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by Andrew Chang, M.D., F.A.C.E.P., F.A.A.E.M. - Albert Einstein College of Medicine; Assistant Professor, Department of Emergency Medicine; Attending Physician, Montefiore Medical Center, Bronx, NY; by Joel Kravitz, M.D., F.A.C.E.P., F.R.C.P.S.C. - Jefferson Medical College, Thomas Jefferson University; Assistant Professor, Department of Emergency Medicine; Assistant Residency Director, Emergency Medicine Residency Program, Albert Einstein Medical Center, Philadelphia, PA and by Pinaki Mukherji, M.D. - Albert Einstein College of Medicine; Assistant Professor, Department of Emergency Medicine; Attending Physician, Montefiore Medical Center, Bronx, NY.
Learning Objectives
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| EDUCATIONAL GAP AND NEEDS ANALYSIS STATEMENT: The specialty of Emergency Medicine affects most Primary Care practices daily by having to diagnose and treat acute patient complaints such as chest pain, neuromuscular weakness, vertigo, thyroid and glucose disorders and other topics taught in this CME activity. Therefore, Primary Care providers need to review and update their knowledge in the specialty of Emergency Medicine as presented in this course. This activity will help to improve knowledge and patient outcomes in “first-response” health needs as well as prudent, cost-effective, and practical clinical behavior in the overall practice of EM and urgent care.
| | Day 1 |
Disorders of Glucose Control, Part I: Hypoglycemia. Disorders of Glucose Control, Part II: Hyperglycemia. As the World Turns: Peripheral Vertigo in the ED. Electrolytes at Panic Levels. |
| Day 2 |
Supraventricular Tachycardias. Seizures in the Emergency Department. Neuromuscular Weakness. Hand and Wrist Injuries. |
| Day 3 |
Thyroid Emergencies. Sexually Transmitted Diseases. EKG Interpretation. Approach to Chest Pain. |
| Day 4 |
Congestive Heart Failure. Breathless: Does This Patient Have a PE? Psychiatric Emergencies. Drug Interactions – A Shared Doctor/Patient Problem. |
| Day 5 |
Headache in the Emergency Department. Sepsis Advances. Abdominal Pain – The Black Box of the Belly. Facial Trauma. |
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Emergency Medicine: An Evidence-Based Approach to Adult Care
February 23-27, 2009
Location: Hyatt Regency Sarasota, Florida
OBJECTIVES
| OVERALL OBJECTIVES: The overall objective is to provide the participant with practical and clinically relevant information. Upon completion of this CME activity, the physician or healthcare provider should be able to describe the current approach to formulating differential diagnoses, diagnostic, therapeutic, and preventive management of the various disciplines presented. |
| SPECIFIC OBJECTIVES
| | Day 1 | Disorders of Glucose Control, Part I: Hypoglycemia. - Upon completion of this session, the participant should be able to:
| 1. | Integrate the understanding of glucose handling to create a treatment plan for Hypoglycemia and Alcoholic Ketoacidosis.
| | 2. | Identify potential pitfalls in the treatment and disposition of Hypoglycemia.
| | Disorders of Glucose Control, Part II: Hyperglycemia. - Upon completion of this session, the participant should be able to:
| | 1. | Create, using latest evidence, a comprehensive treatment plan for Diabetic Ketoacidosis (DKA).
| | 2. | Compare and contrast DKA and hyperosmolar non-ketotic states (HONK).
| | As the World Turns: Peripheral Vertigo in the ED. - Upon completion of this session, the participant should be able to:
| | 1. | Review the common causes of peripheral vertigo.
| | 2. | Appreciate the pathophysiology of benign positional vertigo.
| | 3. | Discuss how to perform various diagnostic tests in the evaluation of patients with peripheral vertigo.
| | 4. | Discover how to perform various therapeutic maneuvers, such as the Epley maneuver, in the treatment of patients with benign positional vertigo.
| | Electrolytes at Panic Levels. - Upon completion of this session, the participant should be able to:
| | 1. | Identify common symptoms and signs that suggest an electrolyte abnormality.
| | 2. | List the various therapies used to treat hyperkalemia.
| | 3. | Review the various formulas used to correct disorders in sodium homeostasis.
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| | Day 2 | Supraventricular Tachycardias. - Upon completion of this session, the participant should be able to:
| 1. | Review the characteristic EKG findings for atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, and Wolf-Parkinson-White syndrome.
| | 2. | Appreciate the factors determining the seriousness of any tachycardia.
| | 3. | Recognize the treatment options for various supraventricular tachycardias.
| | Seizures in the Emergency Department. - Upon completion of this session, the participant should be able to:
| | 1. | Outline key demographic information related to epidemiology of seizures in the ED setting.
| | 2. | Review the ACEP seizure clinical policy.
| | 3. | Identify appropriate interventions for acute seizures and status epilepticus in the ED setting.
| | 4. | Raise awareness of nonconvulsive status epilepticus.
| | Neuromuscular Weakness. - Upon completion of this session, the participant should be able to:
| | 1. | Compare and contrast upper and lower motor neuron disease.
| | 2. | Discriminate between various clinical entities that cause neuromuscular weakness, including Guillain-Barré Syndrome, Myasthenia Gravis, and others.
| | 3. | Demonstrate techniques to be able to discriminate between organic and functional weakness.
| | Hand and Wrist Injuries. - Upon completion of this session, the participant should be able to:
| | 1. | Review of the anatomy of the wrist and hand, with attention to surface anatomy and how it correlates to injury patterns.
| | 2. | Review the common pitfalls in diagnosis and treatment of hand and wrist injuries. This will be a case-base approach utilizing an Audience Response System.
| | 3. | Review hand injuries that should not be missed and/or require orthopedic follow-up.
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| | Day 3 | Thyroid Emergencies. - Upon completion of this session, the participant should be able to:
| 1. | Describe the presentation of life-threatening hyperthyroid states to the Emergency Department.
| | 2. | Prepare a comprehensive treatment plan for patient with thyroid storm and thyrotoxicosis.
| | 3. | Describe the presentation of myxedema coma.
| | 4. | Justify the use of intravenous Synthroid in the potentially hypothyroid patient.
| | Sexually Transmitted Diseases. - Upon completion of this session, the participant should be able to:
| | 1. | Integrate into their own practice some of the latest recommendations by the CDC with respect to the treatment of Sexually Transmitted Diseases.
| | 2. | Solve treatment issues in some of the more ‘controversial’ patients – including pregnant and HIV patients.
| | 3. | Differentiate between the various STDs that present with genital ulcers.
| | EKG Interpretation. - Upon completion of this session, the participant should be able to:
| | 1. | Standardize the approach to the initial ECG and discuss common artifacts and misreads.
| | 2. | Discriminate subtle presentations of abnormal rhythm and ischemia.
| | 3. | Describe signs of ischemia in patients with underlying bundle branch blocks.
| | 4. | Appreciate possible non-cardiac causes of abnormal ECGs.
| | Approach to Chest Pain. - Upon completion of this session, the participant should be able to:
| | 1. | Identify warning signs in the typical and atypical presentation of chest pain.
| | 2. | Appreciate factors in the history and physical which will alter risk stratification, and which interventions will alter outcome.
| | 3. | Formulate an initial treatment plan for every patient before obtaining the ECG or lab testing.
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| | Day 4 | Congestive Heart Failure. - Upon completion of this session, the participant should be able to:
| 1. | Recognize the presenting signs and symptoms of congestive heart failure (or lack thereof).
| | 2. | Formulate a rapid treatment plan and reassess response to therapy.
| | 3. | Initiate non-invasive ventilation in appropriate candidates.
| | 4. | Consider alternative diagnoses in patients who are refractory to treatment.
| | Breathless: Does This Patient Have a PE? - Upon completion of this session, the participant should be able to:
| | 1. | Design an appropriate algorithm for the diagnosis of pulmonary embolus based on clinical pre-test probability.
| | 2. | Describe the appropriate use of the D-dimer and define those patients who would benefit from its use.
| | 3. | Recognize the signs of pulmonary embolus on the screening ECG.
| | 4. | Manage the pulmonary embolism patient in a stepwise fashion with anticoagulation or interventions.
| | Psychiatric Emergencies. - Upon completion of this session, the participant should be able to:
| | 1. | Recognize the early signs of agitation and employ strategies to resolve them.
| | 2. | Diagnose and manage the complications of commonly used psychiatric medications.
| | 3. | Develop a plan for the medical clearance of a psychiatric patient.
| | Drug Interactions – A Shared Doctor/Patient Problem. - Upon completion of this session, the participant should be able to:
| | 1. | Assess the scope of the problem of drug-drug interactions as it pertains to both the outpatient and emergency settings.
| | 2. | Explore interactions between prescription and non-prescription medications and review their treatments.
| | 3. | Review common drug-drug interactions and their complications commonly seen in the emergency room.
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| | Day 5 | Headache in the Emergency Department. - Upon completion of this session, the participant should be able to:
| 1. | Discuss common headache syndromes and differentiate them from dangerous pathology.
| | 2. | Avoid the typical pitfalls of misdiagnosis in the “rule out subarachnoid hemorrhage” patient.
| | 3. | Rapidly create a treatment plan for the unstable patient with severe headache.
| | Sepsis Advances. - Upon completion of this session, the participant should be able to:
| | 1. | Choose appropriate initial antibiotics based on presenting complaints and indicators of resistance.
| | 2. | Describe special considerations in non-antibiotic therapy of selected infections.
| | 3. | Initiate early goal-directed therapy for the septic shock patient.
| | Abdominal Pain – The Black Box of the Belly. - Upon completion of this session, the participant should be able to:
| | 1. | Review some challenging cases of abdominal pain.
| | 2. | Explore diagnoses of abdominal pain in the absence of abdominal pathology.
| | 3. | Discuss the utility of various tests, including labs, ultrasound and CT scan in the diagnosis of abdominal pain.
| | Facial Trauma. - Upon completion of this session, the participant should be able to:
| | 1. | Perform both a rapid screen and a thorough evaluation of the patient with facial trauma.
| | 2. | Outline the challenges in securing an airway in the patient with facial trauma.
| | 3. | Describe the indication for different imaging procedures for facial trauma.
| | 4. | Manage injuries to the soft tissues of the face (lips, tongue, eyelids…).
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