EM Bound Newsletter | April 2020

**A newsletter for medical students pursuing a career in Emergency Medicine**

April 2020

We are thrilled that you are interested in the exciting field of Emergency Medicine (EM)! We are beyond excited to launch the inaugural issue of Academic Life in Emergency Medicine’s (ALiEM) EM Bound. This free monthly newsletter for EM-bound medical students serves as a resource and guide on their journey to the residency match and beyond.

TOP NEWS

If you are anything like we were as senior medical students, you are eager to start learning “real” EM. In the midst of such a vast abundance of options, you are likely lost about which resources to use. This is why Bridge to EM was created! Launched in March 2020, it provides a practical reading plan as a path to follow on your journey to becoming a competent and skilled emergency physician. This 8-week guide provides structured preparation in the weeks between Match Day in March and the beginning of your EM internship year on July 1.

From the first day of internship, members of your team will look to you for guidance and recommendations on the management of patients. We want to equip you with the tools to help build your medical knowledge foundation so you can start your first day with confidence. All of these resources are free for medical students (assuming an EMRA membership), provide practical, high-yield Emergency Department pearls, and have been vetted to ensure up-to-date recommendations.

SPOTLIGHT

The COVID-19 Pandemic

Here are some fast facts to know about COVID-19 and a few quick reads to help you get up to date on the latest in this pandemic.

Fast Facts on COVID-19 from the CDC website [1]

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus responsible for causing Coronavirus Disease 2019 (COVID-19).
Incubation period: 2-14 days with a median of 4-5 days.
At risk populations: Elderly, diabetes, heart disease, chronic lung disease, those receiving immunosuppressive medications, and pregnant patients.
Transmission: COVID-19 is spread through droplets that can become airborne when a person coughs or sneezes.
Protect yourself: Wear a surgical mask, gown (if possible), eye protection, and gloves. If doing high-risk, aerosolization procedures (i.e., endotracheal intubation, obtaining nasal or oropharyngeal swabs, nebulizer treatment), wear an N-95 mask or higher-order respirator.
Flatten the curve: Handwashing and avoiding touching your face is key to preventing spread! Crucial practices include social distancing of 6 feet, limiting travel to high risk areas, and avoiding sick people are also crucial.
Treatment: Supportive care. There are no vaccinations or proven medications available, although rapid research is being conducted.

Pearl: Instead of using nebulized albuterol and ipratropium, deliver these via metered dose inhaler (MDI) to avoid aerosolization of the virus. Rather than 3 DuoNeb (albuterol/ipratropium) nebulized treatments spaced 20 minutes apart, MDI formulations can be used [2, 3]:

Albuterol (90 mcg/actuation): 4-8 puffs every 20 minutes
Ipratropium (17 mcg/actuation): 2-4 puffs every 420 minutes

Additional Vetted Resources:

RebelEM: COVID-19: The Novel Coronavirus 2019
Hippo EM: Impact of COVID-19 on Healthcare Workers [podcast]
EmDocs: Managing the Critical COVID-19 Patient – SCCM Guidelines
JournalFeed: COVID-19 | Spoon-Feed Version
JAMA: COVID-19 Update – March 2020
Society of Critical Care Medicine: Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)

References

Coronavirus (COVID-19). Centers for Disease Control and Prevention (CDC) website
Albuterol sulfate. Prescribers Digital Reference (pdr.net)
Ipratropium bromide. Prescribers Digital Reference (pdr.net)

CLERKSHIP LIFE & RESIDENCY APPLICATION SEASON

Growing concerns over COVID-19 transmission in the healthcare setting has led to policy changes impacting undergraduate medical education. This has been most true in acute care settings with undifferentiated patients such as the Emergency Department. Restrictions on the clinical experience have ranged from limiting medical students to patients with no respiratory symptoms to suspension of clerkship rotations altogether.

How will clerkship restrictions impact graduating students now that they’ve matched?

The answer is evolving every day. The complexity of your remaining few months will depend on whether you have required rotations or mostly electives remaining.

Clerkships: On March 30, 2020, the Association for American Medical Colleges (AAMC) issued updated guidance as follows: “… we strongly suggest that medical students not be involved in any direct patient care activities for the next two weeks, through April 14, 2020.” As educators shift towards digital learning during your remaining clerkships, you will likely encounter creative innovations to supplement the clinical, in-person experience. Be open to new ideas and remote learning to prepare you for internship year.
Graduation: Each medical school ultimately develops its own criteria in planning for graduation. Make sure you are on any important mailing lists and check websites often for new updates. By this time (April), most students will have completed required rotations anyway. For those with remaining requirements, special accommodations will likely take place. If you haven’t done so, check in with your advisors today to ensure that you have fulfilled the most updated requirements.

Other Resources:

American Medical Association (AMA): How the virus is impacting medical schools

EXPAND YOUR SOCIAL MEDIA HORIZONS

Have you joined Twitter yet? There are plenty of smart clinicians filtering the literature for landmark findings, which may potentially change your practice. As a word caution, do not follow too many people to start because the information feed often becomes too noisy. Thereafter, it is common practice “prune” your list of followed accounts, especially when you no longer find their tweets helpful to you. Building your social-media based personal learning network early will prepare you well for residency, because it is impossible to stay current with the literature all by yourself on a sustainable basis.

Two suggested Twitter accounts to follow today:

Check out this site:

JournalFeed: A blog and a free email-based subscription service summarizing new EM literature

BE AN EFFICIENT LIFELONG LEARNER

The skills for finding, learning, and retaining information are key to your growth as a lifelong learner throughout your career. Here are resources to start building and customizing a learning approach that works for you.