Academic Life in Emergency Medicine

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

ACEP E-QUAL 38: Opioid Use Disorder Access in the Time of COVID

A panel of experts talks about the experience with opioid use disorder (OUD) in the time of COVID and specifically efforts to maintain access to MAT during COVID. Note that the original recording contained contributions from Dr. Karen Scott (President, Foundation for Opioid Response Efforts) and Dr. Alister Martin (Emergency Medical Specialist, Founder Get Waivered) but were cut for the podcast due to time constraints.

Guests: Gail D’Onofrio, MD, MS (Professor and Chair, Department of Emergency Medicine, Yale School of Medicine Chief of Emergency Services, Yale New Haven Hospital), Emily Kauffman, DO, MPH (Assistant Clinical Professor Ohio State University Wexner Medical Center), Sandra Schneider, MD, FACEP (Associate Executive Director, Clinical Affairs Past President American College of Emergency Physicians), Karen Scott, MD, MPD(President, Foundation for Opioid Response Efforts (FORE), Alister Martin MD, MPP (Emergency Medical Specialist, Founder, Get Waivered)

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

www.acep.org/equal

Additional Resources:

• www.forefdn.org
• www.getwaivered.com/remote
• https://www.drugabuse.gov/ed-buprenorphine
• https://medicine.yale.edu/edbup/

References

1. Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Ann Intern Med. 2020;173(1):61-62. doi:10.7326/M20-1212
2. Hedegaard H, Minino A and Warner M. Drug Overdose Deaths in the United States, 1999-2018. NCHS Data Brief, number 356. Hyattsville, MD: National Center for Health Statistics 2020.
3. Hall OT, Hall OE, Kolodny A, Teater J, McGrath RP. Assessment of Excess Mortality Associated With Drug Overdose in Ohio From 2009 to 2018. JAMA Netw Open. 2020;3(4):e202183. Published 2020 Apr 1. doi:10.1001/jamanetworkopen.2020.2183
4. Hall OT, Hall OE, McGrath RP, Haile ZT. Years of Life Lost due to Opioid Overdose in Ohio: Temporal and Geographic Patterns of Excess Mortality. J Addict Med. 2020;14(2):156-162. doi:10.1097/ADM.0000000000000554

ACEP E-QUAL 37: Supercharging Medication-Assisted Treatment for OUD with PAs and APRNs

In this episode from the ACEP-EQUAL series, guests Ariana Samson and Dr. Andrew Herring share their experiences with the use of PAs and APRNs to drive the treatment of opiate use disorder in the ED.

Guests: Ariana Samson PA-C (ED APP Lead for US Acute Care Solutions, Marshall Medical Center); Andrew Herring, MD (Associate Director of Research, Highland Hospital, Alameda Health System Medical Director, Substance Use Disorder Treatment Program; Assistant Clinical Professor, UCSF)

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

www.acep.org/equal

ACEP E-QUAL 36: Buprenorphine After Opiate Overdose Part 2

This is part 2 of a 2 part discussion with Dr. Andrew Herring on the use of Buprenorphine after an opiate overdose, primarily in the ED.

Guest: Andrew Herring MD (Associate Director of Research, Highland Hospital, Alameda Health System; Medical Director, Substance Use Disorder Treatment Program; Assistant Clinical Professor, UCSF)

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

www.acep.org/equal

References:

1. Weiner, Scott, et al. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Annals of Emergency Medicine. April 2, 2019. doi.org/10.1016/j.annemergmed.2019.04.020
2. Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994;55(5):569-580. doi.org/10.1038/clpt.1994.71
3. Dahan A, Yassen A, Romberg R, et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth. 2006;96(5):627-632. doi.org/10.1093/bja/ael051
4. Ciraulo DA, Hitzemann RJ, Somoza E, et al. Pharmacokinetics and pharmacodynamics of multiple sublingual buprenorphine tablets in dose-escalation trials. J Clin Pharmacol. 2006;46(2):179-192. doi.org/10.1177/0091270005284192
5. Ang-Lee K, Oreskovich MR, Saxon AJ, et al. Single dose of 24 milligrams of buprenorphine for heroin detoxification: an open-label study of five inpatients. J Psychoactive Drugs. 2006;38(4):505-512. doi.org/10.1080/02791072.2006.10400589
6. Wang D, Sun X, Sadee W. Different effects of opioid antagonists on mu-, delta-, and kappa-opioid receptors with and without agonist pretreatment. J Pharmacol Exp Ther. 2007;321(2):544-552. doi.org/10.1124/jpet.106.118810
7. Boysen K, Hertel S, Chraemmer-Jørgensen B, Risbo A, Poulsen NJ. Buprenorphine antagonism of ventilatory depression following fentanyl anaesthesia. Acta Anaesthesiol Scand. 1988;32(6):490-492. doi.org/10.1111/j.1399-6576.1988.tb02772.x
8. Zamani N, Buckley NA, Hassanian-Moghaddam H. Buprenorphine to reverse respiratory depression from methadone overdose in opioid-dependent patients: a prospective randomized trial. Crit Care. 2020;24(1):44. Published 2020 Feb 7. doi.org/10.1186/s13054-020-2740-y
9. Phillips RH, Salzman M, Haroz R, Rafeq R, Mazzarelli AJ, Pelletier-Bui A. Elective Naloxone-Induced Opioid Withdrawal for Rapid Initiation of Medication-Assisted Treatment of Opioid Use Disorder. Ann Emerg Med. 2019;74(3):430-432. doi.org/10.1016/j.annemergmed.2019.01.006
10. Tompkins DA, Bigelow GE, Harrison JA, Johnson RE, Fudala PJ, Strain EC. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009;105(1-2):154-159. doi.org/10.1016/j.drugalcdep.2009.07.001
11. Carroll GG, Wasserman DD, Shah AA, et al. Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series [published online ahead of print, 2020 May 4]. Prehosp Emerg Care. 2020;1-5. 10.1080/10903127.2020.1747579

ACEP E-QUAL 35: Buprenorphine after Opiate Overdose Part 1

This is part 1 of a 2 part discussion with Dr. Andrew Herring on the use of Buprenorphine after an opiate overdose, primarily in the ED.

Guest: Andrew Herring MD (Associate Director of Research, Highland Hospital, Alameda Health System; Medical Director, Substance Use Disorder Treatment Program; Assistant Clinical Professor, UCSF)

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

www.acep.org/equal

References:

1. Weiner, Scott, et al. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Annals of Emergency Medicine. April 2, 2019. https://doi.org/10.1016/j.annemergmed.2019.04.020 
2. Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994;55(5):569-580. https://doi.org/10.1038/clpt.1994.71
3. Dahan A, Yassen A, Romberg R, et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth. 2006;96(5):627-632. https://doi.org/10.1093/bja/ael051
4. Ciraulo DA, Hitzemann RJ, Somoza E, et al. Pharmacokinetics and pharmacodynamics of multiple sublingual buprenorphine tablets in dose-escalation trials. J Clin Pharmacol. 2006;46(2):179-192. https://doi.org/10.1177/0091270005284192
5. Ang-Lee K, Oreskovich MR, Saxon AJ, et al. Single dose of 24 milligrams of buprenorphine for heroin detoxification: an open-label study of five inpatients. J Psychoactive Drugs. 2006;38(4):505-512. https://doi.org/10.1080/02791072.2006.10400589
6. Wang D, Sun X, Sadee W. Different effects of opioid antagonists on mu-, delta-, and kappa-opioid receptors with and without agonist pretreatment. J Pharmacol Exp Ther. 2007;321(2):544-552. https://doi.org/10.1124/jpet.106.118810
7. Boysen K, Hertel S, Chraemmer-Jørgensen B, Risbo A, Poulsen NJ. Buprenorphine antagonism of ventilatory depression following fentanyl anaesthesia. Acta Anaesthesiol Scand. 1988;32(6):490-492. https://doi.org/10.1111/j.1399-6576.1988.tb02772.x
8. Zamani N, Buckley NA, Hassanian-Moghaddam H. Buprenorphine to reverse respiratory depression from methadone overdose in opioid-dependent patients: a prospective randomized trial. Crit Care. 2020;24(1):44. Published 2020 Feb 7. https://doi.org/10.1186/s13054-020-2740-y
9. Phillips RH, Salzman M, Haroz R, Rafeq R, Mazzarelli AJ, Pelletier-Bui A. Elective Naloxone-Induced Opioid Withdrawal for Rapid Initiation of Medication-Assisted Treatment of Opioid Use Disorder. Ann Emerg Med. 2019;74(3):430-432. https://doi.org/10.1016/j.annemergmed.2019.01.006
10. Tompkins DA, Bigelow GE, Harrison JA, Johnson RE, Fudala PJ, Strain EC. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009;105(1-2):154-159. https://doi.org/10.1016/j.drugalcdep.2009.07.001
11. Carroll GG, Wasserman DD, Shah AA, et al. Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series [published online ahead of print, 2020 May 4]. Prehosp Emerg Care. 2020;1-5. 10.1080/10903127.2020.1747579