Academic Life in Emergency Medicine

ACEP E-QUAL 45: Protected Code Stroke

In this episode from the ACEP E-QUAL series, guest Dr. Houman Khosravani (Medical Director, Inpatient Stroke Unit Assistant Professor of Neurology, Department of Medicine, University of Toronto Sunnybrook Health Sciences Center; Staff Intensivist, Southlake Regional Health Center) discusses the concept of a "protected code stroke", how to operationalize the concepts, and how this system can be applied in your local circumstances. Host: Jason Woods, MD. Podcast sound engineer: Kellen Vu. www.acep.org/equal

References

Rajendram P, Notario L, Reid C, Wira CR, Suarez JI, Weingart SD, Khosravani H. Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care. Neurocritical Care. 2020; 33(2), 338–346. https://doi.org/10.1007/s12028-020-01057-4

Codestroke.net

 

ACEP E-QUAL 44: Stroke transfer protocolization

In this episode from the ACEP-EQUAL series, guest Dr. William Meurer (Associate Professor of Emergency Medicine and Neurology University of Michigan) discuss how to protocolize of transferring stroke patients, how to identify and appropriately chose transfer destinations, and how to better align patient needs with the resources of the receiving sites. Host: Jason Woods, MD; Podcast Sound Engineer: Kellen Vu. www.acep.org/equal

1. Saver JL, Goyal M, van der Lugt A, et al; HERMES Collaborators. Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA. 2016 Sep 27;316(12):1279-88. doi: 10.1001/jama.2016.13647. PMID: 27673305.
2. Campbell BCV, Mitchell PJ, Churilov L, et al; EXTEND-IA TNK Part 2 investigators. Effect of Intravenous Tenecteplase Dose on Cerebral Reperfusion Before Thrombectomy in Patients With Large Vessel Occlusion Ischemic Stroke: The EXTEND-IA TNK Part 2 Randomized Clinical Trial. JAMA. 2020 Apr 7;323(13):1257-1265. doi: 10.1001/jama.2020.1511. PMID: 32078683; PMCID: PMC7139271.
3. Prabhakaran S, O'Neill K, Stein-Spencer L, Walter J, Alberts MJ. Prehospital triage to primary stroke centers and rate of stroke thrombolysis. JAMA Neurol. 2013 Sep 1;70(9):1126-32. doi: 10.1001/jamaneurol.2013.293. PMID: 23817961.

ACEP E-QUAL 43: Intracranial Hemorrhage Scoring and Prognostication

In this episode from the ACEP-EQUAL series, guest Dr. Bruce Lo (Chief, Department of Emergency Medicine, Sentara Norfolk General Hospital; Professor of Emergency Medicine, Eastern Virginia Medical School) reviews several common intracerebral hemorrhage scoring systems, the components, and tips on how to use them in real world practice.

Host: Jason Woods, MD; Podcast Sound Engineer: Kellen Vu

www.acep.org/equal

References

1. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001 Apr;32(4):891-7. doi: 10.1161/01.str.32.4.891. PMID: 11283388.
2. Clarke JL, Johnston SC, Farrant M, Bernstein R, Tong D, Hemphill JC 3rd. External validation of the ICH score. Neurocrit Care. 2004;1(1):53-60. doi: 10.1385/NCC:1:1:53. PMID: 16174898.
3. Gregório T, Pipa S, Cavaleiro P, Atanásio G, Albuquerque I, Chaves PC, Azevedo L. Assessment and Comparison of the Four Most Extensively Validated Prognostic Scales for Intracerebral Hemorrhage: Systematic Review with Meta-analysis. Neurocrit Care. 2019 Apr;30(2):449-466. doi: 10.1007/s12028-018-0633-6. PMID: 30426449.
4. Pinho J, Costa AS, Araújo JM, Amorim JM, Ferreira C. Intracerebral hemorrhage outcome: A comprehensive update. J Neurol Sci. 2019 Mar 15;398:54-66. doi: 10.1016/j.jns.2019.01.013. Epub 2019 Jan 14. PMID: 30682522.
5. Øie LR, Madsbu MA, Solheim O, Jakola AS, Giannadakis C, Vorhaug A, Padayachy L, Jensberg H, Dodick D, Salvesen Ø, Gulati S. Functional outcome and survival following spontaneous intracerebral hemorrhage: A retrospective population-based study. Brain Behav. 2018 Oct;8(10):e01113. doi: 10.1002/brb3.1113. Epub 2018 Sep 21. PMID: 30240164; PMCID: PMC6192392.
6. Hemphill JC 3rd, Greenberg SM, et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 Jul;46(7):2032-60. doi: 10.1161/STR.0000000000000069. Epub 2015 May 28. PMID: 26022637.
7. Houben R, Schreuder FHBM, Bekelaar KJ, et al. Predicting Prognosis of Intracerebral Hemorrhage (ICH): Performance of ICH Score Is Not Improved by Adding Oral Anticoagulant Use. Front Neurol. 2018 Feb 28;9:100. doi: 10.3389/fneur.2018.00100. PMID: 29541054; PMCID: PMC5836590.

EM Match Advice 32: Virtual Interviews in the COVID-19 Era

Hosted by Dr. Mike Gisondi (Stanford) and Dr. Michelle Lin (UCSF), this episode discusses the uncharted waters of conducting virtual interviews for the EM residency match season in the era of COVID-19. Featured EM Program Director Panelists: Dr. David Caro (University of Florida, Jacksonville), Dr. Erica Shaver (West Virginia University), Dr. Cedric Lefebvre (Wake Forest University)

Podcast engineer: Kellen Vu

https://www.aliem.com/em-match-advice-virtual-interviews-covid/

ACEP E-QUAL 42: Intracranial Hemorrhage after tPA

In this episode from the ACEP-EQUAL series, guest Dr. Joshua Goldstein (Professor of Emergency Medicine, Harvard Medical School; Director, Center of Neurologic Emergencies, Massachusetts General Hospital) discusses ICH after TPA. He reviews what evidence exists, the timing, potential treatment targets, and medications.

Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu

www.acep.org/equal

References:

1. Yaghi S, Willey JZ, Cucchiara B, et al. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017;48(12):e343-e361. doi:10.1161/STR.0000000000000152

ACEP E-QUAL 41: Treating Blood Pressure in Intracranial Hemorrhage

In this episode from the ACEP-EQUAL series, guest Dr. Lantha Ganti (Professor of Emergency Medicine & Neurology; Vice Chair for Research and Academic Affairs; University of Central Florida) reviews how to evaluate and treat blood pressure in the setting of ICH. She reviews the major existing data, BP targets, and medications to use.

Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu

www.acep.org/equal

References:

1. Butcher KS, Jeerakathil T, Hill M, et al. The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial. Stroke. 2013;44(3):620-626. doi:10.1161/STROKEAHA.111.000188

2. Butcher KS, Baird T, MacGregor L, Desmond P, Tress B, Davis S. Perihematomal edema in primary intracerebral hemorrhage is plasma derived. Stroke. 2004;35(8):1879-1885. doi:10.1161/01.STR.0000131807.54742.1a

3. https://www.mdcalc.com/modified-rankin-scale-neurologic-disability

ACEP E-QUAL 40: Substance Use Disorder Chat

In this episode, Dr. Gail Donofrio (Director, National Institute on Drug Abuse) and Dr. Nora Volkow (Professor and Chair of Emergency Medicine, Yale School of Medicine; Chief of Emergency Services, Yale New Haven Hospital) share their experience with substance use disorder in the time of COVID, as well as some thoughts on needed regulatory change. 

Host: Jason Woods, MD; Podcast Sound Engineer: Kellen Vu

www.acep.org/equal

EM Fellowship Match Advice 31: Administration Fellowship

Hosted by Dr. Michael Gisondi (Stanford) and Dr. Michelle Lin (UCSF), an expert panel of directors of Administration fellowships discuss the nuts and bolts of the who, what, why, and how of applying to this fellowship.

Panelists: Martin Reznek, MD MBA (University of Massachusetts), Jennifer Wiler, MD MBA (University of Colorado), Robert Tanouye, MD MBA (Cornell University)

Podcast audio engineer: Kellen Vu

https://www.aliem.com/em-match-advice-administration-fellowship/

The Leader's Library 4 : The Power of Moments

Join us in the fourth installment of ALiEM's The Leader's Library, which is a professional development book club for health professionals. Led by Dr. Dina Wallin and a team of renowned educators, the featured book is THE POWER OF MOMENTS by Chip and Dan Heath. Come sign up! https://www.aliem.com/the-leaders-library-power-of-moments/

 

ACEP E-QUAL 39: Transitioning to Outpatient Care in Opioid Use Disorder (OUD)

In this episode from the ACEP-EQUAL series, guests Dr. Aimee Moulin and Dr. Hannah Snyder discuss how to transition a patients treatment for opiate use disorder from the ED to the outpatient environment. They discuss how to use local resources, legal ramifications, waivers, and why they think a formal system to accomplish this is achievable.

Guests: Aimee Moulin, MD (Associate Professor, UC Davis; Behavioral Health Director for Emergency Department; Dual appointments in EM and psychiatry), Hannah Snyder MD (Assistant Professor of Family Community Medicine, UCSF; Primary Care Addiction Medicine Specialist)

Host: Jason Woods, MD; Podcast Sound Engineer: Kellen Vu

www.acep.org/equal