Acep Sa Replay

Hyperoxia has been quoted as being independently associated with in-hospital mortality. Can the care we provide in the ED impact the patient’s outcome? Is there a “sweet spot” for oxygen titration? Should our therapy differ for patients status post cardiac arrest versus traumatic brain injured patients? Can we prevent the complications of oxygen toxicity?

"Pneumonia Alert! Did you order antibiotics?” the charge nurse asks you. It seems there is always some new process by which we identify patients with pneumonia, but what really is the current evidence behind the treatment of this common disease? The speaker will focus on the epidemiology of different types of pneumonia, including CAP, HCAP (HealthCare Acquired Pneumonia), HAP (Hospital Acquired Pneumonia), VAP (Ventilator Associated Pneumonia), review the current guidelines for diagnosis and management, and highlight antimicrobial resistance and antibiotic stewardship principles.

Emergency physicians deal with difficult conversations every shift. Whether it is resolving misunderstandings between provider and the patient/family regarding testing and treatment or discussing highly charged topics like “code status,” the ED physician must be expert in this “soft skill.” Using a case-based format with role playing exercises, the speaker will identify areas where ED physicians have difficulty with effective communication. The speaker will lead participants through scenarios where they will be provide scripting tools and key words to help negotiate difficult scenarios and facilitate a mutually agreeable plan.

Thoracic aortic dissection is an uncommon but extremely lethal condition that emergency physicians should be keenly aware of. Aortic dissection has a high mortality rate, and is commonly missed for a number of reasons. This presentation will highlight why the diagnosis is missed and what emergency physicians can do to decrease their miss rates.

It’s unusual to go through a shift without seeing a patient with shortness of breath. Many times the diagnosis is obvious – asthma, COPD, or CHF. But not always. Some patients will present with dyspnea from anemia, or a PE, cardiac tamponade, methemoglobinemia, or acute metabolic acidosis. The speaker will go through a systematic approach to the acutely dyspneic patient, to not miss the case that isn’t so obvious. Not-so-typical cases of dyspnea also will be presented.

High Flow O2 via a heated humidified Nasal Cannula (HFNC) has been reported to be useful in a hypoxic respiratory failure resulting from pneumonia, asthma, congestive heart failure, and pulmonary embolism. Additionally, HFNC effectively delivers a high FiO2 during pre-oxygenation for intubation, DNR/Palliative Care situations, and during invasive procedures such as EGD. In this case based discussion, the speaker will discuss the evidence behind and actual set up of HFNC, as well as common uses in the ED.

Diabetic ketoacidosis and hyperosmolar syndrome are the most common life-threatening complications of the growing epidemic of diabetes in the US. Timely recognition is essential to initiating appropriate management in the ED. Careful attention to fluid administration, electrolyte replacement, and insulin therapy is essential to reducing hospital length of stay and complications. During this case-based interactive discussion, the speaker will review cases of diabetic emergencies. Important similarities and differences in pathophysiology and management will be reviewed. Best evidence will be summarized in practical strategies to bring back to your ED.

Empathy is defined as the ability to understand the feelings and perspective of another person. There are numerous studies that have examined the science and art of empathy. Empathy has been proven to increase patient satisfaction and provider satisfaction. There are practical and simple techniques to increase empathetic behaviors even the chaotic setting of an ED. The audience will be able to apply these techniques easily on their next clinical shift for patient-centered bedside communication.

How does the expert clinician manage to sort through a sea of seemingly vague and disconnected complaints to pick up that rare but critically-ill patient whose condition is potentially devastating if missed? What clues do astute physicians hone in on and why? What tipped them off? Our patients don’t read the textbook ahead of time and rarely volunteer the key pieces of information needed to come up with the tough diagnosis. Test your skills as the presenter works through challenging cases. Will you sort out the clues and make the right call?