The content expert program: A structured approach to increase emergency medicine resident scholarly activity.

Objectives: The Accreditation Council for Graduate Medical Education requires residents to participate in scholarship and requires residency programs to provide an environment within which residents can acquire skills related to scholarly activities. However, consensus on the definition of scholarship and structure of program environments does not yet exist. We designed and implemented a content expert program (CEP) in 2015, in which each resident worked with a faculty advisor to develop a longitudinal scholarly activity linked to a core area of practice and, in doing so, became the department's "content expert.

Implementation of a pilot novel objective peer comparison evaluation system in an emergency medicine residency program.

Objectives: Emergency medicine (EM) residents are currently evaluated via The Milestones, which have been shown to be imperfect and subjective. There is also a need for residents to achieve competency in patient safety and quality improvement processes, which can be accomplished through provision of peer comparison metrics. This pilot study aimed to evaluate the implementation of an objective peer comparison system for metrics that quantified aspects of quality and safety, efficiency and throughput, and utilization.

The Council of Emergency Medicine Residency Directors Speaker Evaluation Form for Medical Conference Planners.

Objectives: No summative speaker evaluation form with validity and reliability evidence currently exists in the English medical education literature specifically to help conference planners make future decisions on speakers. We seek to perform a proof-of-concept evaluation of a concise, effective evaluation form to be filled out by audience members to aid conference planners.

Methods: We created the Council of Emergency Medicine Residency Directors (CORD-EM) form, a novel, three-question speaker evaluation form for the CORD-EM national conference and evaluated it for proof of concept.

Do Emergency Medicine Residency Graduates Feel Prepared to Manage Closed Fractures After Training?

Objectives: Fractures comprise 3% of all emergency department (ED) visits. Although emergency physicians are often responsible for managing most of the initial care of these patients, many report a lack of proficiency and comfort with these skills. The primary objective was to assess how prepared recent emergency medicine (EM) residency graduates felt managing closed fractures upon completion of residency.

Care of the Critically Ill Pregnant Patient and Perimortem Cesarean Delivery in the Emergency Department.

Background: Maternal resuscitation in the emergency department requires planning and special consideration of the physiologic changes of pregnancy. Perimortem cesarean delivery (PMCD) is a rare but potentially life-saving procedure for both mother and fetus. Emergency physicians should be aware of the procedure's indications and steps because it needs to be performed rapidly for the best possible outcomes.

Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome.

Background: Orbital compartment syndrome is a sight-threatening emergency. Vision may be preserved when timely intervention is performed.

Objective: To present a case of orbital compartment syndrome caused by traumatic retrobulbar hemorrhage and the procedure of lateral canthotomy and cantholysis, reviewed with photographic illustration.

Emergency department management of shoulder dystocia.

Background: Precipitous obstetric deliveries can occur outside of the labor and delivery suite, often in the emergency department (ED). Shoulder dystocia is an obstetric emergency with significant risk of adverse outcome.

Objective: To review multiple techniques for managing a shoulder dystocia in the ED.

Appendicitis, diverticulitis, and colitis.

Appendicitis, diverticulitis, and colitis are common gastrointestinal conditions presenting to the emergency department (ED). Although it is a common condition, the diagnosis of appendicitis remains challenging, and the approach to this disease continues to evolve. The diagnostic approach to diverticulitis is more straightforward, and treatment and the decision whether to hospitalize varies with disease severity.

Two days of dexamethasone versus 5 days of prednisone in the treatment of acute asthma: a randomized controlled trial.

Study Objective: Dexamethasone has a longer half-life than prednisone and is well tolerated orally. We compare the time needed to return to normal activity and the frequency of relapse after acute exacerbation in adults receiving either 5 days of prednisone or 2 days of dexamethasone.

Methods: We randomized adult emergency department patients (aged 18 to 45 years) with acute exacerbations of asthma (peak expiratory flow rate less than 80% of ideal) to receive either 50 mg of daily oral prednisone for 5 days or 16 mg of daily oral dexamethasone for 2 days.

Ethics curriculum for emergency medicine graduate medical education.

Background: Ethics education is an essential component of graduate medical education in emergency medicine. A sound understanding of principles of bioethics and a rational approach to ethical decision-making are imperative.

Objective: This article addresses ethics curriculum content, educational approaches, educational resources, and resident feedback and evaluation.

Lateral-horizontal patient position and horizontal orientation of the endotracheal tube to prevent aspiration in adult surgical intensive care unit patients: a feasibility study.

Background: Recent data suggest that during mechanical ventilation the lateral-horizontal patient position (in which the endotracheal tube is horizontal) decreases the risk of ventilator-associated pneumonia, compared to the recommended semi-recumbent position (in which the endotracheal tube slopes downward into the trachea). We tested the feasibility of the lateral-horizontal patient position, measured the incidence of aspiration of gastric contents, and watched for any adverse effects related to the lateral-horizontal position.

Methods: Ten adult intensive care unit patients were ventilated for 64 hours in the standard semi-recumbent position, and ten for 12-24 hours in the lateral-horizontal position.

The effect of emergency department crowding on education: blessing or curse?

Emergency department (ED) crowding is a national crisis that contributes to medical error and system inefficiencies. There is a natural concern that crowding may also adversely affect undergraduate and graduate emergency medicine (EM) education. ED crowding stems from a myriad of factors, and individually these factors can present both challenges and opportunities for education.

Anion gap as a screening tool for elevated lactate in patients with an increased risk of developing sepsis in the Emergency Department.

Objectives: Serum lactate levels are a useful tool in monitoring critically ill patients, especially those who are septic. However, lactate levels are often not routinely drawn or rapidly available in some institutions. The objective of this study was to determine if a readily available anion gap (AG) could be used as a surrogate marker for abnormal lactate level in Emergency Department (ED) patients at risk for sepsis.

Utility of routine testing for patients with asymptomatic severe blood pressure elevation in the emergency department.

Study Objective: Recommendations for the treatment of emergency department (ED) patients with asymptomatic severely elevated blood pressure advise assessment for occult, acute hypertensive target-organ damage. This study determines the prevalence of unanticipated, clinically meaningful test abnormalities in ED patients with asymptomatic severely elevated blood pressure.

Methods: This was a prospective observational study at 3 urban academic EDs.

Temporary transvenous pacemaker placement in the Emergency Department.

Emergency Department placement of a temporary transvenous cardiac pacemaker offers potential life-saving benefits, as the device can definitively control heart rate, ensure effective myocardial contractility, and provide adequate cardiac output in select circumstances. The procedure begins with establishment of central venous access, usually by a right internal jugular or left subclavian vein approach, although the femoral vein is an acceptable alternative, especially in patients who are more likely to bleed should vascular access become complicated. The indications for the procedure, as well as the equipment needed, are reviewed.

Peripheral venous cutdown.

Timely establishment of vascular access is a critical component of the care of the acutely ill or injured patient. Peripheral venous cutdown, once a mainstay in the care of the severely traumatized patient, has progressively lost favor since the introduction of the Seldinger technique of central venous line placement. In fact, recent editions of the Advanced Trauma Life Support (ATLS) text refer to saphenous venous cutdown as an optional skill to be taught at the discretion of the instructor.

Charlson Index is associated with one-year mortality in emergency department patients with suspected infection.

Objectives: A patient's baseline health status may affect the ability to survive an acute illness. Emergency medicine research requires tools to adjust for confounders such as comorbid illnesses. The Charlson Comorbidity Index has been validated in many settings but not extensively in the emergency department (ED).

Evaluation and treatment of patients with severely elevated blood pressure in academic emergency departments: a multicenter study.

Study Objective: Current guidelines advise that emergency department (ED) patients with severely elevated blood pressure be evaluated for acute target organ damage, have their medical regimen adjusted, and be instructed to follow up promptly for reassessment. We examine factors associated with performance of recommended treatment of patients with severely elevated blood pressure.

Methods: Observational study performed during 1 week at 4 urban, academic EDs.