Conference Introduction- Dr Shaw

• Expectations
  • Come prepared
  • Deliver as if you are giving it at a regional/national meeting
  • Stay within time frame given
• Changes to conference for this year ***Full details in e-mail***
  • Will be given 2 days a semester (6 month period) that you can attend via Zoom
    • recurring meeting ID and password in e-mail
    • Please keep camera on during conference
    • Allowed 2 conference days a semester that you can attend via Zoom
    • FOAMed on 3^rd Thursday of each month
    • Will continue journal club during conference
    • EMCAT (the Emergency Medicine Curriculum Assessment Tool)
      • Link in email
      • Eval_Session_ID is the date of the lecture, followed by the presentation title, followed by presenter
      • Evals are anonymous but please keep professional
      • Conference curriculum will be online, link in email (word document will still be sent each month via email)

Sedation in the ED – David Roy, PharmD

• Know dosing, adverse effects, and benefits of the following sedatives:
  • Benzodiazepines
    • Provide amnesia, anxiolysis, and sedation but no analgesia
    • Drawbacks: respiratory depression, apnea, hypotension, variable response
  • Propofol
    • Reduces ICP and has anticonvulsive properties
    • Drawbacks: hypotension, myocardial depression
  • Ketamine
    • Amnestic, analgesic, sympathomimetic properties
    • Utility in pts with asthma/COPD, hypotension, status epilepticus
    • Look for nystagmus as sign achieved dissociation
    • Drawbacks increased secretions, caution in CV disease (hypertension, tachycardia)
  • Etomidate
    • Remember 15 (onset 15 secs, duration 15 minutes)
    • Hemodynamically neutral
    • Drawbacks: adrenal suppression, myoclonus
• Practicing using different agents during residency to get comfortable with them
• If remember RSI dosing, procedural duration doses are typically half and duration typically half as well

How to: Room 9 – Dr. Turner

• Familiarize yourself where equipment and supplies are located
• Examples of types of patients needing room 9: unconscious patients, GSWs(examine head to toe for wounds if rolling out), stab wounds, open fractures, STEMIs, and strokes
• familiarize with level 1 criteria and understand it’s purpose
• Provider roles: as intern -primarily US/procedures, upper level – team leader
• have a system that works for you and do it the same every time
• review imaging as soon as possible on these patients, don’t wait for the radiologist
• if you roll out patient, it is your patient

Transfer of Care, Dr. Platt

• happens more than you think! A patient can have multiple transfers of care for during ED stay
• good TOCs are clear, brief, timely, and complete
• for sample verbal handoff structure, look up IPASS
• use transfer of care note in Cerner at during sign-outs
• watch your tone and bias when talking to consults
• lead/frame the consult the way you want patient care to go
• if consulting medicine, be direct that you are consulting them for “admission”

US Basics, Jessica Kotha

• US generally safe. However, in first trimester, use M mode (not doppler) when calculating fetal heart rate
• linear probe (high frequency ), good for veins, soft tissue, ocular exam
• curvilinear probe (lower frequency) sacrifice resolution for depth, RUSH Exam
• Basic modes: 2-D (B-mode), M-mode (motion), doppler (Color, power)
• types of artifacts (posterior acoustic shadowing, reverberation, mirroring, etc)
• troubleshooting images: try more gel or pressure, adjust depth/gain
• RUSH exam: Heart, Inferior vena cava (IVC), Morrison’s/FAST abdominal views, Aorta, and Pneumothorax (HI-MAP).
• subxiphoid view- most sensitive for pericardial effusion
• familiarize yourself with findings of tamponade (diastolic RV collapse) as well as R heart strain for PE (RV dilation, McConnell’s sign)
• Look for lung sliding AND lung point when looking for pneumothorax
• measure aorta from outer wall to outer wall when evaluating for AAA