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The Unit: The Official Newsletter of the ACEP Critical Care Section - Winter 2014

Volume 16, Issue 1

Esmolol Reduces Mortality in Septic Shock: A discussion with the author

Joseph TonnaAbout a year ago, Dr. Andrea Morelli and colleagues published an open label randomized controlled trial in the Journal of the American Medical Association (JAMA) showing that administering esmolol in septic shock reduced heart rate.1  This is not a surprising finding.  The secondary outcomes, however, deserve attention and yet they seem to have been largely overlooked for the past 12 months.

Dr. Morelli’s study showed that esmolol reduced 28-day mortality by 30% absolute risk (adjusted and unadjusted).  Other outcomes included a 500 mL reduction in fluid requirements at 96 hours, decreased vasopressor use, increased systemic vascular resistance, stroke volume, and stroke work index.  Subjects who were randomized to esmolol had improved glomerular filtration rate, increased PaO2/FiO2 ratio, and decreased lactate.  All of these findings were achieved with an infusion of esmolol at standard dosing (average of <200mcg/kg/min; IQR 50-400mcg/kg/min) after 24 hours of resuscitation and stabilization. I read these outcomes last year and braced myself for the onslaught of esmolol use in septic shock.  Surprisingly, it never came.

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Notes from the Chair: Looking Forward

Marcolini_9-13There is a movement underfoot. Emergency medicine/critical care physicians are moving out of the shadows and into the forefront of emergency medicine and the intensive care unit (ICU); and our colleagues in various ICUs are taking note as well.  I don’t need to chronicle to you the pathway we all took to get here – time to look ahead and strategize about initiatives to make this transition successful. 

Yes, I did say successful.  Just because we gained the ability to sit for board certification doesn’t mean that we automatically have credibility in the eyes of those whom we are now joining.  As with any new job, new venture or new group of people there is a period of testing.  Think back to when you started a new job in the emergency department; do you remember the first nurse who challenged you?  I certainly do.

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Critical Care Board Certification

CCM Board CertDuring the ACEP Scientific Assembly 2014 Critical Care Section Meeting, the American Board of Emergency Medicine released recent subspecialty critical care board exam pass rates.  For the Internal Medicine-Critical Care examination, candidates have taken the exam for two consecutive years, with a total of 44 candidates passing the subspecialty examination for board certification.  The Anesthesia-Critical Care examination was only available to emergency medicine diplomates starting in 2013, and 12 of 14 candidates have passed.

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

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University of Michigan Critical Care Fellowhsip

By Carrie Harvey, MD and Ivan Co, MD
Critical Care Fellows, University of Michigan

Univeristy of MichiganName of program:  University of Michigan

Specialty certification pathway:  Anesthesia or Internal Medicine

Length of fellowship: Two years

Number of fellows: Anesthesia - 1 dedicated EM fellow/year, Internal Medicine - 1 dedicated EM fellow/year

Click 'Read More' for details and how to apply. 

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Hypothermia after Cardiac Arrest: A Summary of the ACEP Panel Discussion

CCM Hypothermia PanelThe critical care section meeting at Scientific Assembly 2014 featured an expert panel discussing therapeutic hypothermia during cardiac arrest.  Panel moderators included (from left) Dr. Ayan Sen and Dr. Evie Marcolini, and panel participants included (from left) Dr. Michael Donnino, Dr. Clifton Callaway, Dr. Jordan Bonomo, and Dr. Scott Weingart.

Therapeutic hypothermia became a preferred treatment for out-of-hospital cardiac arrest after two trials were published in 2002 that demonstrated improved survival and neurological recovery when patients were cooled to 32 – 34ºC.1,2  Medical professionals have commented on how fast these recommendations were accepted, however most clinicians agreed that these studies were rigorous.  The International Liaison Committee on Resuscitation (ILCOR) and the American Heart Association (AHA) quickly supported the use of cooling and incorporated it in cardiac arrest guidelines.

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News from the EMRA Critical Care Division

EMRAThe EMRA Critical Care Division has had a banner 2014 year and is looking forward to a great 2015. We’ve been involved in disseminating the message of ED Critical Care training opportunities through collaboration with the ACEP Critical Care Section. Highlights of the past few months have included revision and publication of the PressorDex manual, Emergency Medicine Foundation Critical Care Research Grants awarded to two division members, and creation of a webinar on “Applying to Critical Care Medicine” with support from ACEP and the Society of Critical Care Medicine.

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Updates from the Society of Critical Care Medicine

Brian WessmanThe EM/CCM section is excited for the upcoming Society of Critical Care Medicine (SCCM) 44th Critical Care Congress and we hope to see all of you in sunny Phoenix, AZ.  The Congress is scheduled for January 17-21, 2015.  Our section meeting will kick off with a social hour followed by our annual business meeting on Monday, January 19th from 11:00A – 1:00P (conference center location still TBD).  Our section will also be providing instructors and helping to sponsor the ever-popular procedural cadaver lab pre-congress educational session, scheduled for Saturday, January 17th (two half-day sessions).  Please refer to the 2015 SCCM congress program for updated information and locations.

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