. In 2006 there were 5.1 million people living with heart failure in the United States and an estimated 23 million people worldwide.[1,2] Patients can present to the emergency department as a new, acute failure or an acute-on-chronic exacerbation. They typically complain of dyspnea, fatigue, paroxysmal nocturnal dyspnea, or orthopnea, the latter two of which are highly sensitive and specific.[3] Additional symptoms may include cough, chest pain, palpitations, tachypnea, peripheral edema, weight gain, or decreased exercise tolerance, depending especially on the presence of a precipitant. These can include volume excess, especially in renal or liver failure patients, sudden hypertensive states, acute myocardial infarction, myocarditis, pulmonary embolus, excessive exertion in a deconditioned state, changes to drug therapies, including the addition or removal of drugs or changes in dosages, and substance abuse.[3] The most important piece of history to establish in a patient is a previous diagnosis of heart failure. Consideration should be given to systolic dysfunction/heart failure with reduced ejection fraction (HFrEF) versus diastolic dysfunction/heart failure with preserved ejection fraction (HFpEF); left-sided versus right-sided heart failure; and high-output versus low-output failure, which can change the acute management of the patient.[4] Previous echocardiogram records may be beneficial in making this determination if available.

Thursday, November 9, 2017

Spinal Epidural Abscess vs. Cauda Equina Syndrome

This post was peer reviewed.
Click to learn more.
Image Credit: Wikipedia

Author: Patrick Wallace, OMS-IV
Rocky Vista University College of Osteopathic Medicine
AAEM/RSA Education Committee

Spinal Epidural Abscess
Spinal epidural abscess (SEA) is a potentially debilitating and life-threatening cause of low back pain. It occurs in 0.2 to 2 cases per 10,000 hospital admissions.[1-3] However, recent articles note the incidence is increasing as much as five-fold.[4,5] SEA most commonly occurs in the thoracic and lumbar regions.[4,6] The difficulty in diagnosing an SEA is due to the nonspecific symptoms that often mimic the more common benign low back pain complaints seen in the emergency department. Making the diagnosis prior to the development of neurological symptoms is rare, so this cause should always be considered in the differential.

Sunday, November 5, 2017

The Challenge of Identifying a Septic Joint

Authors: Raymond Beyda, MD; Lee Grodin, MD; Jackie Shibata, MD; Ted Segarra MD
Editors: Kelly Maurelus, MD FAAEM and Michael Bond, MD FAAEM 

Originally Published: Common Sense May/June 2017

The ED evaluation of patients with acute monoarthritis is often challenging given the broad differential diagnosis and significant morbidity which can result from missed septic arthritis (SA). The following articles aim to simplify the work-up of the undifferentiated hot and swollen joint.

Thursday, November 2, 2017

Updates in the Emergency Department Management of Acute Liver Failure

Authors: David Bostick, MD MPH; Megan Donohue, MD; Robert Brown, MD; and Nicholas Santavicca, MD
Edited by: Michael C. Bond, MD FAAEM and Kelly Maurelus, MD
Originally Published: Common Sense July/August 2017

Patients with chronic liver disease and acute liver failure have disease specific needs for which Eps must be cognizant. Below we review topics related to acetaminophen hepatotoxicity, use of rifaximin and lactulose in hepatic encephalopathy, and thromboelastography (TEG) directed transfusion in patients with liver disease requiring procedures.