Esmolol Reduces Mortality in Septic Shock: A discussion with the author
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About 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.
Notes from the Chair: Looking Forward
There 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. Read More »
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.
Critical Care Board Certification
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During 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.
University of Michigan Critical Care Fellowhsip
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By Carrie Harvey, MD and Ivan Co, MD
Critical Care Fellows, University of Michigan
Name 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.