Here are a few highlights of recent resident involvement in national organizations:

• Joseph Pate, MD served as an 2013 SAEM Annual Meeting Abstract Submission Reviewer (along with attending David Milzman, MD)
• Bonnie Yen, MD is organizing this year's AAEM/RSA med student symposium
• Katie Voss, MD serving as a resident representative on the DC ACEP board

Our Program's Sim Wars Team at SAEM

Pediatric Potpourri                                                                  Amy Weis, MD and Tamara Katy, MD

• Remember to order AP & bilateral frog leg views to evaluate for SCFE
• Treatment for tinea capitas/kerion must be oral griseofulvin, rather than topical antifungals
• First line treatment, if non-penicillin allergic, for strep. pneumoniae is high dose amoxicillin, 80-90 mg/kg/day. Remember to use this dosing for pneumonia and AOM
• A serious complication of prostaglandin therapy is apnea

Sepsis Update                                                                         Alan Jones, MD

Here are a few updates on debated topics in sepsis management from the 2013 Surviving Sepsis Campaign

• Norepinephrine remains the first choice vasopressor (grade 1B).  Epinephrine is second choice (grade 2B).
• Corticosteroids are not recommended if fluid resuscitation and vasopressors are able to restore hemodynamic stability.  If not, hydrocortisone 200mg/day (grade 2C)
• ACTH stim tests should not be used (grade 2B)
• Use albumin in the resuscitation of severe sepsis and septic shock when substantial amounts of crystalloid are required (grade 2C, no definition of substantial given)

Ocular Trauma:  Visual Diagnosis                                             Jeff Love, MD

• Eyelid laceration primary closure can be delayed 24 hours due good perfusion
• Call ophthalmology for closure if the laceration:                            1. has subcutaneous fat visible on the eyelid                                2. is through and through                                                            3. involves the lid margin                                                            4. is medial to the punctum (canaliculi involvement)
• Corneal burns need ophtho consultation and to be irrigated to maintain a pH between 7.0 and 7.7

Dellinger, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Intensive Care Med. 2013 Feb;39(2):165-228.

ECG of one of our patients, a 55 yo F with know known past medical history, who presented with central chest pain and heaviness that started 1 hour earlier.  She also endorsed 3 days of chest pain while walking.  Given Aspirin by EMS.  BP 108/72, HR 96, and diaphoretic.  Where is the lesion?  What would you do? Once you have an answer, click here to see the answer and a repeat ECG after treatment.

This month we reviewed Prediction Value of the Canadian CT Head Rule and the New Orleans Criteria for Positive Head CT Scan and Acute Neurosurgical Procedures in Minor Head Trauma: A Multicenter External Validation Study by Bouida et al.  In this observational cohort study, the Canadian CT Head Rule had higher sensitivity (100%) than the New Orleans Criteria (82%) for neurosurgical intervention. Of 1,582 patients 13.8% had positive head CTs, with 2.1% needing neurosurgical intervention.

In contrast to the PECARN Head CT Rule for pediatrics, we noted that adult head CT rules are utilized less often.   With the growing national focus on radiation exposure, these rules are expected to play a larger role in decision making.  Do you currently use either of these rules in your practice?  Are you satisfied with their level of validation?  Although we had great debate as to the current utility of these rules, as Emergency Medicine physicians we should be aware of this data as current ACEP policy highlights both of these rules.