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THE UNIT: The Official Newsletter of the ACEP Critical Care Medicine Section - Spring 2015

Volume 16, Issue 2

Life After Fellowship, Part I: Types of Critical Care Jobs

RaghuSeethala2015Editor’s Note: This article is the first in a 3-part series on Life After Fellowship. This series will explore how to find the right job after fellowship and considerations for new graduates on practice life.
Part I: Types of Critical Care Jobs
Part II: Getting the Right Job
Part III: How to Structure a Job for Professional Satisfaction

You are in your last year of a critical care medicine (CCM) fellowship. You have spent countless hours and nights mastering the intricacies of ventilator management and the art of vasopressor usage. At this point you can intubate a patient, place a sterile central line and arterial line, and have the mean arterial pressure above 65 mm Hg for any patient in less than 30 minutes! All your hard work during the past 5-6 years is about to pay off. You are going to be an attending and conquer the frontier of EM-CCM! But wait ... what’s next? What kind of job are you going to get? How do you go about finding this job? How do you stay happy and have a long and fruitful career? EM physicians have pursued CCM training as far back as the 1970s, but much has changed in the past few years. What lies ahead for you? We have put together a series of articles to address this important topic. We interviewed several experienced EM-CCM clinicians and combined their wisdom into these articles. This first article will focus on the type of jobs and opportunities available for EM-CCM trained physicians.

What kinds of jobs exist for EM-CCM trained physicians?

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The Use of Saline as a Resuscitation Fluid in ED

One of the growing debates in the critical care literature is the role of chloride-rich and chloride-poor crystalloid resuscitation fluids in critical care. This month, The Unit sponsors a point/counter-point on the use of saline as a resuscitation fluid in ED.

Yes -Normal Saline: The Elixir of Life                                                                   
Christopher M. Palmer, MD
Brian M. Fuller, MD, MSCI
Washington University School of Medicine

  No -Saline Should Not Be Used Routinely for Volume Resuscitation in the Emergency Department  

Michael C. Scott, MD
Michael E. Winters, MD, FACEP
University of Maryland School of Medicine
It’s 2 AM during a busy ED shift on a Saturday night and you’ve identified a septic patient with pneumonia whose most recent blood pressure reading is 70/30 with a heart rate of 130. The nurse turns to you and asks, “Should I start a one liter normal saline bolus?” The answer in your mind has always been “yes” in this situation throughout your career, is there any reason to doubt that now?Since 1832, when Dr. Thomas Latta administered “two drachms of muriate and two scruples of carbonate, of soda, in sixty ounces of water” to a patient in hypovolemic shock from cholera, the administration of intravenous fluids has been the cornerstone of resuscitation of critically ill patients. Intravenous fluids are often given to critically ill patients to augment cardiac output and improve tissue perfusion and oxygenation. It is clear that the timing and dosing of their administration are critical to patient outcomes.

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Notes from the Past Chair

Shiber_smallAt the Society of Critical Care Medicine (SCCM) 2015 Critical Care Congress held in Phoenix, AZ, last month, the ongoing joint efforts of the ACEP Critical Care Section and the SCCM Emergency Medicine Section continued. Under the leadership of Isaac Tawil, the SCCM EM Section Chair, a Critical Care Procedure Workshop was offered as one of the pre-congress events. It was the second year of this event, as last year we had the inaugural event of this type led by both of the “sister sections” developed and directed by Tim Ellender, previous SCCM EM Section Chair, and myself. Chris Ross added his experience running procedure workshops at previous ACEP Scientific Assembly events again as a course consultant, and we featured many section members and EM-CCM leaders as instructors including Evie Marcolini, Lillian Emlet, Brian Wessman, and more. We again were fortunate this year to have the support of Michelle Fox from Vidacare/Teleflex for underwriting the course.

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Critical Care Board Certification

For candidates seeking an upcoming board exam, click 'Read More' for the application deadlines.

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Section Elections

The ACEP Critical Care Medicine Section will elect officers prior to the annual meeting to be held during ACEP15 in Boston, MA, October 27, 2015. Election results will be announced at the meeting.

· Enthusiastic;
· Willing to set the leadership pace; and
· Willing to tackle the important issues?

If you -- or someone you know -- is interested in sub-specialization in critical care medicine and in the interface between emergency medicine and critical care medicine, and you are willing to serve as a leader of the Section then WE WANT YOU!

Officer terms are two years. The positions now open for nomination are:
• Chair Elect
• Secretary/Newsletter Editor
• Website Editor

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Book Review: Decision Making in Emergency Critical Care

DecisionMakinginECCThis book is a concise and evidence-based text that will help you manage critically ill patients in the emergency department and beyond. Whether you find yourself in a busy ED or in the ICU this multidisciplinary handbook is designed to help you efficiently find the facts and incorporate them into the management of your patients

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Critical Care Tracks in Emergency Medicine

JenelleHolst2015HSNow that there are multiple board-eligible pathways for critical care fellowships available to EM residents, interest in this career path is blossoming. The critical care applicant’s road can be challenging, though, and guidance and support through residency is needed to navigate these new pathways. The critical care track during residency is an effective tool not only to recruit potential residents to a career in critical care medicine but also to cultivate their interests and talents throughout residency and create competitive fellowship applicants.

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Notes from the Chair

EvieMarcoliniThis is an exciting and dynamic time for the world of stroke and emergency medicine. At the recent International Stroke Conference, three new studies were revealed that confirm and extend the results of MR CLEAN, demonstrating that mechanical clot removal after IV t-PA nearly doubles the rate of good outcomes (modified Rankin score 0-1) compared with IV t-PA alone.

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University of Maryland Critical Care Medicine Fellowship

UofMarylandSpecialty certification pathway: American Board of Internal Medicine

Length of fellowship: 2 years

Number of fellows: 4 per year. EM-trained candidates are accepted in accordance with the ACGME requirement, “Fellows from ACGME-accredited emergency medicine programs should have completed at least six months of direct patient care experience in internal medicine, of which at least three months must have been in a medical intensive care unit.” Remaining required internal medicine months upon starting the fellowship must be completed prior to functioning in the clinical capacity of a critical care fellow.

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The Unit is produced by the ACEP Critical Care Medicine Section

Newsletter Editor: Nick Mohr, MD, FACEP
Associate Editor: Joseph Tonna, MD
Associate Editor: Raghu Seethala, MD
Assistant Editor: Michael Haarstad, MD

If you are interested in contributing to The Unit, please contact Nick Mohr via email.

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