VTCEM Residents & Faculty,

That was nice weekend weather for October…


-Thanks to Faculty, Staff Admin, and Residents who helped to make HEENT Sim Lab for the residents last Thursday successful.

House Scoring


-House Assignments: https://drive.google.com/file/d/1RyeevW45TS0D8Myk1bURlTIOSMeIYa1w/view?usp=sharing

-Standings:  House Clinton: 41, House Perkins: 38.5,  House Kuehl: 36.5, House Fortuna 35.5

Dear Doc Mystery Case Competition


-Dr. Perkins’s Monthly Mystery Case 

-1st place: 50 pts,  2nd place: 25 pts, 3rd place: 15 pts, 4th place: 10 pts, 5th place: 0 pts

-Each House should designate one person who will submit the Dear Doc Mystery Case answers to Dr. Perkins.

General Program

-Temporary Resident Room Displacement: 10/19-10/21 – the ED Resident room will be undergoing some renovation/maintenance.  Please remove contents of your locker and remove any locks on the locker ASAP.  The 1S ED Admin Conference Room will be a temporary workroom for residents.-Epistaxis Learning Pearls:https://drive.google.com/file/d/1_cGm0K7yirqcGN8yuGpEsTP_zlzlnLBJ/view?usp=sharing

Ultrasound Peritonsillar abscess – Courtesy of Dr. Clinton:https://drive.google.com/file/d/12ElysHr-6MLypNj3j9d5wYEEc7dHji1L/view?usp=sharinghttps://drive.google.com/file/d/1WtSnoqOMYJvWmzjz4KLQ6kJz40bDBvLR/view?usp=sharing

-Residents – please note that a Mock ITE is being scheduled for early December 2020.  It is designed to simulate the content, pace, and conditions of the formal ITE being held in late February 2021.  ED Admin is currently coordinating a 5-day period during which a resident may complete the Mock exam in one sitting. More information to come.
-Dear Doc Concise Consults: https://drive.google.com/file/d/1tK5vjzdCN7OyV0gKL0Nejhw1a4pdVsZY/view?usp=sharing
-Courtesy of Dr. Janet Young – regarding CORD case submissions: https://drive.google.com/file/d/1f_8PDEB6FoHpUAzf70yOUgr3JN2rnYJe/view?usp=sharing

-Courtesy of Dr. Klemencic – Monthly LOA food box delivery, Tuesday Oct 20 10a-2p:https://drive.google.com/file/d/1Ynxge5wgKjiDzk60AVgLvPwdKiFdZ9GR/view?usp=sharing

-Update on Cures Act and Note Etiquette:https://drive.google.com/file/d/1Y6Pgb9Xg_UI5Llq6cBn0X68y-pSRtkoQ/view?usp=sharing

-E5 & E6 Retrofitting: https://drive.google.com/file/d/1TnOJ99RV2nRkkkkLteo1qlbtodTOagLn/view?usp=sharing
-Family Medicine: Please Call Family Medicine Resident 24/7 for any patient you plan to refer ED Obs – now through 10/30:https://drive.google.com/file/d/13u2DcFoRurbOCFoFGoduHb379FTXSuX2/view?usp=sharing

-Octreotide Shortage/Recommendations for Use:https://drive.google.com/file/d/111FiKyZE2S9sHZqCvwHrCH6P1G1q_Z4_/view?usp=sharinghttps://drive.google.com/file/d/1EklnFfznMpk1E_5qTbGzgqe8mwxNfYhB/view?usp=sharing

-Usability Study/Product Evaluation Opportunity:https://drive.google.com/file/d/1EZQ7m9SLSSvfxvYziG9_xWKxwcZzQiIJ/view?usp=sharing

Peds Corner Peds Rescue Seizure Medications – Courtesy of Dr. Uherick and PharmD Kelly Mcallister
Midazolam INH – On the inpatient side, providers tend to lean towards using inhaled midazolam. It is easier to administer than PR diazepam. Dosing for Midazolam INH  is 0.2 mg/kg (Max 10 mg) split between the nares. There is a new commercial product made specific for intra-nasal administration, however, insurance companies are not covering it. Our inpatient Peds pharmacist has only had it successfully covered by insurance once. The pharmacists are sending patients home after educating them on how to draw up meds and use an atomizer.  
Diazepam PR – If a patient is already on Diastat PR (Diazepam PR), then sometimes inpatient providers will not switch them over because the patient is already used to it and has had success. The dose for Diastat PR is based on age and weight. Using the parenteral formulation (5 mg/mL): 0.5 mg/kg/dose, followed by 0.25 mg/kg/dose in 10 mins, prn (Max 20 mg dose). Rectal gel formulation: 2-5 years: 0.5 mg/kg PR; 6-11 years: 0.3 mg/kg PR; >= 12 years/adolescents: 0.2 mg/kg
Clonazepam ODT – Clonazepam ODT is interesting and specific to certain kids. It is not actually sublingual like one would think.  It is just a rapidly dissolving oral tablet (like Zofran ODT) that has the same pharmacokinetics as a regular tablet.  Kids just don’t have to swallow it.  Onset is close to 40 minutes, so it will not really help with an acute seizure.  Our providers tend to use it more for those patients who have cluster seizures.  If a kid presents with a respiratory infection and tends to seize often with those symptoms, pediatric providers will often start them on Clonazepam ODT for 3-4 days while they are symptomatic and then discontinue after symptom resolution.  There are several different dosage forms: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg. 

Fellowship News

Wilderness Medicine:

 Please email StephLareau@gmail.com with any questions.

WM Calendar
-Oct 19: Fellowship Journal Club 6p-10p:https://drive.google.com/file/d/1lhkS1VpBodS5dgIGb0yJZF95rqeTFt25/view?usp=sharing

-Oct 20: Joint WM/EMS Fellowship Scenario: 2p-8p(Residents welcome to join)
Nov 4: Fellowship Journal Club (virtual with WM Fellowships nationwide)-Nov 7-8: Mountain Shepherd Survival School (ask Dr. Justin Gardner at jgardner4028@gmail.com for more details)
WM PearlsCourtesy of Dr. Lareau:
Accidental hypothermia can be a huge problem in cold weather for patient populations who cannot get out of the cold weather or people who are outdoors and get stuck there (think exhaustion, trauma, slips and falls, or intoxication).  
Patients who become really cold often appear dead, however, there have been some very impressive case reports of heroic efforts to re-warm seemingly dead people with normal neurological recoveries.  One is a case of Anna B√•genholm, a Swedish ortho resident, who survived a body temperature of 56.7F after a 9 hour resuscitation effort involving cardiac bypass.  


Rescuers working frantically to save Anna Bagenholm from a hole in the ice of a mountain stream.

Another case in which a patient was pulseless for at least 70 minutes after hypothermic arrest without CPR also had a full neuro recovery after resuscitation was initiated.  So remember you are not dead until you are warm and dead!


EMS Pearls
-Not all prehospital time is equal: Influence of scene time on mortality: https://drive.google.com/file/d/1Iet4fzXoL-BcRJvb-V9yYejfgZB70Z6R/view?usp=sharing

Ultrasound:US Pearls-Necrotizing Fasciitis: https://litfl.com/ultrasound-case-092/


Please read the following from the Program Director regarding the Academic Curriculum this year:


-Overall curriculum: https://drive.google.com/file/d/16GE4pUmUOqFOW2xCXjXHcEMzhrx28rwN/view?usp=sharing

PGY1: Reading:Foundations 1 –  https://foundationsem.com/heent/Foundations 1 – https://foundationsem.com/immunology-dermatology/EM Coach – https://www.emcoach.org/ – F1 – Unit 16 HEENT, Unit 30 Immuno/Derm 
Review Tests due 10/30:EM Coach F1 – Unit 16 HEENT, Unit 30 Immuno/Derm Rosh Tests: Foundations I – F1 – Unit 16 HEENT, Unit 30 Immuno/Derm, Unit 3 – GI III
PGY-2/3: Reading:Foundations 1 –  https://foundationsem.com/heent/Foundations 1 – https://foundationsem.com/immunology-dermatology/EM Coach – https://www.emcoach.org/ – F1 – Unit 16 HEENT, Unit 30 Immuno/Derm AliEMU – https://aliemu.com/courses/cutaneous2019/                   https://aliemu.com/courses/heent-2018/
Review Tests due 10/30:EM Coach F1 – Unit 16 HEENT, Unit 30 Immuno/Derm, PGY-3: F2 – Unit 16 HEENT 

Rosh Tests: Foundations I – F1 – Unit 16 HEENT, Unit 30 Immuno/Derm, Unit 3 – GI III

Conference-Conference this week on Thursday will start at 7:30a with Multi-disciplinary Critical Care Case Conference followed by the VTCEM Residency Program Business Retreat.  -Below is a general idea of how the Business Retreat may go.  Please note that the location and timing has not been officially confirmed and may be subject to change.  More information to come early this week. 

8:30-9:30a Transition to Lancerlot Sports Complex, 1110 Vinyard Road, Vinton, VA 24179

9:30-11a Complete Business Retreat Work Items

11a-1p Eat lunch/Ice-Skating

Scheduling-Block 4 and 5 shift scheduling complete. 

Oldies, but Goodies
-Please continue to report events, near misses, and unsafe conditions to SafeWatch or by calling 540-981-7233 (7-SAFE).

Interns/PGY-1s: Important Email Points

Reading:Foundations 1 –  https://foundationsem.com/heent/

Foundations 1 – https://foundationsem.com/immunology-dermatology/

EM Coach – https://www.emcoach.org/ – F1 – Unit 16 HEENT, Unit 30 Immuno/Derm 

Review Tests due 10/30:

EM Coach F1 – Unit 16 HEENT, Unit 30 Immuno/Derm 

Rosh Tests: Foundations I – F1 – Unit 16 HEENT, Unit 30 Immuno/Derm, Unit 3 – GI III

-You should attend the upcoming VTCEM Business Retreat on Thursday, 10/22.  

Website: damonsdue.com

Email: rmhchiefs@gmail.com


Stay safe.

Lu Ojeifo, MD

Chief Resident, VTCEM


cc: Chief Resident, VTCEM, Dr. Cassie Schandel, 540-529-1180

Chief Resident, VTCEM, Dr. Zach Williams, 540-597-5495

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