Academic Life in Emergency Medicine (ALiEM) Podcast

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, Placerville, VA Andrew Herring MD. Associate Director of Research, Highland Hospital, Alameda Health System Medical Director, Substance Use Disorder Treatment Program Assistant Clinical Professor, University of California San Francisco Host: Jason Woods, MD Audio Editor: 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, University of California San Francisco Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.com/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

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, University of California San Francisco Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.com/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

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.

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. Guests: Dr. Adam Oostema, Associate Professor of Emergency Medicine, Director of Neurological Emergency Medicine Research, Michigan State University College of Human Medicine Host: Jason Woods, MD Podcast editing assistance: Kellen Vu www.acep.org/equal

In this episode from the ACEP-EQUAL series, Dr. 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: Jason Woods, MD Podcast editing assistance: 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. Panelists include: Dr. Sean Fox (Carolinas Medical Center) Dr. Amy Stubbs (University of Missouri-Kansas City) Dr. Butch Humbert (Indiana University) Hosted by Dr. Michael Gisondi (Stanford) and Dr. Michelle Lin (UCSF) Show notes: 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. Hosts: Dr. Michael Gisondi (Stanford) and Dr. Michelle Lin (UCSF) Panelists: Dr. Charles Khoury (University of Alabama Birmingham, Dr. Melissa Platt (University of Louisville, Dr. Paul DeKoning (Dartmouth-Hitchcock Medical Center)

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)

A deep dive into the Standardized Letter of Evaluation (SLOE) for emergency medicine residency applicants. Hosts: Dr. Michael Gisondi and Dr. Michelle Lin Panelists: Dr. Abra Fant (Northwestern), Dr. David Gordon (Duke), Dr. Michael Takacs (University of Iowa)

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, Drs. Godwin and Shih review the recently published ACEP clinical policy regarding the treatment of headaches in the emergency department. Guests: Dr. Steven Godwin, Professor and Chair, Department 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: Jason Woods, MD 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