Acute Decompensated Heart Failure: What is the Current Evidence for Intravenous Diuretic Therapy? - Resident Journal Review

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Authors: Kaycie Corburn, MD; Lee Grodin, MD; Jackie Shibata, MD; Eli Brown, MD
Edited by: Jay Khadpe, MD FAAEM; Michael C. Bond, MD FAAEM
Originally published: Common Sense May/June 2015

The most common cause of hospitalization in the United States and Europe is acute decompensated heart failure (ADHF). ADHF is associated with high baseline mortality rates that only increase after hospitalization. Unfortunately, there is a paucity of high quality evidence for treating this disease. Both the European Society of Cardiology and the Heart Failure Society of America offer practice guidelines that are mainly based on Class C (consensus opinion) recommendations. The complicated pathophysiology of ADHF adds difficulty to finding treatments with both short and long-term benefits.[1] Currently, over 80% of patients hospitalized for ADHF receive IV diuretic therapy.[2] This article reviews key existing studies to examine the evidence for using IV diuretic therapy for patients with ADHF.

From Resident to Attending

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Author: Meaghan Mercer, DO
AAEM/RSA 2015-2016 Immediate Past President
Originally Published: Common Sense May/June 2015

As residency comes to an end, I realize that although I feel ready for life as an attending from a clinical standpoint, we are provided little education on life outside of academia. Many questions remain, such as: What tests do I have to take, what do I have to do to get credentialed, how do I stay up to date? As we transition back into the “real world” we have to acclimate to managing our own affairs.

ABEM.org
If you haven’t looked at the website, do it now. Initial application for the board exam (Qualifying Exam per ABEM terminology) lasts from May 1-November 5 and costs $960. Yes, you can and should apply prior to finishing residency. The qualifying exam will be administered November 16 - 21, 2015. Plan ahead to have ample time to study and have access to your desired date to take your exam. Once you pass your written exam you will then be given a date in the spring or fall of 2016 to take your oral board exam. After you pass the oral board you will be officially board certified for ten years. However, you are not done. To maintain your certification you must participate in maintenance of certification (MOC). Requirements in the first five full years of certification include the following: Passing four ABEM LLSA tests, one of which must be the patient safety LLSA; completing an average of 25 AMA PRA Category 1 CreditsTM or equivalent, with an average of eight of those credits being self-assessment; completing an Assessment of Practice Performance (APP) patient care practice improvement (PI) activity; and completing an APP patient-centered Communication/Professionalism activity. For more information go to www.abem.org.

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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Image Source: Wikipedia

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.