Publications by authors named "Michael Gottlieb"

418 Publications

Further considerations regarding lipid emulsion for LAST.

Am J Emerg Med 2022 Sep 16;59:170-171. Epub 2022 Jul 16.

Emergency Medicine, Brooke Army Medical Center, Fort Sam, Houston, TX, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.07.027DOI Listing
September 2022

Managing Temporomandibular Joint Dislocations.

Ann Emerg Med 2022 Jul 13. Epub 2022 Jul 13.

Department of Emergency Medicine (Long), Brooke Army Medical Center, Fort Sam Houston, TX.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2022.05.031DOI Listing
July 2022

Can't Stop, Won't Stop: The Return of Tranexamic Acid for Epistaxis.

Ann Emerg Med 2022 Jul 13. Epub 2022 Jul 13.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2022.04.032DOI Listing
July 2022

Just the facts: point-of-care ultrasound for the diagnosis and management of acute heart failure.

CJEM 2022 Jul 14. Epub 2022 Jul 14.

Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, NB, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s43678-022-00356-3DOI Listing
July 2022

Program evaluation: An educator's portal into academic scholarship.

AEM Educ Train 2022 Jun 23;6(Suppl 1):S43-S51. Epub 2022 Jun 23.

Faculty of Health Sciences McMaster University Hamilton Ontario Canada.

Program evaluation is an "essential responsibility" but is often not seen as a scholarly pursuit. While Boyer expanded what qualifies as educational scholarship, many still need to engage in processes that are rigorous and of a requisite academic standard to be labelled as scholarly. Many medical educators may feel that scholarly program evaluation is a daunting task due to the competing interests of curricular change, remediation, and clinical care. This paper explores how educators can take their questions around outcomes and efficacy of our programs and efficiently engage in education scholarship. The authors outline how educators can examine whether training programs have a desired impact and outcomes, and then how they might leverage this process into education scholarship.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/aet2.10745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222891PMC
June 2022

Local anesthetic systemic toxicity: A narrative review for emergency clinicians.

Am J Emerg Med 2022 Sep 13;59:42-48. Epub 2022 Jun 13.

Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA. Electronic address:

Introduction: Emergency clinicians utilize local anesthetics for a variety of procedures in the emergency department (ED) setting. Local anesthetic systemic toxicity (LAST) is a potentially deadly complication.

Objective: This narrative review provides emergency clinicians with the most current evidence regarding the pathophysiology, evaluation, and management of patients with LAST.

Discussion: LAST is an uncommon but potentially life-threatening complication of local anesthetic use that may be encountered in the ED. Patients at extremes of age or with organ dysfunction are at higher risk. Inadvertent intra-arterial or intravenous injection, as well as repeated doses and higher doses of local anesthetics are associated with greater risk of developing LAST. Neurologic and cardiovascular manifestations can occur. Early recognition and intervention, including supportive care and intravenous lipid emulsion 20%, are the mainstays of treatment. Using ultrasound guidance, aspirating prior to injection, and utilizing the minimal local anesthetic dose needed are techniques that can reduce the risk of LAST.

Conclusions: This focused review provides an update for the emergency clinician to manage patients with LAST.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.06.017DOI Listing
September 2022

Just the facts: point-of-care ultrasound in cardiac arrest.

CJEM 2022 Jun 30. Epub 2022 Jun 30.

Department of Emergency Medicine, Dalhousie University, Horizon Health, Saint John, New Brunswick, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s43678-022-00336-7DOI Listing
June 2022

Remote Collaborative Writing: A Guide to Writing Within a Virtual Community of Practice.

J Grad Med Educ 2022 06 13;14(3):256-259. Epub 2022 Jun 13.

is Associate Professor, Department of Medicine, Division of Emergency Medicine and Division of Education & Innovation, Clinician Scientist, MERIT, and Associate Dean of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4300/JGME-D-21-01108.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9200254PMC
June 2022

Diagnostic accuracy of point-of-care ultrasonography for intussusception in children: A systematic review and meta-analysis.

Am J Emerg Med 2022 08 15;58:255-264. Epub 2022 Jun 15.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.

Objectives: Ileocolic intussusception can be challenging to diagnose due to vague complaints, but rapid diagnosis and treatment can help prevent morbidity and mortality. Prior research has focused on radiologic ultrasound, with more recent studies focusing on point-of-care ultrasonography (POCUS). This systematic review and meta-analysis assesses the diagnostic accuracy of POCUS for children with suspected ileocolic intussusception.

Methods: PubMed, Embase, CINAHL, LILACS, the Cochrane databases, Google Scholar, conference abstracts, and bibliographies of selected articles were searched for studies evaluating the accuracy of POCUS for the diagnosis of intussusception in children. Data were dual extracted into a predefined worksheet, and quality analysis was performed with the QUADAS-2 tool. Data were summarized, and a meta-analysis was performed.

Results: Eleven studies (n = 2400 children) met our inclusion criteria. Overall, 14.4% of children had intussusception. POCUS was 95.1% (95% CI: 90.3% to 97.2%) sensitive and 98.1% (95% CI: 95.8% to 99.2%) specific with a positive likelihood ratio of 50 (95% CI: 23 to 113) and a negative likelihood ratio of 0.05 (95% CI: 0.03 to 0.09).

Conclusions: POCUS has excellent diagnostic accuracy for intussusception in children presenting to the emergency department.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.06.025DOI Listing
August 2022

Sex and race visual representation in emergency medicine textbooks and the hidden curriculum.

AEM Educ Train 2022 Jun 1;6(3):e10743. Epub 2022 Jun 1.

Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA.

Introduction: In addition to formal training, informal training often occurs through a hidden curriculum. As the hidden curriculum shapes the knowledge and values held by learners, we must consider its role in implicit bias. One example is through the selection of images used in formal instruction. This study aimed to examine the representation of sex and race among images in two textbooks in emergency medicine (EM).

Methods: We performed a cross-sectional study of the sex and race representation of figures in : and : . Two reviewers screened all images for inclusion, with disagreements resolved by a third reviewer. Images were excluded if they did not include visualized skin. Two reviewers independently reviewed each image and assessed the sex, race, and roles in the image. A third reviewer resolved any disagreements.

Results: A total of 959 images (Rosen's  = 377; Tintinalli's  = 582) met inclusion criteria. Race was estimated in 877 cases (91.3%). Of those, White individuals comprised 77.6% (95% confidence interval [CI] 75.0%-80.2%). Sex was estimated in 362 cases (37.7%). Of those images, males comprised 70.2% (95% CI 65.4%-74.9%), and females comprised 29.8% (95% CI 25.1%-34.6%).

Conclusion: There is a male sex and White race predominance in visual representation among two EM textbooks. We propose a call to action for the mindful selection of images in formal education to represent diversity, equity, and inclusion and close the gap between the formal and hidden curriculum.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/aet2.10743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9197153PMC
June 2022

Managing Elbow Dislocations.

Authors:
Michael Gottlieb

Ann Emerg Med 2022 Jun 16. Epub 2022 Jun 16.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2022.04.029DOI Listing
June 2022

What Is the Efficacy and Safety of Direct Oral Anticoagulants Compared With that of Vitamin K Antagonists in Patients With Cerebral Vein Thrombosis?

Ann Emerg Med 2022 Jun 16. Epub 2022 Jun 16.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2022.05.007DOI Listing
June 2022

A 10-year bibliometric analysis of publications in emergency medicine.

Am J Emerg Med 2022 08 9;58:215-222. Epub 2022 Jun 9.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL 60612-3833, USA.

Objective: Emergency medicine (EM) research is growing at a rapid pace. It is important to understand the scope and trends over time in order to identify gaps and future areas for growth. This study aimed to describe trends in scientific publications within EM over the past decade.

Methods: We searched the Web of Science database's Emergency Medicine category for all scientific publications published between 2010 and 2019. Data were presented via descriptive statistics. Inferential bibliometric analyses included clustering of the selected parameters of keywords, Keyword Plus, titles, and abstracts; Bradford's law to evaluate core journals, and the Sankey diagrams to evaluate the flows between research themes over time.

Results: We identified 32,858 articles written by 85,693 authors. The mean citations per document were 11. The top five countries with the highest number of publications were the United States (n = 42,221), Turkey (n = 6595), Canada (n = 6545), Australia (n = 5867), and China (n = 5322). The journals with the highest number of publications: the American Journal of Emergency Medicine, Journal of Emergency Medicine, Resuscitation, and Pediatric Emergency Care. The most frequent topics were cardiovascular emergencies, resuscitation, mortality, patient outcomes, emergency imaging, triage, education, and management.

Conclusion: This bibliometric study is a quick snapshot of research in the EM field in the last decade and may provide insights into the scientific agendas of the EM professionals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.06.016DOI Listing
August 2022

Promotion and tenure letters: A guide for faculty.

AEM Educ Train 2022 Jun 1;6(3):e10759. Epub 2022 Jun 1.

Department of Emergency Medicine Geffen School of Medicine University of California at Los Angeles Los Angeles California USA.

Promotion and tenure (P&T) letters are a key component of the academic advancement portfolio. Despite their importance, many faculty are not trained to write these letters and there is limited literature describing the approach and key components. This paper reviews the role of P&T letters and provides general guidelines for writers. We present a step-by-step guide, which includes how to respond to requests, the role of institutional guidelines, providing context to the letter, evaluating candidates, and delivering an overall recommendation. Finally, we discuss current controversies in P&T letters. This paper is intended to help novice and more experienced writers to enhance their P&T letters, while also helping applicants for promotion understand what is being asked of their letter writers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/aet2.10759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178369PMC
June 2022

Comparison of saline versus air for identifying endotracheal intubation with ultrasound.

Am J Emerg Med 2022 08 2;58:131-134. Epub 2022 Jun 2.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.

Introduction: After intubation has been performed, it is important to rapidly confirm the correct location of the endotracheal tube (ETT). Multiple techniques have been described, each with different limitations. Ultrasound has been increasingly recognized as an alternate modality for identifying the ETT location. However, it can be challenging to visualize the air-filled ETT cuff. Saline insufflation of the ETT cuff has been suggested to improve visualization of the ETT but data are limited. Our study sought to compare the diagnostic accuracy of air versus saline ETT cuff inflation on the diagnostic accuracy of intubation.

Methods: This was a randomized trial comparing air versus saline cuff inflation using a cadaver model. Adult cadavers were intubated in a random sequence with respect to both the location of intubation (i.e., tracheal vs esophageal) and air versus saline. Blinded sonographers assessed the location of the ETT using the static technique. Outcomes included accuracy of sonographer identification, time to identification, and operator confidence.

Results: 480 total assessments were performed. When using air, ultrasound was 95.8% sensitive (95% CI 90.5% to 98.6%) and 100% specific (95% CI 97.0% to 100%) with a mean time to confirmation of 8.5 s (95% CI 7.6 s to 9.4 s) and a mean operator confidence of 4.32/5.0 (95% CI 4.21 to 4.42). When using saline, ultrasound was 100% sensitive (95% CI 97.0% to 100%) and 100% specific (95% CI 97.0% to 100%) with a mean time to confirmation of 6.3 s (95% CI 5.9 s to 6.8 s) and a mean operator confidence of 4.52/5.0 (95% CI 4.44 to 4.60).

Conclusion: There was no statistically significant difference between air versus saline for intubation confirmation. However, saline was associated with fewer false negatives. Additionally, time to confirmation was faster and operator confidence was higher with the saline group. Further studies should determine if the outcomes would change with more novice sonographers or in specific patient populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.05.053DOI Listing
August 2022

Holistic Review, Mitigating Bias, and Other Strategies in Residency Recruitment for Diversity, Equity, and Inclusion: An Evidence-based Guide to Best Practices from the Council of Residency Directors in Emergency Medicine.

West J Emerg Med 2022 May 10;23(3):345-352. Epub 2022 May 10.

Duke University School of Medicine, Department of Emergency Medicine, Durham, North Carolina.

Advancement of diversity, equity, and inclusion (DEI) in emergency medicine can only occur with intentional recruitment of residency applicants underrepresented in medicine (UIM). Shared experiences from undergraduate and graduate medical education highlight considerations and practices that can contribute to improved diversity in the resident pool, such as holistic review and mitigating bias in the recruitment process. This review, written by members of the Council of Residency Directors in Emergency Medicine (CORD) Best Practices Subcommittee, offers best practice recommendations for the recruitment of UIM applicants. Recommendations address pre-interview readiness, interview approach, and post-interview strategies that residency leadership may use to implement holistic review and mitigate bias for recruitment of a diverse class.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5811/westjem.2022.3.54419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9183777PMC
May 2022

Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation.

Am J Emerg Med 2022 08 14;58:43-51. Epub 2022 May 14.

SAUSHEC, Emergency Medicine, Brooke Army Medical Center, United States of America. Electronic address:

Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved.

Objective: This narrative review provides emergency clinicians with a focused update of the resuscitation and airway management of COVID-19.

Discussion: Patients with COVID-19 and septic shock should be resuscitated with buffered/balanced crystalloids. If hypotension is present despite intravenous fluids, vasopressors including norepinephrine should be initiated. Stress dose steroids are recommended for patients with severe or refractory septic shock. Airway management is the mainstay of initial resuscitation in patients with COVID-19. Patients with COVID-19 and ARDS should be managed similarly to those ARDS patients without COVID-19. Clinicians should not delay intubation if indicated. In patients who are more clinically stable, physicians can consider a step-wise approach as patients' oxygenation needs escalate. High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) are recommended over elective intubation. Prone positioning, even in awake patients, has been shown to lower intubation rates and improve oxygenation. Strategies consistent with ARDSnet can be implemented in this patient population, with a goal tidal volume of 4-8 mL/kg of predicted body weight and targeted plateau pressures <30 cm HO. Limited data support the use of neuromuscular blocking agents (NBMA), recruitment maneuvers, inhaled pulmonary vasodilators, and extracorporeal membrane oxygenation (ECMO).

Conclusion: This review presents a concise update of the resuscitation strategies and airway management techniques in patients with COVID-19 for emergency medicine clinicians.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.05.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9106422PMC
August 2022

Prophylactic antiemetics for adults receiving intravenous opioids in the acute care setting.

Cochrane Database Syst Rev 2022 05 19;5:CD013860. Epub 2022 May 19.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.

Background: Physicians often prescribe opioids for pain in the acute care setting. Nausea and vomiting are well-described adverse events, occurring in over one-third of patients. Prophylactic antiemetics may be one option to reduce opioid-associated nausea and vomiting. However, these medications also have their own adverse effects, so it is important to understand their efficacy and safety prior to routine use. This is a review of randomized controlled trials comparing prophylactic antiemetics versus placebo or standard care for preventing opioid-associated nausea and vomiting.

Objectives: To assess the effects of prophylactic antiemetics for nausea and vomiting in adults (aged 16 years or older) receiving intravenous opioids in the acute care setting.

Search Methods: We searched CENTRAL (the Cochrane Library), MEDLINE (OVID), Embase (OVID) from inception to January 2022, and Google Scholar (17 January 2022). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and screened reference lists.

Selection Criteria: We included randomized controlled trials of prophylactic antiemetics versus placebo or standard care in adults prior to receiving an intravenous opioid.

Data Collection And Analysis: Two review authors (MG, JNC) independently determined the eligibility of each study according to the inclusion criteria. Two review authors (MG, GDP) then independently extracted data, assessed risk of bias, and determined the certainty of evidence using GRADE. Our primary outcomes were the occurrence of nausea, vomiting, and adverse events. Secondary outcomes included nausea severity, number of vomiting episodes, and number of participants requiring antiemetic rescue therapy. We presented outcomes as risk ratios (RR) for dichotomous data (e.g. presence of vomiting, presence of nausea, number of participants requiring rescue medication, adverse events) and mean difference (MD) or standardized mean difference for continuous data (e.g. number of vomiting episodes, nausea severity) with 95% confidence intervals (CI).

Main Results: We included three studies involving 527 participants (187 women and 340 men) with a mean age of 42 years.  All studies used intravenous metoclopramide (10 mg) as the intervention and a placebo for the comparator. No studies assessed any other antiemetic or compared the intervention to standard care. Compared to placebo, metoclopramide did not reduce vomiting (RR 1.18, 95% CI 0.26 to 5.32; low-certainty evidence) or nausea (RR 0.55; 95% CI 0.15 to 2.03; low-certainty evidence) and there was no difference in adverse events (RR 2.34, 95% CI 0.47 to 11.61; low-certainty evidence).  No data were available regarding the number of vomiting episodes. Metoclopramide did reduce the severity of nausea compared with placebo (MD -0.49, 95% CI -0.75 to -0.23; low-certainty evidence) but did not reduce the need for rescue medication (RR 1.86, 95% CI 0.17 to 20.16; low-certainty evidence).  Two studies were at unclear risk of bias for random sequence generation, one for blinding of outcome assessors, one for incomplete outcome data, and two for selective reporting. The studies were at low risk of bias for all remaining components.

Authors' Conclusions: There was no evidence that prophylactic metoclopramide affected the risk of vomiting, nausea, or the need for rescue medication when provided prior to intravenous opioids in the acute care setting. There was a clinically insignificant difference in nausea severity when comparing prophylactic metoclopramide with placebo. Overall, the evidence was of low certainty. Future research could better delineate the effects of prophylactic antiemetics on specific populations, and new studies are needed to evaluate the use of other prophylactic antiemetic agents, for which there were no data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/14651858.CD013860.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9119423PMC
May 2022

Clinical update on COVID-19 for the emergency clinician: Cardiac arrest in the out-of-hospital and in-hospital settings.

Am J Emerg Med 2022 07 27;57:114-123. Epub 2022 Apr 27.

SAUSHEC Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Houston, TX, United States of America.

Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Its impact on the health and welfare of the human population is significant; its impact on the delivery of healthcare is also considerable.

Objective: This article is another paper in a series addressing COVID-19-related updates to emergency clinicians on the management of COVID-19 patients with cardiac arrest.

Discussion: COVID-19 has resulted in significant morbidity and mortality worldwide. From a global perspective, as of February 23, 2022, 435 million infections have been noted with 5.9 million deaths (1.4%). Current data suggest an increase in the occurrence of cardiac arrest, both in the outpatient and inpatient settings, with corresponding reductions in most survival metrics. The frequency of out-of-hospital lay provider initial care has decreased while non-shockable initial cardiac arrest rhythms have increased. While many interventions, including chest compressions, are aerosol-generating procedures, the risk of contagion to healthcare personnel is low, assuming appropriate personal protective equipment is used; vaccination with boosting provides further protection against contagion for the healthcare personnel involved in cardiac arrest resuscitation. The burden of the COVID-19 pandemic on the delivery of cardiac arrest care is considerable and, despite multiple efforts, has adversely impacted the chain of survival.

Conclusion: This review provides a focused update of cardiac arrest in the setting of COVID-19 for emergency clinicians.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.04.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9045864PMC
July 2022

What is the Impact of Low Tidal Volume Ventilation for Emergency Department Patients?

Ann Emerg Med 2022 May 5. Epub 2022 May 5.

Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2022.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9072851PMC
May 2022

Vaccine-induced immune thrombotic thrombocytopenia: why, what, who, and how?

Am J Emerg Med 2022 07 25;57:158-159. Epub 2022 Apr 25.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.04.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9040367PMC
July 2022

Gender differences in emergency medicine standardized letters of evaluation.

AEM Educ Train 2022 Apr 1;6(2):e10740. Epub 2022 Apr 1.

Department of Emergency Medicine Rush University Medical Center Chicago IL USA.

Objectives: The Standardized Letter of Evaluation (SLOE) is a vital portion of any medical student's emergency medicine (EM) residency application. Prior literature suggests gender bias in EM SLOE comparative ranking, but there is limited understanding of the impact of gender on other SLOE components. The study objective was to evaluate the presence of gender differences in the 7 Qualifications for EM (7QEM), Global Assessment (GA), and anticipated Rank List (RL) position. A secondary objective was to evaluate the gender differences in 7QEM scores and their link to GA and anticipated RL position.

Methods: We performed a cross-sectional study using SLOEs from a subset of United States applicants to three EM residency programs during the 2019-2020 application cycle. We collected self-reported demographics, 7QEM scores, GA, and anticipated RL position. We utilized linear regression analyses and repeated measures ANOVA to evaluate if the relationship between the 7QEM scores, GA score, and anticipated RL position was different for men and women.

Results: 2103 unique applicants were included (38.6% women, 61.4% men), with 4952 SLOEs meeting inclusion criteria. The average QEM (2.51 vs. 2.39;  < 0.001), GA (2.68 vs. 2.48;  < 0.001), and RL (2.68 vs. 2.47;  < 0.001) scores were statistically higher for women than men. When exploring the relationship between the 7QEM and GA, was not found to be a statistically significant predictor for men, but it was for women. When exploring the relationship between 7QEM and RL, was not a significant predictor for men, but it was for women.

Conclusions: Women scored higher than men on the 7QEM, GA, and anticipated RL position on SLOEs. The 7QEM scores factored differently for men and women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/aet2.10740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9045574PMC
April 2022

Mechanical thrombectomy for anterior circulation stroke beyond 6 h from stroke onset.

Acad Emerg Med 2022 Jun 22;29(6):801-803. Epub 2022 May 22.

Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/acem.14516DOI Listing
June 2022

Near fatal interstitial pregnancy.

Am J Emerg Med 2022 07 12;57:235.e5-235.e8. Epub 2022 Apr 12.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.

Interstitial pregnancies are a rare form of ectopic pregnancy that occur when there is implantation of a fetus into the interstitial portion of the uterus. These can be particularly challenging to diagnose and have a high risk of morbidity and mortality due to the relatively late presentation compared to other ectopic pregnancies. Here we present a gravida 3, para 2 female patient at 14 weeks gestational age who suffered uterine rupture and hemoperitoneum leading to cardiac arrest in the Emergency Department. This case demonstrates the importance of ultrasound as a critical tool in the diagnosis of interstitial pregnancy and the sonographic findings. It is essential for emergency clinicians to be aware of this rare diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.04.007DOI Listing
July 2022

What is the Efficacy and Safety of Intravenous Thrombolysis and Thrombectomy Among Patients With a Wake-Up Stroke?

Ann Emerg Med 2022 08 21;80(2):165-167. Epub 2022 Apr 21.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2022.02.013DOI Listing
August 2022

Clinical update on COVID-19 for the emergency and critical care clinician: Medical management.

Am J Emerg Med 2022 06 26;56:158-170. Epub 2022 Mar 26.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA. Electronic address:

Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved.

Objective: This is the second part in a series on COVID-19 updates providing a focused overview of the medical management of COVID-19 for emergency and critical care clinicians.

Discussion: COVID-19, caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality worldwide. A variety of medical therapies have been introduced for use, including steroids, antivirals, interleukin-6 antagonists, monoclonal antibodies, and kinase inhibitors. These agents have each demonstrated utility in certain patient subsets. Prophylactic anticoagulation in admitted patients demonstrates improved outcomes. Further randomized data concerning aspirin in outpatients with COVID-19 are needed. Any beneficial impact of other therapies, such as colchicine, convalescent plasma, famotidine, ivermectin, and vitamins and minerals is not present in reliable medical literature. In addition, chloroquine and hydroxychloroquine are not recommended.

Conclusion: This review provides a focused update of the medical management of COVID-19 for emergency and critical care clinicians to help improve care for these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.03.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8956349PMC
June 2022

Gender Distribution of Emergency Medicine Podcast Speakers.

Ann Emerg Med 2022 07 6;80(1):60-64. Epub 2022 Apr 6.

Department of Emergency Medicine, Rush University Medical Center. Chicago, IL.

Study Objective: Over the past 2 decades, podcasting has become an easy and inexpensive way to disseminate information. Given the increasing importance of podcasts in medicine and medical education, it is important to understand the current status of diverse voices on podcasts. The primary objective of this study was to describe the distribution of women and men as hosts and guest speakers among 3 popular emergency medicine podcasts across a 10-year period. The secondary objective was to evaluate the association between host gender and speaker gender.

Methods: We performed a retrospective cohort study of the gender distribution of hosts and guest speakers among 3 popular emergency medicine podcasts from July 2011 to June 2021. Data were extracted and their gender determined using pronouns listed in their faculty profiles or using Genderize. The data were presented descriptively using subanalyses by year and the type of speaker. We calculated the odds ratio (OR) with 95% confidence interval (CI) for the likelihood of a single host predicting a speaker's gender.

Results: We identified 2,834 podcasts (n=5,962 speakers), with 964 (16.2%) women and 4,996 (83.8%) men speakers. Among hosts, 10.2% were women and 89.8% were men, whereas among guest speakers, 23.4% were women and 76.5% were men. The distribution of women speakers increased from 9.1% in 2011 to 23.1% in 2021. Having a woman host had an OR of 2.40 (95% CI 1.72 to 3.34) for having a woman guest speaker, whereas having a man host had an OR of 0.42 (95% CI 0.30 to 0.58) for having a woman guest speaker.

Conclusion: Among the 3 popular emergency medicine podcasts, there are few women speakers, hosts, and guest speakers; however, the proportion has risen over the past 10 years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2022.02.008DOI Listing
July 2022

Identifying Social Media Competencies for Health Professionals: An International Modified Delphi Study to Determine Consensus for Curricular Design.

Ann Emerg Med 2022 06 24;79(6):560-567. Epub 2022 Mar 24.

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL. Electronic address:

Study Objective: The use of social media by health professionals is widespread. However, there is a lack of training to support the effective use of these novel platforms that account for the nuances of an effective health and research communication. We sought to identify the competencies needed by health care professionals to develop an effective social media presence as a medical professional, with the goal of building a social media curriculum.

Methods: We conducted a modified Delphi study, utilizing Kraiger's Knowledge, Skills, and Attitudes framework to identify appropriate items for inclusion in a social media curriculum targeted at health care professionals. Experts in this space were defined as health care professionals who had delivered workshops, published papers, or developed prominent social media tools/accounts. They were recruited through a multimodal campaign to complete a series of 3 survey rounds designed to build consensus. In keeping with prior studies, a threshold of 80% endorsement was used for inclusion in the final list of items.

Results: Ninety-eight participants met the expert criteria and were invited to participate in the study. Of the 98 participants, 92 (94%) experts completed the first round; of the 92 experts who completed the first round, 83 (90%) completed the second round; and of the 83 experts who completed the second round, 81 (98%) completed the third round of the Delphi study. Eighteen new items were suggested in the first survey and incorporated into the study. A total of 46 items met the 80% inclusion threshold.

Conclusion: We identified 46 items that were believed to be important for health care professionals using social media. This list should inform the development of curricular activities and objectives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2022.02.016DOI Listing
June 2022

Drug reaction with eosinophilia and systemic symptoms: An emergency medicine focused review.

Am J Emerg Med 2022 06 18;56:1-6. Epub 2022 Mar 18.

Department of Emergency Medicine, Brooke Army Medical Center, USA.

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction associated with potentially severe morbidity and mortality.

Objective: This narrative review evaluates the pathogenesis, diagnosis, and management of DRESS for emergency clinicians.

Discussion: DRESS is a severe hypersensitivity reaction which can involve multiple organ systems, including the skin, lymphatic system, lungs, kidneys, and heart. Treatment is primarily supportive care combined with removal of the offending agent and initiation of corticosteroids. Additional options include cyclophosphamide, cyclosporine, intravenous immunoglobulin, and N-acetylcysteine.

Conclusion: It is important for the emergency clinician to be aware of the diagnosis and management of DRESS in order to best optimize care for these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.03.024DOI Listing
June 2022
-->