Winter 2011 Issue

From the President
Jason K. Fleming, MD, FACEP

Dear Colleagues,
 
With the beginning of a new year, your Hawaii ACEP Board of Directors looks forward to working with local organizations and government leadership to bring about improvements for emergency physicians in Hawaii. With new elected officials, both at the state and county levels, we hope to be instrumental in communicating the needs of our members and in being a strong, positive advocate of change.
   
Hawaii ACEP is your organization. We are working hard, often behind the scenes, to find common sense solutions that further the practice of emergency medicine in our state. If you are interested in being more involved in Hawaii ACEP, or if you have ideas that can help us better serve local emergency physicians, please contact me at jflemingmd@mac.com.
 
Aloha, Jason K. Fleming, MD, FACEP
President, American College of Emergency Physicians – Hawaii Chapter.

Annual Meeting and Dinner – CHANGE OF DATE

The date for the Hawaii ACEP Annual Meeting and Dinner has been changed to Wednesday, April 27, 2011, 4:00pm-9:30pm, at the Outrigger Canoe Club. Mark your calendars for our special event! We are proud to announce that our Keynote Speaker will be Dr. David C. Seaberg, President Elect of National ACEP. There will be a mailing to members in February. For more information, contact Debbie Sanders.

UH JABSOM Emergency Medicine Interest Group (EMIG)

A recent workshop was held at the medical school, helping med students learn how to read X-rays and EKGs. This event was very successful, with a good turnout. Currently, there are over 50 students on the EMIG roster, with about 20-30 first years attending workshops. More events are planned in the near future, including an ultrasound workshop, an IV workshop, and a semi-annual skills workshop.
  
Students also got some hands-on experience in December, helping to run a medical aid station for the Honolulu Marathon. The students attended a sports medicine workshop prior to the race, and they look forward to participating again in the future.
  
Students have begun participating in an ER shadowing program at Queen’s, with MS1s and MS2s “shadowing” physicians to gain some practical knowledge. All involved have really enjoyed their time in the ER.
  
EMIG is planning a “meet and greet” dinner, tentatively scheduled for April 1, to introduce students to ER physicians in the community. The event will be held at a physician’s home.
  
EMIG offers a valuable opportunity for med students to interact with other students considering a career in Emergency Medicine, as well as drawing on the knowledge and experience of local working Emergency docs. They welcome any and all Emergency physicians who would like to help mentor medical students. Please contact emigjabsom@gmail.com to get involved, propose your ideas, or show your support.

Hawaii ACEP Board Meetings

The Hawaii ACEP Board meetings are held every other month, on the third Wednesday of the month. Hawaii ACEP members are welcome to attend the Board meetings. For more information on the meetings, contact Debbie. Upcoming Board meetings will be held on the following dates: March 16, July 20, September 21, and November 16.
  
Visit our Hawaii ACEP web site.

A Note from ACEP Executive Director Dean Wilkerson, JD, MBA, CAE

Emergency Medicine Foundation/Blue Jay Consulting ED Director of the Year Award

I am very pleased to announce that the Emergency Medicine Foundation (EMF) and Blue Jay Consulting will be collaborating again this year for the second annual award to recognize an outstanding Emergency Department Director of the Year.

The purpose of this important award is to recognize and honor an emergency department physician leader who is currently in leadership of an emergency department and who has made a significant impact on improving the operations of his or her department, resulting in improvements in the quality of patient care.

I am calling on your support to identify and nominate an emergency department physician leader who you believe is qualified and deserving of this national recognition.

To submit your nomination, please email the enclosed form, nominee’s abbreviated curriculum vitae, and any supporting materials to info@emfoundation.org, or you can download the application at the foundation website.

The deadline for nomination entries is Friday, February 18, 2011, so I am asking you to please carefully consider possible candidates for this award and submit your nominees.

I believe this award will serve now and in future years to encourage and recognize emergency department directors who are committed to quality patient care and operational effectiveness. The award will be presented at the Monday, May 2, 2011, ACEP Emergency Department Directors Academy in Dallas, TX. If the awardee is not scheduled to attend this course, airfare and one night’s hotel will be provided.

Thank you in advance for supporting this initiative. We look forward to receiving your nominations. If you have further questions, please contact Holly Miori, EMF Manager, at 800-798-1822 ext. 3216.

Clinical News

CMS Tweaks Hospital Sedation Policy, Again
The Centers for Medicare and Medicaid Services has revised its recently updated anesthesia guidelines, following complaints the policy was unworkable.

Hospitals are now directed to develop their own internal policies concerning what is anesthesia versus analgesia, which leaves open the option of using different guidelines in different clinical departments. The revisions also provide greater flexibility regarding pre- and postanesthesia evaluations, while particularly problematic references to propofol and labor epidural anesthesia were dropped entirely.
Read the entire article online

Food Allergy Guidelines Encourage Earlier Use of IM Epinephrine
New federal guidelines on food allergy recommend “prompt and rapid” treatment of food-induced anaphylaxis with intramuscular epinephrine as first-line therapy.

And in cases of a suboptimal response to epinephrine – or if symptoms progress – “repeat epinephrine dosing remains first-line therapy over adjunctive treatments,” the guidelines say.

The “consistency and strength” of the recommendation for prompt treatment with IM epinephrine may come as a surprise to some emergency physicians who “reserve treatment with epinephrine until patients are in shock, which is an extreme and late manifestation” of anaphylaxis, said Dr. Carlos A. Camargo Jr., an emergency physician who served on the multidisciplinary expert panel that developed the guidelines for the National Institute of Allergy and Infectious Diseases.

“Earlier diagnosis of anaphylaxis and earlier treatment with epinephrine would benefit patients,” said Dr. Camargo of Massachusetts General Hospital and Harvard Medical School, both in Boston. “The guidelines strongly encourage earlier use of IM epinephrine for food-induced anaphylaxis.”
Read the entire article online

Focus On: Best Practices for Seizure Management in the Emergency Department
“Focus On” is an ongoing series of articles that examine common complaints that present to the emergency department or highlight new literature or treatment options. The January 2011 article reviews the current evaluation, management, and disposition of patients presenting to the emergency department with seizures.

Learning objectives for this article include the ability to discuss the presentation of seizure in the emergency department and common mimics of seizure; discuss the management of first-time and recurrent seizures in the emergency department; outline an aggressive treatment regimen for status epilepticus, including the emerging role of levetiracetam in the treatment algorithm; and list several practices that will improve the ED care of seizure patients.
After reading the article, take the CME quiz online.

Emergency Medicine Foundation Call for Proposals

EMF is pleased to announce a call for proposals due April 1, 2011:

Ultrasound Grant proudly underwritten by Siemens
The goal of this $20,000, one-year grant is to gain a better understanding of the comparative effectiveness of emergency ultrasound as performed by emergency physicians.

EMF/EMPSF Patient Safety Grant
The goal of this $10,000, one year grant is to identify ways and means to improve patient safety in emergency medicine.

EMF/Baxter Grant on Rehydration
The goal of this $50,000, one year grant is to study subcutaneous rehydration for pediatric and/or adult patients in the emergency department.

EMF/ENA Foundation Team Grant
The goal of this $50,000, one year grant is to have physician and nurse researchers combine their expertise to develop, plan, and implement clinical research in emergency care.

All grants will be funded July 1, 2011-June 30, 2012.

Welcome New Members

Jeremy G. Stone