Join us in welcoming our new class of residents!

Kevin Blythe
Meharry Medical College

Kayla Dewey
Keck School of Medicine

Mallory Glass
University of Florida College of Medicine

Daniel Herzberg
Jefferson Medical College

Rajdeep Kanwar
New York Medical College

Mike Nitzberg
University of Rochester

Jessica Palmer
Temple University School of Medicine

Jessica Shackman
Temple University School of Medicine

Alexander Shuster
Georgetown University School of Medicine

Christie Sun
Tufts University School of Medicine

Congratulations again to our seniors graduating this month!

• Lauren Arnold
• Shannon Graf
• Erinn Hama
• Clare Johnson
• Judy Lin
• Jennifer McBride
• Melissa McGuire
• Neal Shelley

A Few of Our Residents at SAEM in Atlanta

The Critically Ill Poisoned Patient                                                  Chris Holstege, MD

Five toxicologic causes of hyperthermia

• Serotonin Syndrome
• Neuroleptic Malignant Syndrome
• Malignant Hyperthermia
• Uncoupling Oxidative Phosphorylation (e.g. Aspirin)
• Anticholinergic

Pediatric Syncope ECG Pearls                                               Elizabeth Delasobera, MD

Always refer to cardiology and restrict from any athletic activity with exertional syncope or chest pain

• T-Wave Inversions after puberty are always abnormal
• Q-Waves in kids are always abnormal
• Always look closely at the QT-Interval (QTc > 480msec or QTc < 330msec are always abnormal)
• Look for delta and epsilon waves

ED Thoracotomy                                                                     Munish Goyal, MD

• No indication for ED Thoracotomy if blunt trauma and no vital signs in the field.  0% survival in 1998 case series.

Branney SW. Moore EE. Feldhaus KM. Wolfe RE. Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center.  Journal of Trauma-Injury Infection & Critical Care. 45(1):87-94; discussion 94-5, 1998 Jul.

ECG of one of our patients, a 67 yo M, who presented with 1.5 weeks of dizziness and chest tightness.  Heart rate in the 270s, BP 98/65.  What is the underlying rhythm?  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 Vasopressin, Epinephrine, and Corticosteroids for In-Hospital Cardiac Arrest by Mentzelopoulos et al.  In this randomized prospective trial, there was a improvement in outcome of the subset of patients who received epinephrine, vasopressin and corticosteroids during in hospital cardiac arrests.  

While not directly addressing individual drug effect, this algorithm reminds us of a few key questions in the resuscitation literature - and stimulated a great discussion at our journal club.  Consider these questions:  Is there a benefit to starting corticosteroids early in resuscitation?  Vasopressin: why has it fallen out of our common practice; what subset of patients should we consider it in; and is there a benefit from the combination of vasopressin and epinephrine delivered together?