• Congratulations and good luck to the 3rd years on their jobs that begin shortly after graduation:
  
  Lauren Arnold
  Carolinas Medical Center - Pineville
  Charlotte, NC
  
  Shannon Graf
  MedStar Union Memorial Hospital
  Baltimore, MD
  
  Erinn Hama
  Kaiser South San Francisco
  San Francisco, CA
  
  Clare Johnson
  Dekalb Medical Center
  Atlanta, GA
  
  Judy Lin
  Emergency Ultrasound Fellow
  MedStar Washington Hospital Center
  Washington, DC
  
  Jennifer McBride
  Virginia Hospital Center
  Arlington, VA
  
  Melissa McGuire
  Pediatric Emergency Medicine Fellow
  Shands Hospital and Wolfson Children's Hospital
  Jacksonville, FL
  
  Neal Shelley
  INOVA Fairfax Hospital
  Falls Church, VA
  
   
• We had TEN nominees for the Georgetown Medical University Resident Teaching Award (String of Pearls) this year. The residents are nominated by the Georgetown students: 
  
  FIRST YEAR
  Daisi Choi
  Frank Tift
  
  SECOND YEAR
  Curtis Knight
  Mark Pittman
  Richard Kwong
  Shane Kappler (2013 Winner)
  Tariq Khan
  
  THIRD YEAR
  Clare Johnson
  Lauren Arnold (2012 Winner)
  Neal Shelley
  
   
• RECENT PUBLICATIONS:
  
  Neal Shelley, MD, Matthew Borloz, MD, and Bill Frohna, MD
  The Journal of Emergency Medicine
  Female with Flank Pain and Hypotension
  
  Mark Pittman, MD and David Lane, MD
  The Journal of Emergency Medicine
  Black Spot Poison Ivy: Under the Cover of Darkness
  
   
•  SAEM ANNUAL MEETING:  ATLANTA, GA - MAY 15-18
  
  SAEM/EMRA SimWars
  Be sure to come by and cheer on the GUH/WHC Emergency Medicine SimWars team:
  Mark Pittman, Katie Voss, Alexander Kheradi and Geoff Froelich
  May 17, 8a - 1p
  
  POSTER ABSTRACTS:
  
  Erin Hama, MD, Kevin Reed, MD, Sangeeta Desai, MD, Dave Milzman, MD and Christine Trankiem, MD
  Simulation Emergency Department Thoracotomy: A Novel Simulation Teaching Model to Enhance Residency Training
  
  Shannon Graf, MD, Lauren Arnold, MD, Munish Goyal, MD, Rahul Bhat, MD, Jeff Dubin, MD and Bill Frohna, MD
  BMI is Associated with Inappropriate Tidal Volume Settings in Adult Patients Intubated in the ED
  
  Dave Milzman, MD and Mark Smith, MD
  Presence of Third Molars Predicts Increased Mandible Fractures in Blunt Facial Trauma
  
  Dave Milzman, MD
  Comparison of Peak Troponin (cTnI) Levels Based on Various Patient Characteristics
  
  Jeff Love, MD
  Self-regulated Learning and Study Time Allotment
  
  
  ORAL ABSTRACTS:
  
  Munish Goyal, MD
  Higher Hospital Case Volume Is Associated With Decreased In-hospital Mortality In Patients With Severe Sepsis

  Risk Factors for Infection with Resistant Organisms in Severe Sepsis Patients Admitted from the Emergency Department

  The Impact of Crowding Upon Implementation of Early Goal Directed Therapy in the Emergency Department
  
  
  PRESENTATIONS:
  
  Terry Fairbanks, MD
  We All Make Mistakes. But What Do You Do Afterwards?
  
   

Graduating class at Winter Retreat, 2012

Anaphylaxis
Jonathan Davis, MD

• Cutaneous findings can be absent in up to 15% of cases of anaphylaxis
• Consider and document symptom trajectory in your reasoning to give (or not give) epinephrine
• Treatment guidelines recommend intramuscular epinephrine (preferably in lateral thigh) over subcutaneous epinephrine

The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 2010;126:3:477.
Cydulka R, Davison D, Grammer L et al. The use of epinephrine in the treatment of older adult asthmatics. Ann Emerg Med 1988; 17:4:322-6.

Evidence Based Anecdotes
Munish Goyal, MD

• Oxygen and IVF are drugs. Only use as much as you need.
• Guide resuscitation with endpoints, usually a combination of gross (mental status), physiologic (HR, MAP) and laboratory (Lactate) markers.
• Consider using BiPAP for 3+ minutes pre-intubation to increase PaO2 for hypoxemic patients who require intubation.
• If you are going to cool a patient post-arrest, initiate ASAP. Also, titrate down the FiO2 to maintain an SpO2 around 96%.

Bickell WH, Wall MJ, et al.  Immediate versus delayed fluid resuscitation for hypotensive patients with penatrating torso trauma.  NEJM. Vol 331;17.  1994. 1105-9.   
Balan IS, Fiskum G, et al.  Oximetry-guided reoxygenation improves neurologic outcomes after experimental cardiac arrest.  Stroke.  2006, Dec.  37(12). 3008-13. 
Che D, Li L, et al.  Impact of therapeutic hypothermia onset and duration on survival, neurologic function, and neurodegeneration after cardiac arrest.  Critical Care Med, 2011.  39(6).  1423-30.   
Kilgannon JH, Jones AE, et al.  Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality.  JAMA, 2010.  303(21).  2165-71. 
Baillard C, Fosse JP, et al.  Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients.  American Journal of Respiratory and Critical Care Med,  2006.  174.  171-7. 

Disaster Medicine
Lauren Wiesner, MD

• Blast lung is the most common fatal injury among initial blast survivors
• Beware of delayed presentation of blast injuries (especially GI), up to 48 hours after the explosion
• Classic blast lung x-ray shows butterfly pattern
• Avoid positive pressure ventilation if possible in blast lung. If necessary, use low peep, low tidal volumes (6-8ml/kg), low peak inspiratory pressures less than 35-40 cmH2O, and permissive hypercapnia to pH of 7.25