Department Blog - March 2016

Terry Mulligan DO, MPH, was elected to the Board of Directors of the American Academy of Emergency Medicine at the organization’s 22nd Annual Scientific Assembly, held in Las Vegas in late February. He also chairs the organization’s International Emergency Medicine Committee and Government Affairs Committee.

Hong Kim, MD, MPH, is the lead author of the article titled “Reversal of Opioid-Induced Ventilatory Depression Using Low-Dose Naloxone (0.04 Mg): A Case Series,” published in the March 2016 issue of The Journal of Medical Toxicology. His co-author is Lewis Nelson, MD, from New York University School of Medicine/Bellevue Hospital Center.

R. Gentry Wilkerson, MD, and Bryan D. Hayes, PharmD, published a letter in this month's issue of Clinical Toxicology. They were reacting to a case description in the October issue of the same journal, in which a patient’s uvular edema was linked to MDMA and treated with icatibant. Drs. Wilkerson and Hayes advised caution about the assumption that the drug induced the angioedema and about the use of such an expensive medication when a causative link is questionable.

Amal Mattu, MD, is a co-author of the article titled “The Electrocardiogram in the ACS Patient: High-Risk Electrocardiographic Presentations Lacking Anatomically Oriented ST-Segment Elevation,” published in the March issue of The American Journal of Emergency Medicine. In this article, Dr. Mattu and his colleagues from the University of Virginia School of Medicine and Madison County EMS in Virginia review five electrocardiographic patterns (“STEMI equivalents”) caused by occlusion of an epicardial coronary artery, which threatens the left ventricle and thus heightens the risk of poor patient outcome without prompt recognition and intervention.

Mike Abraham, MD, is the lead author of an article on the diagnosis and treatment of influenza, published in the March issue of The Journal of Emergency Medicine. The report was approved by the Clinical Guidelines Committee of the American Academy of Emergency Medicine. One of Mike's co-authors on this paper is Jack Perkins, MD, a 2007 graduate of our EM/IM residency, who is now on the faculty of Virginia Tech Carilion School of Medicine in Roanoke. Their article is available at www.jem-journal.com/article/S0736-4679%2815%2901147-6/abstract.

The February issue of The American Journal of Emergency Medicine contains an analysis of factors influencing emergency department (ED) performance, based on a national data set compiled by the Emergency Department Benchmarking Alliance. The authors are Laura Pimentel, MD, CPME, and Jon Mark Hirshon, MD, MPH, PhD, and their colleagues from the business schools at City University of New York, the University of Maryland, College Park, and American University. The investigators found that the most important correlate with patients’ departure before completion of treatment was the time between arrival in the ED and the time the patient was first seen by a care provider. The most important factors in the time to first contact with a care provider were physician and nursing staffing levels and ED operations, not patient volume. The title of the article is “Drivers of ED Efficiency: A Statistical and Cluster Analysis of Volume, Staffing, and Operations.

Ben Lawner, DO, MS, EMT-P, and Kevin Seaman, MD (Executive Director, Maryland Institute for Emergency Medical Services Systems), were panelists at "EMS Today: The JEMS Conference and Exhibition," which was held in Baltimore in late February. Their topic was the emerging public health threat of designer drugs such as MDMA (Ecstasy) at music festivals.

Stephen Thom, MD, PhD, Professor, Ming Yang, MD, Research Associate, Kevin Yu, MD, Lead Research Specialist, Veena Bhopale, MPhil, PhD, Laboratory Manager, and Svitlana Kovtun, MD, Research Specialist, in the Department of Emergency Medicine, with colleagues from the Perelman School of Medicine, Penn Presbyterian Medical Center, and Roxborough Memorial Hospital in Philadelphia, published “Measurements of CD34+/CD45-dim Stem Cells Predict Healing of Diabetic Neuropathic Wounds” in the February issue of the journal Diabetes. After analyzing specimens from patients with foot ulcers, the investigators concluded that the number of blood-borne stem/progenitor cells and the cellular content of hypoxia-inducible factors are indicators of how well wounds will respond to treatment.

George Willis, MD, our department's Director of Medical Student Education, and Phil Magidson, MD, MPH, a fourth-year EM/IM resident, have been elected to the Alpha Omega Alpha (AOA) Honor Medical Society by its Beta Chapter at the University of Maryland School of Medicine. AOA members are most commonly thought of as top-tier medical students, but the society can also nominate and elect physician educators who exemplify leadership qualities, academic excellence, and professionalism. That is the honor bestowed on Dr. Willis and Dr. Magidson. Congratulations to them!

Ben Lawner was a faculty member for the 23rd Annual Conference of the National Collegiate EMS Foundation, held in Philadelphia in late February and attended by more than 1200 college-based EMS providers. Dr. Lawner led a workshop titled “Delirium, Designer Drugs, and Teen Death: Electronic Dance Music Festivals,” which focused on patient encounters during Moonrise Festivals at Pimlico Race Course. He also narrated a trauma skills competition and led a skills lab on resuscitation after cardiac arrest. In a roundtable discussion, Ben reviewed recent articles on resuscitation, airway management, and trauma care, and he participated as a panelist in the final plenary session, describing how he combines his passion for EMS with his career in emergency medicine. In addition to his academic appointment in the Department of Emergency Medicine, Dr. Lawner is the Deputy Medical Director for the Baltimore City Fire Department and provides medical oversight to several paramedic programs.

Dr. Michael Bond, Residency Program Director, along with emergency medicine program directors from Staten Island University Hospital, Hofstra North Shore-LU School of Medicine, the University of Kentucky, and Michigan State University, is a co-author of “Have First-Year Emergency Medicine Residents Achieved Level 1 on Care-Based Milestones?,” published in the December issue of the Journal of Graduate Medical Education. The investigators surveyed 41 interns from 4 programs and their supervising attendings regarding the residents’ fulfillment of clinical expectations that constitute Level 1 ability (at the level of a medical school graduate). One-fourth of the study group fell short of meeting all nine care-based milestones. The findings of this study have implications for training programs in all medical specialties.

Ben Lawner, DO, MS, EMT-P, R. Gentry Wilkerson, MD, and Jenny Guyther, MD, were faculty members for the national paramedic refresher course hosted by UMBC in late February. They presented lectures titled "Resuscitation Review: Articles You've Got to Know!," “Disaster Response/Preparedness,” and “Pediatrics,” respectively. More than 50 prehospital care providers from across the country earned continuing education certificates at this 4-day event.

Stephen Thom, MD, PhD, and his colleagues from the University of Split School of Medicine in Croatia, published the article titled “Exercise Before and After SCUBA Diving and the Role of Cellular Microparticles in Decompression Stress” in the January issue of Medical Hypotheses. Their observations contribute to the ongoing examination of the role of venous gas emboli in decompression sickness. Elucidation of the effect of pre-dive practices such as exercise, ingestion of antioxidants, and hydration on an individual’s response to dive stresses could lead to applications in the management of diseases that involve endothelial dysfunction and microparticle production.

Jon Mark Hirshon, MD, MPH, PhD, and Bryan D. Hayes, PharmD, along with Gordon S. Smith, MBChB, MPH, from the Department of Epidemiology and Public Health, and Wendy Klein-Schwartz, PharmD, MPH, from the Department of Pharmacy Practice and Science in the School of Pharmacy, and their Egyptian colleagues, are the authors of an article in the January issue of Clinical Toxicology. Its title is “Epidemiology of Acute Poisoning in Children Presenting to the Poisoning Treatment Center at Ain Shams University in Cairo, Egypt, 2009-2013.” The 38,470 children treated at the center during the study period accounted for 44% of total patients seen. Poisoning in preschool children was mainly unintentional and commonly caused by nonpharmaceutical agents, whereas most poisonings among adolescents were intentional. Pesticides, most commonly organophosphorus compounds and carbamates, were the agents that most often led to morbidity and mortality.