Volume 1: Issue 1

"Tox Talks"

When should you suspect an ethylene glycol overdose? Ethylene Glycol poisoning is suggested by an elevated anion gap, osmolar gap, and metabolic acidosis. Don't be fooled: the anion and osmolar gap are reciprocal so both may not be elevated at the same time!

Critical Care Pearl

The proper ventilator settings in an asthmatic that is intubated include low tidal volumes and slow respiratory rate, which allows for permissive hypercapnea and prevents air trapping.

Image of the Month

The patient's chest x-ray reveals multiple, bilateral, calcified nodules with a "popcorn" like appearance, consistent with a remote fungal infection (most likely hisoplasmosis!).





Health Policy Corner
The Future of Health Care under the Obama Administration

Health care reform was a front and center issue during the presidential campaign of 2008. As the economy has soured, the country's attention has turned to financial stability and health care, to an extent, has been placed on the back burner.

Thus far, the administration has acted on its campaign promise to expand the Children's Health Insurance Plan, providing funding to insure an additional four million children.

However, the details of the Obama plan for comprehensive health care reform remain to be seen. Recent developments seem to suggest that the major legislation may be debated and possibly enacted as early as this year.

Congressional negotiators reached a deal that will allow a health care bill to be considered under a special process called ”budget reconciliation.” In normal circumstances, before the Senate votes to pass a bill, they open up the floor to debate amongst the Senators. Before the bill can come up for a simple up or down vote, the Senators must first vote to end the debate, also known as ”invoking cloture.” This step can be very difficult when the bill is particularly contentious because it requires 60 votes to end the debate or filibuster.

Under the special process of budget reconciliation, the Senate rules would be sidestepped, and the bill could come for a simple majority vote without having to invoke cloture. This means that with a Democratically controlled House and Senate, the President can likely move a health care bill through Congress without the threat of a Republican filibuster. Stay tuned for more updates as the actual bill is rolled out.

AAEM's Exclusive - a must have!

Emergency Medicine:
A Focused Review of the Core Curriculum

22 chapters, 250 board-style questions, 78 images...one way to excel! Here's a sneak peak:

Question: A family of four presents with large-volume, watery stools several hours after eating potato salad at an outdoor picnic. Which of the following is true?

  1. Antibiotics are useful to rapidly kill the responsible organism.
  2. This family's symptoms will likely last 1 or 2 weeks.
  3. There is a high likelihood of the children developing hemolytic uremic syndrome.
  4. Symptoms are caused by ingestion of a preformed toxin.

To purchase this incredible new resource, visit https://ssl18.pair.com/aaemorg/aaemrsa/book_store/index.php for your member discount!

Answer: The correct answer is D. The short incubation period and exposure to mayonnaise-containing food is classic for diarrhea from the ingestion of the preformed toxin of Staphylococcus aureus. Antibiotics are not useful, there is no carrier state, and symptoms last only 1 day on average. Hemolytic uremic syndrome is associated enterohemorrhagic E. coli.

Emergency Medicine in the Popular Press

"Many Medicare patients end up back at hospital; Study: 1 in 5 returns within 1 month, costing system billions of dollars year"
Read the whole story: http://www.msnbc.msn.com/id/29994392/

"9 patients made nearly 2,700 ER visits in Texas"
Read the whole story: http://www.msnbc.msn.com/id/29998460/

Can tomorrow's residents be trained even better?

If you are training in an ACGME approved residency, you are almost certainly receiving excellent training. But even within the best programs, there can be areas of strength and areas of weakness. Program directors always want to improve the experience, but often have trouble figuring out exactly where the weaknesses are.

Each residency constantly strives to excel. The ACGME now asks programs to ask their graduates where the strengths of their program were and where there were opportunities for improvement. Emergency Medicine is leading the specialties in designing ways to find areas for focus, without compromising the graduate's privacy.

A pair of surveys has been developed which should help your program identify its strengths and weaknesses - without ever identifying the graduate. Each graduate is anonymously asked his or her opinion of their training program, and each program will be able to compare its graduates' responses with the rest of the country. Meanwhile, each graduate's employer will also receive an anonymous survey asking about that person's skills. Each program will get aggregate data for its graduates, and will be able to compare those results with the rest of the country. No individual survey will ever be reviewed.

While the surveys both assess an individual, the purpose is to evaluate the overall program - NOT the graduate. The program directors have worked with your residency groups to ensure that this is an open process, and poses no risk to any resident or graduate. They are going so far to get consent before sending out the surveys.

We can help tomorrow's residents get the best education possible. This effort will revolutionize the way our programs see themselves, and will help each residency find its opportunities for improvement. The RSA strongly encourages its members to consent to both surveys, and to make sure that each future graduate lets their coordinators know their current email address (even after graduation), as well as that of their employer.

Your Leadership

We welcome your comments and suggestions. Feel free to get in touch with your elected leaders:

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?

Email submissions to: info@aaemrsa.org

Please submit articles by July 15th for the August/September 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!