Volume 1: Issue 2

"Tox Talks"

MDMA, or ecstasy, is an amphetamine derivative and popular recreational drug. Clinical features of ingestion include agitation, hyperthermia, seizures, nausea/vomiting, palpitations, chest pain and diaphoresis. Another common physical exam finding in acute ingestion is bruxism, an involuntary clenching or grinding of the jaw. You should be aware that co-ingestion is common. Treatment is supportive and directed at symptoms. Benzodiazepines are used for anxiety and seizure. Hyperthermia should be treated with fans, cool water, IV fluids and ice bath as needed with a goal of reducing body temperature to 101°F within about 30 minutes. Liberal IV fluids should be given to prevent or treat rhabdomyolysis. Acute ingestion should also be treated with activated charcoal and sorbitol.

Critical Care Pearl

There is substantial agreement between the values obtained by arterial and venous blood gas sampling. Using matched patient samples, one study by Kelly et al. (JEM 22:1:2002) compared the venous and arterial pH and pCO2 pH was found to be highly correlated with venous pH 0.034 units lower than arterial. There was less agreement for pCO2; on average, samples were 5.8mmHg higher in venous samples compared to arterial with a 95% confidence interval of -8.8 - +20.5 mmHg. The authors advance a screening cutoff of venous pCO2 of 45mmHg as able to detect all instances of clinically significant hypercarbia (arterial pCO2 >50 mmHg).





RSA Advocacy
Contract Issues and Fair Business Practices

Senior residents are on the hunt for the perfect job. After nearly a decade of intense medical training, no doubt the newest graduating talent pool is ready to tackle the medical challenges that lie ahead. While our medical education is robust, we have little experience in finding the perfect job.

For most of us, the only experience we have is applying for residency — an artificial job hunt where the terms and conditions of employment vary little across the country. To find the perfect job in the real world, we need to borrow a page from a graduating MBA or law student's playbook. The most important part of the search is found in the small print of the contract, which most of us will reflexively ignore. With the help of Rules of the Road for Emergency Medicine Residents & Graduates, here are a few tips for your job hunt and pitfalls to avoid.

Ask how long the "trial period" of employment lasts. This is typically a period where a new hire can be fired for any reason. Many employers across diverse industry have this assessment period, but the timeframe varies widely. Most fair-business advocates, as well as AAEM and AAEM/RSA, believe this period should be 90 days. If your potential future employer asks you to sign on for a year assessment period, be cautious!

Beyond this reasonable assessment period, there must be a just cause for termination such as chemical impairment on the job, incompetence or unprofessional behavior. Make sure your contract has a mechanism for due process in the case of termination or disciplinary action on the part of your employer. There should be a formal mechanism for reviewing these actions, most appropriately a hearing by the medical staff.

Emergency medicine has typically been a mobile profession, and many graduating residents may not be signing on with the hospital they plan to work at forever. To protect your ability to move and change jobs, be wary of signing a contract that has restrictive covenants or non-compete clauses. These clauses are common in some industries (for example, a programmer for Google may have a non-compete clause preventing him/her from working at Yahoo within a certain timeframe) but are considered improper in most professions such as law and medicine. Read the fine print, and negotiate these clauses out of your contract.

It is also important to ask if you will have access to the billing records of your potential new group. As the physician, the billing for your fees and services is your responsibility. It is standard for most groups to hire a billing company to manage this complicated process. However, physicians can be held criminally responsible for inappropriate billing. You should have the ability to review this important information.

Even though a job's location and salary are important first questions, contract issues and fair business practices will have an incredibly important impact on your happiness and mobility. For more information on these important topics, go to the member's only section of and read Rules of the Road for Emergency Medicine Residents & Graduates.

Disclaimer: This article is not legal advice, and AAEM/RSA recommends each graduating resident have their contract reviewed by an attorney familiar with state law.

AAEM/RSA's Exclusive - A must have!

Emergency Medicine:
A Focused Review of the Core Curriculum

22 chapters, 225 board-style questions, 79 way to excel! Here's a sneak peak:

Question: A 4-year-old girl has high fevers and diarrhea. As you are examining her, she seizes. The likely cause of her diarrhea is:

  1. Campylobacter
  2. Shigella
  3. Yersinia
  4. Staphylococcs aureus toxin
  5. Enterohemorrhagic E. coli

To purchase this incredible new resource, visit for your member discount!

Answer: The correct answer is B. Febrile seizures plus diarrhea in a child is classic for shigellosis.

Save The Date — Upcoming AAEM/RSA sponsored events!

The 3rd Annual Midwest Medical Student Symposium
Saturday, August 22, 2009 — Loyola University Chicago Stritch School of Medicine
For more information and to register, go to!

The Western Regional Emergency Medicine Student Symposium
Saturday, September 12, 2009 — USC Keck School of Medicine
To register, e-mail and include your:
name, school, graduation year & preferred e-mail.
Use Subject Line: Registration 2009

The 16th Annual Scientific Assembly
February 15-17, 2010 — Caesars Palace, Las Vegas, NV
For more information, go to!

Emergency Medicine in the Popular Press

Why has health-care reform stalled? TIME and CNN report on "The Five Biggest Hurdles to Health-Care Reform."
Read more:,8599,1912920,00.html

"Nearly 10 percent of health spending for obesity. Report: Treating weight-related diseases costs U.S. $147 billion."

Dr. Jesse Pines asks one of the most important questions in emergency medicine: "Who Needs to be in the Hospital?"
Read more at the Wall Street Journal website:

Legislative Action Center

Residents and students in emergency medicine — please take a few minutes to familiarize yourselves with AAEM's Legislative Action Center.

Your Leadership

Michael Ybarra

Vice President
Alicia Pilarski

Immediate Past-President
Megan Boysen

Cyrus Shahpar

At-large Board Members
Heather Jimenez
Jennifer Kanapicki
Jeff Pinnow
Ryan Shanahan
Sandra Thomasian

Medical Student Council

Jamie "Akiva" Kahn

Interested in writing?

E-mail submissions to:

Please submit articles by September 15th for the October/November edition.

In the subject line please indicate: "Tox Talk", "Critical Care Pearl", "Board Review", "Journal Club", "Image of the Month", or submit any new articles you would like us to consider!