Academic Life in Emergency Medicine

A major development in curbing the opioid epidemic is the introduction of the medication buprenorphine to address opioid addiction. Being able to prescribe this medication requires a DEA-X Waiver. Dr. Alister Martin, the Founder of the Get Waivered initiative, has reduced the barriers for clinicians to obtain the necessary training and paperwork. https://getwaivered.com/remote/ Disclosure: ALiEM is a proud collaborator with the Get Waivered Initiative, which is funded by the Foundation for Opioid Response Efforts (FORE) Foundation.

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

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 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. 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. 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.

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 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. 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. 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. 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. 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. 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. 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.

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/

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

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

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

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/

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/

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 Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Ann Intern Med. 2020;173(1):61-62. doi:10.7326/M20-1212 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. 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 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

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

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

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: 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 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 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 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 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 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 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 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 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 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 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

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: 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 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 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 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 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 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 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 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 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 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 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

In this Wellness Think Tank series, Dr. Katie Rebillot (LA County-USC) hosts a 2-part series on resident wellness particularly in the COVID era, featuring EM residents Dr. Jacqueline Furbacher (The Ohio State University), Dr. Sydney Beck (Harbor-UCLA), and Dr. Surriya Ahmad (SUNY Downstate/Kings County). This second installment focuses on strategies and resources in navigating resident life during stressful COVID19 times.

In this Wellness Think Tank series, Dr. Katie Rebillot (LA County-USC) hosts a 2-part series on resident wellness particularly in the COVID era, featuring EM residents Dr. Jacqueline Furbacher (The Ohio State University), Dr. Sanida Lukovic (Jacobi-Montefiore), Dr. Sydney Beck (Harbor-UCLA).

In this episode from the ACEP-EQUAL series, Dr. Adam Oostema discusses the diagnosis of hemorrhagic stroke in the ED, the current state of the evidence, and some common pitfalls that can lead to diagnosis error. Guest: Dr. Adam Oostema (Associate Professor of Emergency Medicine, Director of Neurological Emergency Medicine Research, Michigan State University College of Human Medicine) Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu www.acep.org/equal

In this episode from the ACEP-EQUAL series, Dr. Joshua Goldstein discusses anticoagulant reversal in the setting of hemorrhagic stroke. He reviews common anticoagulants, their specific and non-specific reversal agents, and reviews the literature base. Guests: Dr. Joshua Goldstein (Professor of Emergency Medicine, Director of Center for Neurologic Emergencies, Massachusetts General Hospital and Harvard Medical School) Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu www.acep.org/equal

A panel of emergency medicine residency directors reflect on the data and trends from the 2020 EM Match year and use it as a springboard to discuss significant changes coming for the 2021 application season. COVID-19, physical distancing guidelines, and COPA-EM society consensus recommendations are discussed. PD panelists include: Dr. Sean Fox (Carolinas Medical Center), Dr. Amy Stubbs (University of Missouri-Kansas City), Dr. Butch Humbert (Indiana University). Podcast sound engineer: Kellen Vu Hosted by Dr. Michael Gisondi (Stanford) and Dr. Michelle Lin (UCSF) https://www.aliem.com/em-match-advice-program-directors-reflect-2020-residency-match/

Join us in the third 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 an illustrated text by Jon Gordon and Damon West, called THE COFFEE BEAN. https://www.aliem.com/leaders-library-coffee-bean/

Join us in this Q&A session with Dr. Doo Ryeon Chung, MD PhD, Director of Infection Prevention and Control at Samsung Medical Center in Seoul, South Korea. He will be sharing key lessons and strategies for preventing COVID-19 transmission within hospitals, including PPE standards, workflows, infrastructure, and workforce management. Host: Ron C. Li, MD (Stanford) Guest: Doo Ryeon Chung, MD, PhD Podcast Engineer: Kellen Vu (Stanford)

What is going to change and what is not for residency application season in the unprecedented COVID-19 era? What are the nuanced considerations that are affecting medical students, medical schools, residency programs, and hospitals? An expert panel of EM program directors discuss their mindsets and initial advice in the ever-evolving landscape of medical education and training. Hosted by Dr. Michael Gisondi (Stanford) and Dr. Michelle Lin (UCSF) with PD panelists Dr. Charles Khoury (University of Alabama Birmingham, Dr. Melissa Platt (University of Louisville), Dr. Paul DeKoning (Dartmouth-Hitchcock Medical Center). Podcast sound engineer: Kellen Vu https://www.aliem.com/em-match-advice-covid-19-residency-application-season/

Hosted by Dr. Michael Gisondi and Dr. Michelle Lin, an expert panel of directors of EM medical education fellowships discuss the nuts and bolts of the who, what, why, and how of applying to this fellowship. Panelists: Dr. Danielle Hart (Hennepin County), Dr. Dmitri Papanagnou (Thomas Jefferson), Dr. Jeffrey Riddell (LAC-USC) Podcast sound engineer: Kellen Vu https://www.aliem.com/em-fellowship-match-advice-medical-education-fellowship/

A deep dive into the Standardized Letter of Evaluation (SLOE) for emergency medicine residency applicants with hosts, Dr. Michael Gisondi and Dr. Michelle Lin. Panelists include Dr. Abra Fant (Northwestern), Dr. David Gordon (Duke), Dr. Michael Takacs (University of Iowa). Podcast sound engineer: Kellen Vu https://www.aliem.com/em-match-advice-deep-dive-sloe/

Emergency physicians Dr. Vytas Karalius (Northwestern), Dr. Deirdre Goode (University of Chicago), and Dr. Katie Rebillot (Harbor-UCLA and WTT's Chief Operating Officer) discuss imposter syndrome, the 5 different types, how they plague many emergency medicine residents, its contribution to burnout, and how to address it. Have you experienced imposter syndrome (also known as an "imposter experience")? Wellness Think Tank (WTT): https://www.aliem.com/wellness-think-tank/

In this episode from the ACEP-EQUAL series, Dr. Steven Godwin and Dr. Richard Shih review the recently published ACEP clinical policy regarding the treatment of headaches in the emergency department. Guests: Dr. Steven Godwin (Professor and Chair of Emergency Medicine, University of Florida), Dr. Richard Shih (Professor of Integrated Medical Science and Program, Charles E Schmidt College of Medicine at Florida Atlantic University) Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu www.acep.org/equal References: Perry JJ et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013 Sep 25;310(12):1248-55. doi: 10.1001/jama.2013.278018 Carpenter CR et al. Spontaneous Subarachnoid Hemorrhage. A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Exam, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds. Acad Emerg Med. 2016 Sep;23(9):963-1003. doi: 10.1111/acem.12984. Epub 2016 Sep 6. Perry JJ. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4277 Dubosh NM et al. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386. Carstairs SD. Computed tomographic angiography for the evaluation of aneruysmal subarachnoid hemorrhage. Acad Emerg Med. 2006 May;13(5):486-92. Epub 2006 Mar 21. El Khaldi M. et al. Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients. La radiologia medica. 200 Feb;112(1):123–137. Menke J et al. Diagnosing cerebral aneurysms by computed tomographic angiography: meta-analysis. Ann Neurol. 2011 Apr;69(4):646-54. doi: 10.1002/ana.22270. Friedman BW et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Nov 14; 89(20): 2075–2082. doi: 10.1212/WNL.0000000000004642

Hosted by Dr. Michael Gisondi and Dr. Michelle Lin, an expert panel of residency program directors discuss finding the right-fit residency program for you using modern dating terms. Which programs should you swipe right or left on? Panelists: Dr. Arlene Chung (Maimonides), Dr. David Snow (Loyola), Dr. Robin Naples (Thomas Jefferson) https://www.aliem.com/em-match-advice-swipe-right/

Dr. Adam Rodos discusses the CMS measure SEP-1 as well as the EQUAL sepsis initiative. The talk focuses on the effect of these measures on patient care and strategies for sepsis care improvement. Guest: Adam Rodos MD (Assistant Professor, Dept of Emergency Medicine and Medicine, University of Illinois College of Medicine) Host: Dr. Jason Woods www.acep.org/equal References: Barbash IJ, Davis B, Kahn JM. National Performance on the Medicare SEP-1 Sepsis Quality Measure. Critical Care Medicine. 2019. 47(8):1026–1032. doi: 10.1097/CCM.0000000000003613 Kahn JM, et al. Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis. JAMA. 2019. 322(3):240-250. doi: 10.1001/jama.2019.9021. Venkatesh AK et al. Preliminary Performance on the New CMS Sepsis-1 National Quality Measure: Early Insights From the Emergency Quality Network (E- QUAL). Annals of Emergency Medicine. 2018;71(1):10-15.e1. doi: 10.1016/j.annemergmed.2017.06.032

In this episode from the ACEP-EQUAL series, Dr. Alexis LaPietra reviews greater trochanteric pain syndrome and its treatment, as well as gives an overview of one piece of osteopathic manipulative therapy called muscle energy. Guest: Alexis LaPietra, DO (Chair, ACEP Pain/Addiction Section System Chief, Pain/Addiction St. Josephs Health, Paterson NJ) Host: Dr. Jason Woods www.acep.org/equal

In this episode from the ACEP-EQUAL series, Dr. Katherine Vlasica reviews the technique, indications, contraindications, and benefits of the use of occipital nerve blocks and low paraspinous injections in the treatment of headache in the ED. Guest: Katherine Vlasica DO (Director of EM Pain Management, St Joseph’s Health in Paterson NJ; Clinical Assistant Professor of Medicine, New York Medical Center) Host: Dr. Jason Woods www.acep.org/equal Link for video of nerve blocks: https://cha.com/clinician-training-materials/ https://www.youtube.com/user/lmellick/videos

Join us in the second installment of ALiEM's The Leader's Library, which is a professional development book club for health professionals. Hosted by Dr. Dina Wallin, the featured book is Kim Scott's RADICAL CANDOR. https://www.aliem.com/leaders-library-radical-candor/

In this episode from the ACEP-EQUAL series, Dr. Jay Schuur, Dr. Chris Moore, and Dr. Courtney Moreno discuss the development of and recommendations from the new publication from the ACEP EQUAL group, "Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus." Article: https://www.ncbi.nlm.nih.gov/pubmed/31402153 DOSE project (Dose Optimization for Stone Evaluation): https://medicine.yale.edu/emergencymed/dose/ Radiology Safety Information: https://www.radiologyinfo.org/en/info.cfm?pg=safety-xray Host: Dr. Jason Woods www.acep.org/equal

In this episode from the ACEP-EQUAL series, Dr. Jay Schuur, Dr. Deb Diercks, and Dr. Kaushal Shah discuss the development and primary recommendation from the ACEP Clinical Policy for Thoracic Aortic Dissection. Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu www.acep.org/equal

Hosted by Dr. Michael Gisondi and Dr. Michelle Lin, an expert panel of residency program directors reflect on the 2019 Match year based on the NRMP data. Was it more or less competitive? What was new and what is their advice for the 2020 Match? View the data table for 2011-2019 on the ALiEM.com site. PD panelists: Dr. Sorabh Khandelwal (The Ohio State University), Dr. Fiona Gallahue (University of Washington), Dr. Brad Bunney (University of Illinois at Chicago) https://www.aliem.com/em-match-advice-program-directors-2019-residency-match/

In this episode from the ACEP-EQUAL series, Dr. Stephen Wolf (Professor and Vice Chair at the Department of EM, Denver Health Medical Center; Chair of the ACEP clinical policies committee, subcommittee chair for this policy) talks about the development and primary recommendation from the ACEP Clinical Policy: Suspected Acute Venous Thromboembolic Disease Host: Dr. Jason Woods www.acep.org/equal

In this episode, Dr. Craig Hostein and Dr. Thomas Vaughan discuss their success in reducing avoidable imaging for low back pain in the ED. Host: Dr. Jason Woods www.acep.org/equal

Dr. Frank Peacock and Dr. Michael Kontos review the 2015 guidelines, published in the Journal of the American College of Cardiology regarding appropriate use of cardiovascular imaging. Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu www.acep.org/equal PDF of slide deck: https://www.acep.org/globalassets/sites/acep/media/equal-documents/webinar_chestpainw3_policy_cvimaging.pdf References Rybicki FJ, Udelson JE, Peacock F et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/ SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain. JACC. Feb 2016. 67;7. DOI: 10.1016/j.jacc.2015.09.011 Singer AJ, Than MP, Smith S et al. “Missed myocardial infarctions in ED patients prospectively categorized as low risk by established risk scores”. Am J Emerg Med. 2017 May;35(5):704-709. DOI: 10.1016/j.ajem.2017.01.003. Poldevaart JM, Reitsma JB, Backus BE. “Effect of Using the HEART Score in Patients with Chest PAin in the Emergency Department: A Stepped-Wedge, Cluster Randomized Trial.” Ann Intern Med. 2017 May 16;166(10):689-697. doi: 10.7326/M16-1600 Than MP, Aldous SJ, Troughton RW et al. “Detectable High-Sensitivity Cardiac Troponin within the Population Reference Interval Conveys High 5-Year Cardiovascular Risk: An Observational Study.” Clin Chem. 2018 Jul;64(7):1044-1053. DOI: 10.1373/clinchem.2017.285700

Dr. Simon Mahler, Dr. Deborah Diercks, and Dr. Christopher Baugh discuss how to implement the use of high sensitivity troponin in your clinical setting on this featured ACEP E-QUAL podcast. Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu www.acep.org/equal

Dr. Peacock and Dr. Christensen discuss the nuances of the high sensitivity troponin lab test on this featured ACEP E-QUAL podcast. Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu www.acep.org/equal

Host Dr. Jason Woods discusses the new PECARN Infant Fever Prediction Rule with lead author Dr. Nate Kuppermann. They review how this rule is different than its predecessors, understanding recursive partitioning, and how/when to use this rule in clinical practice. Article: Kuppermann et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Peds. Feb 2019.

The Leader's Library book club series kicks off featuring Brene Brown's DARE TO LEAD. Hosted by Dr. Dina Wallin, this podcast provides a teaser on why this book is critical for leaders in healthcare and academia. Learn more at: https://www.aliem.com/the-leaders-library-dare-to-lead/

Guest host, Dr. Michelle Lin chats with Dr. Jill Baren (University of Pennsylvania) on the whys, hows, and behind-the-scenes stories about conducting research under the Exception From Informed Consent (EFIC) regulation. Spoiler alert: It is not for the timid or impatient.

An EM Match Advice episode on promoting diversity and inclusion during residency training, hosted by Drs. Michael Gisondi and Michelle Lin. Featuring Dr. Joel Moll (Virginia Commonwealth), Dr. Tyson Pillow (Baylor), and Dr. Bonnie Kaplan (Denver Health). https://www.aliem.com/em-match-advice-diversity-inclusion/

Facilitated by Dr. Matt Melamed, this podcast features powerful insights from Lt. Col. David Grossman, the author of On Combat, as he relates stories in the military as it applies to emergency physicians. Strategic sleep hygiene, deep breathing, and food/water are discussed as they relate to stress management and staying in a constant "condition yellow" of alertness.

Facilitated by Dr. Matt Melamed and Dr. Nicole Battaglioli, this podcast discusses the 2019 Western Journal of Emergency Medicine's article on The Happiness Practice curriculum for EM residents. This curriculum was modeled after several successful wellness initiatives at the corporate level. Authors Dr. Danielle Hart and Dr. Glenn Paetow from Hennepin join us to discuss their study findings, the broader challenges in studying wellness, and some promising systems-level changes at their institution. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324712/ ALiEM Wellness Think Tank: https://www.aliem.com/wellness-think-tank/

Co-hosted by Drs. Mary and Nate Haas, this episode of the SAEM's Research Learning Series features Dr. Daren Beam (Indiana University) on how to write a winning abstract for a scientific meeting or conference. Take notes and apply his practical pearls of do's and don'ts, while also hearing some funny, behind-the-scenes stories about his time as a research coordinator for the PERC rule.

Co-hosted by Drs. Mary and Nate Haas, this installment of SAEM's Research Learning Series features Dr. Zachary Meisel (University of Pennsylvania) on how to turn your interest into research. Get inspired by his career path from prehospital research to narratives in evidence-based medicine.

Dr. Christian Tomaszewski and Dr. Michael Ross reviews the 2018 ACEP Clinical Policy on Critical Issues in the Evaluation and Management of Emergency Department Patients with Suspected Non–ST-Elevation Acute Coronary Syndromes (NSTEMI). Read the entire policy here: https://www.acep.org/patient-care/clinical-policies/nonst-elevation-acute-coronary-syndromes/ Dr. Tomaszewski was the lead for writing this clinical policy and is a Professor of Emergency Medicine at UC San Diego. Mr. Ross is a Professor of Emergency Medicine at Emory. He is the Medical Director of Observation Medicine for the Department of Emergency Medicine and the Chest Pain Center Director for Emory University. Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu www.acep.org/equal

Dr. Erik Hess, Dr. W. Franklin Peacock, and Dr. Simon Mahler discuss complex issues involving chest pain protocols in "ruling-out" low risk chest pain patients. They tackle the issues of: Troponin-Only Pathway: The Era of High Sensitivity Troponins (Hess) Importance of Incorporating Accelerated Diagnostic Protocols (Peacock) How to Get Buy-In and Implement ADPs in the Emergency Department (Mahler) Dr. Hess is the Vice Chair in the Department of Emergency Medicine at the University of Alabama. Dr. Peacock is the Vice Chair in the Department of Emergency Medicine at Baylor University. Dr. Mahler if the Director of Clinical Research in the Department of Emergency Medicine at Wake Forest University. Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu www.acep.org/equal