EM 2023 LLSA Reading List
Acute Headache
Raam R, Tabatabai RR. Headache in the emergency department: avoiding misdiagnosis of dangerous secondary causes, an update. Emerg Med Clin North Am 2021 Feb;39(1):67-85. doi: 10.1016/j.emc.2020.09.004. PMID: 33218663.
- The Ottawa Subarachnoid Hemorrhage Rule as a decision rule has high sensitivity to rule out SAH for patients presenting to the ED with a normal neurologic examination result and peak headache severity within one ___________________Â of onset of pain symptoms.
- It is recommended to preferentially use ___________________Â medications in the treatment of acute primary headaches in the ED.
Acute Stroke
Powers WJ. Acute ischemic stroke. N Engl J Med 2020 Jul 16;383(3):252-60. doi: 10.1056/NEJMcp1917030. PMID: 32668115.
- For establishing the time of onset of an acute stroke, the Powers’ article in the New England Journal of Medicine, states the time is established as the time that the patient ___________________.
- According to the NEJM review article on acute stroke, intravenous thrombolysis with alteplase (a recombinant tissue plasminogen activator) improves outcomes in selected patients with acute ischemic stroke when administered within ___________________ after onset.
- Endovascular mechanical thrombectomy of occluded large intracranial arteries improves outcomes in selected patients with acute ischemic stroke when performed ___________________.
- In selected patients with mild acute ischemic stroke who do not qualify for intravenous thrombolysis or mechanical thrombectomy, according to the NEJM Stroke article ___________________ when administered within 24 hours after onset and continued for 21 days lowers the risk of recurrent stroke.
Hospice and Palliative Medicine
Long DA, Koyfman A, Long B. Oncologic emergencies: palliative care in the emergency department setting. J Emerg Med 2021 Feb;60(2):175-91. doi: 10.1016/j.jemermed.2020.09.027. PMID: 33092975.
- ___________________, ___________________, and ___________________, while important in every patient encounter, are crucial during the interaction of patients nearing end of life.
- If the patient has no advance directives for health care, the usual hierarchy for determining the health care proxy is the patient’s spouse, adult children, parents, siblings, grandchildren, and close friends. If these individuals are unable to be contacted, the physician should assume the patient wants ___________________.
Nontraumatic Chest Pain
Musey PI Jr, Bellolio F, Upadhye S, Chang AM, Diercks DB, Gottlieb M, et al. Guidelines for reasonable and appropriate care in the emergency department (GRACE): recurrent, low-risk chest pain in the emergency department. Acad Emerg Med 2021 Jul;28(7):718-44. doi: 10.1111/acem.14296. Epub 2021 Jul 6. PMID: 34228849.
- One of the recommendations from the GRACE recurrent, low-risk chest pain article states that patients with recurrent, low-risk chest pain and prior coronary computed tomographic angiography (CCTA) within the past ___________________ receive no further diagnostic testing other than a single, high-sensitivity troponin below a validated threshold to exclude ACS within that time frame.Â
- Â In the GRACE recurrent, low-risk chest pain article, recurrent was defined as ___________________. Â
- In the GRACE recurrent, low-risk chest pain article, the authors defined low-risk as ___________________.
Opioid Withdrawal
Herring AA, Perrone J, Nelson LS. Managing opioid withdrawal in the emergency department with buprenorphine. Ann Emerg Med 2019 May;73(5):481-7. doi: 10.1016/j.annemergmed.2018.11.032. PMID: 30616926.
- Under Title 21, Code of Federal Regulations, Part 1306.07, discharged patients with opioid withdrawal may return to the ED daily to receive the buprenorphine for up to ___________________ days.
- Buprenorphine is a unique m-opioid receptor partial agonist with minimal euphoric reward and a ceiling effect on both ___________________ and ___________________.
- All patients with opioid withdrawal should be provided the ___________________level of care navigation assistance and the ___________________ possible wait time for an appointment to follow-up with a treatment/recovery provider.
Orthopedic Emergencies
Gottlieb M. Shoulder dislocations in the emergency department: a comprehensive review of reduction techniques. J Emerg Med 2020 Apr;58(4):647-66. doi: 10.1016/j.jemermed.2019.11.031. PMID: 31917030.
- What two variables have been shown to be associated with higher rates of failed reduction ___________________ and ___________________.
- Â The Bokor-Billman Technique, in one study, reported a ___________________% success rate and ___________________Â complications.
Pneumothorax
PSP Investigators. Conservative versus interventional treatment for spontaneous pneumothorax. N Engl J Med 2020 Jan 30;382(5):405-15. doi: 10.1056/NEJMoa1910775. PMID: 31995686.   Â
- In the NEJM study comparing conservative versus interventional treatment of first-time spontaneous pneumothorax, the authors found that the conservative approach was ___________________ and ___________________ to the interventional treatment approach.
- In the NEJM study on pneumothorax, interventions, including chest tube placement, were allowed in the conservative-management protocol under the following conditions: ___________________.Â
- In the NEJM pneumothorax study, the primary outcome was ___________________ within 8Â weeks after randomization.
Pulmonary Embolism
Maughan BC, Frueh L, McDonagh MS, Casciere B, Kline JA. Outpatient treatment of low-risk pulmonary embolism in the era of direct oral anticoagulants: a systematic review. Acad Emerg Med 2021 Feb;28(2):226-39. doi: 10.1111/acem.14108. PMID: 32779290.
- Major adverse outcomes other than mortality were uncommon among studies in the review and similar to or lower than the rate of complications in other ED patients who are often treated on an outpatient basis, such as patients with undifferentiated ___________________, patients with suspected ___________________, and patients with ___________________. Â
- A statistically significant association between ___________________ and rates of major adverse events was not identified.
Sepsis
Wardi G, Brice J, Correia M, Liu D, Self M, Tainter C. Demystifying lactate in the emergency department. Ann Emerg Med 2020 Feb;75(2):287-98. doi: 10.1016/j.annemergmed.2019.06.027. Erratum in: Ann Emerg Med 2020 Apr;75(4):557. PMID: 31474479.
- Type A lactic acidosis is defined by ___________________ and Type B ___________________.
- Cryptic Shock describes patients with ___________________ lactate levels and ___________________ blood pressure.
Sexually Transmitted Infection
Williamson DA, Chen MY. Emerging and reemerging sexually transmitted infections. N Engl J Med 2020 May 21;382(21):2023-2032. doi: 10.1056/NEJMra1907194. PMID: 32433838.
- Lymphogranuloma Venereum(LGV) is caused by what pathogen ___________________ and should be treated with ___________________ for ___________________Â days.
-  N. gonorrhoea infections of the rectum and pharynx are usually ___________________.
Trauma
Peck KA, Ley EJ, Brown CV, Moore EE, Sava JA, Ciesla DJ, et al. Early anticoagulant reversal after trauma: a western trauma association critical decisions algorithm. J Trauma Acute Care Surg 2021 Feb 1;90(2):331-6. doi: 10.1097/TA.0000000000002979. PMID: 33055578.
- In patients taking Warfarin with severe injury or bleeding, the recommended reversal agent is ___________________.
- Dabigitran is reversed by ___________________ ___________________.
Click to see all answers
Acute Headache
- The Ottawa Subarachnoid Hemorrhage Rule as a decision rule has high sensitivity to rule out SAH for patients presenting to the ED with a normal neurologic examination result and peak headache severity within one hour of onset of pain symptoms.
- It is recommended to preferentially use nonopioid medications in the treatment of acute primary headaches in the ED.
Acute Stroke
- For establishing the time of onset of an acute stroke, the Powers’ article in the New England Journal of Medicine, states the time is established as the time that the patient was last known to be well (i.e., in a normal or baseline state, as confirmed by medical history from patient or witness).
- According to the NEJM review article on acute stroke, intravenous thrombolysis with alteplase (a recombinant tissue plasminogen activator) improves outcomes in selected patients with acute ischemic stroke when administered within 4.5 hours after onset.
- Endovascular mechanical thrombectomy of occluded large intracranial arteries improves outcomes in selected patients with acute ischemic stroke when performed up to 24 hours after onset.
- In selected patients with mild acute ischemic stroke who do not qualify for intravenous thrombolysis or mechanical thrombectomy, according to the NEJM Stroke article dual antiplatelet therapy with clopidogrel and aspirin when administered within 24 hours after onset and continued for 21 days lowers the risk of recurrent stroke.
Hospice and Palliative Medicine
- Beneficence, nonmaleficence, and patient autonomy, while important in every patient encounter, are crucial during the interaction of patients nearing end of life.
- If the patient has no advance directives for health care, the usual hierarchy for determining the health care proxy is the patient’s spouse, adult children, parents, siblings, grandchildren, and close friends. If these individuals are unable to be contacted, the physician should assume the patient wants life-sustaining treatment.
Nontraumatic Chest Pain
- One of the recommendations from the GRACE recurrent, low-risk chest pain article states that patients with recurrent, low-risk chest pain and prior coronary computed tomographic angiography (CCTA) within the past two years, with NO coronary stenosis receive no further diagnostic testing other than a single, high-sensitivity troponin below a validated threshold to exclude ACS within that time frame.Â
-  In the GRACE recurrent, low-risk chest pain article, recurrent was defined as patients who have had a previous visit to an ED with chest pain that led to a diagnostic protocol for its evaluation that did not demonstrate evidence of ACS or flow-limiting coronary stenosis. This included two or more ED visits for chest pain in a 12-month period. Â
- In the GRACE recurrent, low-risk chest pain article, the authors defined low-risk as a HEART score < 4 points (and other scores validated in the ED setting such as the HEART pathway or TIMI score) for disease-related poor outcomes within 30 days all of which require an electrocardiogram (ECG) for risk stratification.
Opioid Withdrawal
- Under Title 21, Code of Federal Regulations, Part 1306.07, discharged patients with opioid withdrawal may return to the ED daily to receive the buprenorphine for up to three days.
- Buprenorphine is a unique m-opioid receptor partial agonist with minimal euphoric reward and a ceiling effect on both sedation and respiratory depression.
- All patients with opioid withdrawal should be provided the highestlevel of care navigation assistance and the shortest possible wait time for an appointment to follow-up with a treatment/recovery provider.
Orthopedic Emergencies
- What two variables have been shown to be associated with higher rates of failed reduction delays from the time of injury and emergency department arrival to reduction attempts and repeated reduction attempts.
-  The Bokor-Billman Technique, in one study, reported a 100% success rate and no complications.
Pneumothorax
- In the NEJM study comparing conservative versus interventional treatment of first-time spontaneous pneumothorax, the authors found that the conservative approach was non-inferior and has fewer serious adverse events to the interventional treatment approach.
- In the NEJM study on pneumothorax, interventions, including chest tube placement, were allowed in the conservative-management protocol under the following conditions: clinically significant symptoms persisted despite adequate analgesia; chest pain or dyspnea prevented mobilization; a patient was unwilling to continue with conservative treatment; the patient’s condition became physiologically unstable (systolic blood pressure of <90 mm Hg, heart rate in beats per minute greater than or equal to systolic blood pressure in millimeters of mercury, respiratory rate of >30 breaths per minute, or SpO2 of <90% while the patient was breathing ambient air); or a repeat chest radiograph showed an enlarging pneumothorax along with physiological instability.Â
- In the NEJM pneumothorax study, the primary outcome was complete radiographic resolution of primary spontaneous pneumothorax (full lung re-expansion), as determined by the treating physician within 8 weeks after randomization.
Pulmonary Embolism
- Major adverse outcomes other than mortality were uncommon among studies in the review and similar to or lower than the rate of complications in other ED patients who are often treated on an outpatient basis, such as patients with undifferentiated chest pain, patients with suspected ischemic attack, and patients with community acquired pneumonia. Â
- A statistically significant association between anticoagulant treatment class and rates of major adverse events was not identified.
Sepsis
- Type A lactic acidosis is defined by lactate accumulation in the setting of poor perfusion or hypoxia and Type B without cellular hypoxia.
- Cryptic Shock describes patients with elevated lactate levels and normal blood pressure.
Sexually Transmitted Infection
- Lymphogranuloma Venereum(LGV) is caused by what pathogen Chlamydia trachomatis and should be treated with doxycycline for 21 days.
-  N. gonorrhoea infections of the rectum and pharynx are usually asymptomatic.
Trauma
- In patients taking Warfarin with severe injury or bleeding, the recommended reversal agent is 4F-PCC 1,500 U IV.
- Dabigitran is reversed by idarucizuma 5 g IV (given as 2.5 g IV x 2).
