The American College of Emergency Physicians has issued a new policy on the diagnosis and management of adult psychiatric patients in EDs, available in the April issue of Annals of Emergency Medicine (69:480-498). Jon Mark Hirshon, MD, MPH, PhD, is a member of ACEP's Clinical Policies Committee, which oversaw the development of the document.
Doug Sward, MD, presented a workshop during the Wilderness and Disaster Medicine course at the University of Pennsylvania Perelman School of Medicine in early March. Titled “Search and Rescue: Initial Tasks and Reflex Actions,” his didactic presentation reviewed lost-person behavior and its application to rescue missions and was followed by a hands-on exercise that asked students to develop a search strategy using a topographic map. The 2-week course encourages students to improvise under austere conditions and prepares them to respond to emergencies in wilderness settings as well as disaster scenarios. A Wall Street Journal article about the course can be read here: https://www.wsj.com/articles/latest-medical-school-trend-wilderness-training-1490097604?emailToken=JRryd/96aHqXgdY1b8w43UEldbVNDuKFR1jeKDXRMUjLs3iQvfiswalwmNqzrW61Q0th/JUY9Wc+QzzXjy8zAJ7Jw+8gzw/4
Ming Yang, MD, and Stephen Thom, MD, PhD, collaborated with colleagues from the Department of Anesthesiology and the Shock, Trauma and Anesthesiology Research (STAR) Center (Alok Kumar, PhD, Bogdan Stoica, MD, David Loane, PhD, Gelareh Abulwerdi, Niaz Khan, Asit Kumar, PhD, and Alan Faden, MD) on the study that culminated in the article titled “Microglia-Derived Microparticles Mediate Neuroinflammation After Traumatic Brain Injury,” published in the March issue of the Journal of Neuroinflammation.
Zachary D.W. Dezman, MD, MS, in collaboration with Cheng Gao, PhD, Hsiao-Chi Li, PhD, Shiming Yang, PhD, Peter Hu, PhD, and Colin F. Mackenzie, MBChB, in the Shock Trauma Anesthesiology Research Center, Department of Anesthesiology, and with Yao Li, MS, and Chein-I Chang, PhD, from the Remote Sensing Signal and Image Processing Laboratory, Department of Computer Science and Electrical Engineering at UMBCpublished the article titled “Anomaly Detection Outperforms Logistic Regression in Predicting Trauma Patient Outcomes” in the March/April issue of Prehospital Emergency Care (21:174?179). Their study was based on the records of 5464 patients seen at Shock Trauma in 2009 and 2010. Anomaly detection and logistic regression were equally capable of predicting the need for massive transfusion, but anomaly decision significantly outperformed logistic regression in identifying patients who would receive uncrossmatched blood, who would receive a transfusion within 6 hours after admission, who would need intensive care, and who were most likely to die during hospitalization.
Zachary Dezman, MD, and Laura Bontempo, MD, have been named co-editors of a column in a new journal, Clinical Practice and Cases in Emergency Medicine. Their column, Clinicopathological Cases from the University of Maryland, features descriptions of real patients, with difficult diagnoses, who were assessed and treated in our ED. Based on the format used in CORD's Clinical Pathologic Case Presentation Competition, the articles begin with a resident’s detailed description of a patient’s presentation followed by an attending’s explanation of his or her thought process leading to the diagnosis and an educational section about the disease or condition. The first case report in this series is in the inaugural issue of CPC-EM. Drs. Bontempo and Dezman, in collaboration with Danya Khoujah, MBBS, and Andrew Crouter, MD, present their assessment of an "18-Year-Old Female with a Change in Mental Status” (1:3?8, March 2017).
R. Gentry Wilkerson, MD, has received a grant from Pfizer, Inc., to evaluate the efficacy and safety of rivipansel in the treatment of vaso-occlusive crisis in hospitalized patients with sickle cell disease. Rivipansel is a new drug that reduces cell adhesion and inflammation and therefore could have a variety of clinical applications. Dr. Wilkerson’s multicenter trial will test its ability to improve blood flow in people with sickle cell disease and thus alleviate their pain. The grant is in the amount of $342,232.
Mike Winters, MD, and three other members of the Clinical Practice Committee of the American Academy of Emergency Medicine have a clinical practice paper in the March issue of The Journal of Emergency Medicine (52:379?384). Its title asks, “Does Early Goal-Directed Therapy Decrease Mortality Compared with Standard Care in Patients with Septic Shock?” Based on a review of critical care articles published between 2010 and 2015, the authors concluded that early goal-directed therapy does not convey a benefit in terms of mortality rate compared with standard care. Critical components in the management of septic shock remain early recognition, prompt administration of the right antibiotic, source control, aggressive fluid resuscitation, and use of vasoactive medications when indicated to maintain adequate mean arterial pressure.
Members of the Maryland delegation to this year’s annual meeting of the National Association of EMS Physicians, held in New Orleans last week, received top honors for their poster presentation, “Preliminary and Potential Impacts of a Multi-Phase Intervention Utilizing an EMS-Human Services Partnership on Call Volumes Generated by EMS Super-Users.” The poster presented results of a study of call volumes received by the Montgomery County Fire and Rescue Service before and after partnership with the county’s Department of Health and Human Services. By connecting “super-users” with community care resources, the partnership reduced this vulnerable group’s call volume by 64%. The study was conducted by members of the fire and rescue service, working in collaboration with Roger Stone, MD, MS, Clinical Assistant Professor and Medical Director, Montgomery County Fire and Rescue Service, Ben Lawner, DO, MS, EMT-P, Assistant Professor (now Director of Prehospital Services, Allegheny General Hospital), and Jon Mark Hirshon, MD, MPH, PhD, Professor, Department of Emergency Medicine.