Question Of The Day #17

question of the day
qod17

Which of the following is the most likely cause for the patient’s elevated cardiac troponin level in the emergency department?

Elevated cardiac troponin levels, or troponinemia, are one sign that the myocardium may be infarcting or under some type of stressful condition. Cardiac troponin levels are assessed in conjunction with the clinical history, physical exam, EKG, and another laboratory testing in deciding if troponinemia is due to cardiac ischemia or another condition. Conditions associated with elevated cardiac troponin levels include cardiac ischemia (i.e. STEMI, NSTEMI), cardiac contusion, cardiac procedures, congestive heart failure, renal failure, aortic dissection, tachy- or bradyarrhythmias, rhabdomyolysis with cardiac injury, Takotsubo syndrome, pulmonary embolism, acute stroke, myocarditis, sepsis, severe burns, extreme exertion, and other conditions. It is unlikely that this patient had elevated troponin levels from Acute coronary syndrome (Choice D) as her cardiac catheterization results showed no significant occlusive lesions in the coronary arteries. D-Dimer levels do increase with patient age, but cardiac troponin levels do not increase with patient age (Choice B). Sepsis (Choice C) is a cause for elevated troponin levels, but this patient has no clinical signs or sepsis symptoms. Atrial fibrillation with a rapid rate (Choice A) is the most likely cause of this patient’s elevated troponin level. Correct Answer: A 

References

Cite this article as: iEM Education Project Team, "Question Of The Day #17," in International Emergency Medicine Education Project, October 16, 2020, https://iem-student.org/2020/10/16/question-of-the-day-17/, date accessed: October 20, 2020

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Brenda has just completed her first year of medical school at Central Michigan University. She has an interest in Emergency Medicine, and participated in the 2020 STAR-EM (Summer Training and Research in Emergency Medicine) at Toronto Western Hospital. Aside from school she loves working out, drawing and listening to music. At school she volunteers with Special Olympics, designed a study that aims to develop a crisis preparedness toolkit for rural Older Adults Impacted by COVID-19 through CMU-CARES, and is working with a group of students to host Pre-Medical School Workshops. Brenda loves to see others succeed while keeping a healthy lifestyle and avoiding burnout.

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My name is Sheza Qayyum, and I am a third-year medical student at the University of Toronto in Canada. My interests include medical education, FOAMed, and inner-city health. I am one of the podcast co-directors at the International Student Association of Emergency Medicine (ISAEM), which I enjoy greatly. I also love baking (and really all things food-related), chasing waterfalls with pretty hikes, and laughs with my friends and family.

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Joey Ciano, DO is an Emergency Medicine Physician from New York, USA. He completed his Emergency Medicine Residency in Brooklyn, NY and is the current International Emergency Medicine Fellow in the Northwell-LIJ Health System. One of his main professional interests is building the educational infrastructure of EM in countries where EM is not yet recognized as a field and in countries that are in the early stages of this process. He has partnered with international NGOs in EM educational projects and works as a visiting EM faculty member in West Bengal, India. He is excited to collaborate with the other authors of the iEM Education Project to contribute to world of FOAM-ed.

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I'm a fourth-year medical student at the University of Michigan applying to Emergency Medicine. I am passionate about medical education, especially end-of-life care in the ED, and resilience/wellness. Outside of medical school, I am an avid triathlete, nature-lover, and an advocate on sustainability and climate change.

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My name is Joey Ciano, I am a born and raised New Yorker currently working and living in Queens, NY. I am finishing my first year of International Emergency Medicine Fellowship in the Northwell Health system. My main interest in International EM is promoting EM systems building. This focuses on promoting the development of the specialty of EM in countries that have not yet recognized EM as a field or are in the early stages of this process. My main interest is working on the post-graduate educational infrastructure. I have done EM educational work in Uganda and continue to work in West Bengal, India to help educate practitioners in EM to help specialty development. COVID-19 has changed the way we teach locally and internationally, so I thought this project would be a great opportunity to reach international students in EM during these challenging times.

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Amita Sudhir, MD is the Emergency Medicine Residency Program Director at the University of Virginia, USA. She was also the third year emergency medicine clerkship director for 8 years. She has authored several textbook chapters, an ACEP clinical policy (on NTSEMI ACS), lectured both nationally and internationally and created multiple curricula and educational modules. She is also on the Scientific Advisory Council (First Aid subcommittee) for the American Red Cross.

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The AFEM/GECI Emergency Care Pathways

emergency care pathways
Dr. Emilie Calvello Hynes

In this post, we are sharing an announcement with you. One of our contributors, Dr. Emilie Calvello Hynes has something to share with you. Here is her message.

Dear all,

The Global Emergency Care Initiative has created and maintained its Emergency Care Pathways since 2018 on AgileMD in collaboration with the African Federation of Emergency Medicine. We have recently updated and expanded guidance to reflect COVID-19 care in low and middle-income countries.  

If you have colleagues in other countries who could use curated, clinical support in a single source that is updated daily, please consider letting them know about this resource. A flyer attached to aid in dissemination.  
 

We welcome your thoughts and the ability to disseminate this resource further.

In solidarity,

Emilie 

Description
The AFEM/GECI Emergency Care Pathways were launched in 2018 to provide an “at the bedside” reference to help standardized emergency care for common presentations of acute illness for healthcare workers working with limited resources.  
 
The pathways are available online/offline, available via an app or in printable form. The pathways integrate WHO Emergency Care Checklists, updated AFEM Handbook recommendations, WHO Essential Medication Lists and accepted international standards (e.g. Helping Babies Breathe, MSF Guidelines) as a summary reference of best-practice care. The pathways have been peer-reviewed and tagged for differing levels of possible interventions based on resources. The Emergency Care Pathways are meant to be applied after the initial assessment and management taught by the WHO BEC.
 
In addition, the app serves as a repository for open access commonly reference texts, useful protocols, forms and links. The pathways have been updated to reflect useful at the bedside guidance for clinicians during the COVID-19 pandemic. Resources and clinical guidance are updated almost daily.  The links include ACEP guidance, AFEM, WHO, Partners in Health and any other resources we think would be helpful to clinicians practicing in LMICs. 
 
How to sign up
This resource is free to all users and may be registered for via coloradoglobalem.org/register
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Cite this article as: iEM Education Project Team, "The AFEM/GECI Emergency Care Pathways," in International Emergency Medicine Education Project, April 20, 2020, https://iem-student.org/2020/04/20/the-afem-geci-emergency-care-pathways/, date accessed: October 20, 2020

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Cite this article as: iEM Education Project Team, "COVID19 Info for Medical Students," in International Emergency Medicine Education Project, April 3, 2020, https://iem-student.org/2020/04/03/covid19-info-for-medical-students/, date accessed: October 20, 2020

ISAEM COVID-19 Social Media Initiative

In this post, we are sharing an announcement with you. One of our collaborators, ISAEM, is starting a new social media initiative. Here is their message.

Dear Emergency Physicians, First Responders and Front-Line Health Care Staff:

We are emailing you on behalf of the International Student Association of Emergency Medicine (ISAEM). We hope that you are staying healthy during these difficult times.

Our team is organizing a new social media initiative to share experiences from the frontline across the world during the COVID-19 pandemic in a similar style to the Humans of New York page (https://www.humansofnewyork.com/).

We are looking for short reflections about your experience working in the emergency department and in other health care settings as well as any other thoughts you would like to share. We would also ask for a photo of yourself and/or of your current healthcare environment currently. You may submit multiple photos, but please ensure you have the permission of anyone in the photos before sending it to us. A photo consent form is provided here: https://drive.google.com/file/d/1yERDeZOKKKJTajUJmhsZg9HJ6iX957qR/view?usp=sharing 

You will be featured on the ISAEM Facebook/ Twitter accounts as well as the instagram account @humansofemerg administered by the Canadian Association of Emergency Physicians (CAEP).

You may consider responding to one of these questions, or share a different comment altogether.

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  • How are you staying connected with others?

All submissions can be sent to isaem.info@gmail.com 

We hope that this project will allow us to share candid experiences and perspectives with members of the healthcare community across the world. Thank you for considering to participate and thank you for all the work you are doing every day.

Sincerely,

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Cite this article as: iEM Education Project Team, "ISAEM COVID-19 Social Media Initiative," in International Emergency Medicine Education Project, March 30, 2020, https://iem-student.org/2020/03/30/isaem-covid-19-social-media-initiative/, date accessed: October 20, 2020

Interview: Stephanie Kayden (Part 2)

stephanie kayden md

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This interview recorded and produced by Arif Alper Cevik, Elif Dilek Cakal, Ali Kaan Ataman during the ESEM18 conference, Dubai, UAE.

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Cite this article as: iEM Education Project Team, "Interview: Stephanie Kayden (Part 2)," in International Emergency Medicine Education Project, March 20, 2020, https://iem-student.org/2020/03/20/interview-stephanie-kayden-part-2/, date accessed: October 20, 2020

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stephanie kayden icon360 interview

Are you ready to meet the genuine people behind the professional?

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Stephanie Kayden

Stephanie Kayden, MD, MPH, is Vice Chair of the Department of Emergency Medicine at Brigham and Women’s Hospital and Harvard University. She has a focus on international humanitarian response and leadership. She serves on the faculty of the Humanitarian Studies, Ethics, and Human Rights cluster in the Department of Global Health and Population. As Director of the Lavine Family Humanitarian Studies Initiative at the Humanitarian Academy at Harvard, Dr. Kayden trains students and professionals in global health and humanitarian work.

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This interview recorded and produced by Arif Alper Cevik, Elif Dilek Cakal, Ali Kaan Ataman during the ESEM18 conference, Dubai, UAE.

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Cite this article as: iEM Education Project Team, "Interview: Stephanie Kayden (Part 1)," in International Emergency Medicine Education Project, March 13, 2020, https://iem-student.org/2020/03/13/interview-stephanie-kayden-part-1/, date accessed: October 20, 2020

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