AAEM16 Competitions

DIAGNOSTIC CASES & CHALLENGE BOWL

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015 Call for Photographs

3rd Annual Diagnostic Case Competition

You are invited to submit original photographs for presentation at the AAEM 22nd Annual Scientific Assembly in Las Vegas. Photographs of patients, pathology specimens, Gram stains, EKGs, and radiographic studies or other visual data may be submitted. Your submission should depict clear examples of findings that are relevant to the practice of emergency medicine or findings of unusual interest that have educational value. If your submission is accepted, you must mount it for viewing.

22nd Annual AAEM Scientific Assembly, Las Vegas, NV

No more than three different photos may be submitted for any one case.

Please submit digital copies in JPEG or TIFF format through the online submission system at www.aaem.org/AAEM16/competitions.

Photo submissions must be accompanied by a brief case history written as an “unknown” in the following format: 1) chief complaint, 2) history of present illness, 3) pertinent physical exam (other than what is depicted in the photo), 4) pertinent laboratory data, 5) one or two questions asking the viewer to identify the diagnosis or pertinent finding. In a separate MS Word document, please list the following information: 6) answer(s) and brief discussion of the case, including an explanation of the findings in the photo, and 7) one to three bulleted take home points or “pearls.” Please submit only blind copies, omitting your name, institution, city, state, or any other identifier.

The case history is limited to no more than 250 words. If accepted for display, AAEM reserves the right to edit the submitted case history.

Submissions are selected based on educational merit, relevance to emergency medicine, quality of the photograph, the case history, and appropriateness for public display. If your photograph is accepted, you will be notified and informed of set-up and dismantle times. Patients and patient identifiers must be appropriately masked. Additionally, you must attest that written consent and release of responsibility have been obtained for all photos EXCEPT for isolated diagnostic studies such as EKGs, radiographs, Gram stains, etc.

Responsibility for bringing photo and case submission(s) to the Scientific Assembly rests with the submitter. A 4´ x 8´ vertical area will be available for each submission.

Photo competition participants who submit by November 15, 2015, will receive notification of acceptance or rejection by January 13, 2016.

8 feet wide Option 1 8x4 vertical poster

Option 2 4x4 vertical poster

4 feet wide

Pre-sorted Standard Mail US Postage PAID Milwaukee, WI Permit No. 1310

555 East Wells Street, Suite 1100 Milwaukee, WI 53202-3823

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS

Eligible Participants • AAEM Full Voting Members • AAEM Associate Members • AAEM Fellow-in-Training Members Participant Guidelines — General Overview The PRESENTER has five minutes to describe the case as it appeared in the emergency department. Only the information provided to the discussant when the case was submitted may be presented at the diagnostic case competition.

Presenters must not surprise the discussant with information not previously provided.

Planet Hollywood Resort & Casino

Following the presenter’s five-minute presentation, the DISCUSSANT has 20 minutes to discuss the case, emphasizing the emergency medicine approach to the diagnostic reasoning that leads to a final diagnosis. Generally, the salient features of the case are highlighted, a differential diagnosis is offered, and a logical discussion is provided to argue to a final diagnosis. Although an accurate final diagnosis is important, the majority of the judging focuses on the discussion and presentation.

The discussant should not utilize the time to discuss the final diagnosis; this will be done by the presenter.

The PRESENTER then has 10 minutes to give the final diagnosis and discuss the disease process, its relevance to emergency medicine, and describe the elements in the ED encounter that support the final diagnosis.

The presentation time frames (5, 20, & 10 minutes) are rigidly set and observed.

Timers will be utilized to assist the speakers. Substantial scoring penalties will be imposed for exceeding the prescribed time limits.

All diagnostic cases will be presented using the provided laptop computer and LCD projector. A laser pointer, microphone, and handheld slide advancer will also be provided. All presentation files will be preloaded onto the laptop at the podium prior to the onset of the conference. No personal flash drives will be used on the day of the competition.

Please organize or facilitate another person to be available to present on your behalf in the case of any unforeseen circumstances that would prevent you from presenting on the day of the competition. If a backup is needed, he or she must be on staff at your hospital.

Presentation Guidelines • All slides must be created using PowerPoint® software and must be in Windows® format.

• Slides may contain text and static images but no video clips, audio clips, hyperlinks to the web, nor embedded files or links to other files. Violating this rule will result in a substantial scoring penalty.

• Moving “slide transitions” between slides are permitted. Using the slide show “animation” feature within PowerPoint® is permitted.

• Speaker notes within the PowerPoint® presentations are not permitted.

• The slides will be shown using the slide show feature in PowerPoint® 2007 on a Windows®-based computer.

• The “Presenter View” option will not be utilized on the day of the competition.

• This is not an interactive presentation. Please do not solicit audience participation.

• Please only submit a blinded version of your PowerPoint.

Deadline for case submission is November 13, 2015, with notification of acceptance or rejection by February 13, 2016.

For additional information about the Diagnostic Case Competition including submission questions, competition/registration questions, and discussant questions, please visit: www.aaem.org/education/scientific-assembly/competitions.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

American Academy of Emergency Medicine

AAEM-0515-611

Call for Papers & Photos

• Diagnostic Cases • Emergency Medicine PA Fellowship Challenge Bowl

Call for Papers & Photos

Submission Deadline: November 13, 2015

• Diagnostic Cases • Emergency Medicine PA Fellowship Challenge Bowl Submission Deadline: November 13, 2015

American Academy of Emergency Medicine

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

FEBRUARY 17-21, 2016

FEBRUARY 17-21, 2016 www.aaem.org/AAEM16

18TH ANNUAL AAEM/JEM RESIDENT AND STUDENT RESEARCH COMPETITION

CALL FOR PAPERS

18TH ANNUAL AAEM/JEM RESIDENT AND STUDENT RESEARCH COMPETITION 22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015

The AAEM/JEM Resident and Student Research Competition is designed to recognize outstanding research achievements by residents and students in emergency medicine. To apply, you should submit an abstract summarizing the objectives, methods, results, and conclusions of the research performed according to the instructions detailed in this brochure. Submitted abstracts will be judged by the AAEM Abstract Review Committee, who will select eight for oral presentation at the Resident and Student Research Forum during AAEM’s 22nd Annual Scientific Assembly, February 17-21, 2016, in Las Vegas.

Final judging of the eight oral presentations will take place at the Scientific Assembly. Abstracts not selected for oral presentation will be displayed as 4´ x 8´ vertical poster presentations during the Scientific Assembly. Please do not submit an abstract if you are not prepared to travel to the Scientific Assembly in Las Vegas and present it in the session selected by AAEM. The presenter of the oral abstract judged to represent the most outstanding research achievement will receive a $3,000 honorarium. $1,500 and $500 honoraria will go to the presenters of the second and third place oral abstracts, respectively.

Abstract Submission Instructions Please read the abstract submission instructions carefully. The deadline and space requirements are strictly enforced in order to give all authors an equal opportunity to submit their data in the same amount of space and under the same time constraints.

1. Resident or Medical Student Status ­— In order to be eligible for consideration, the first author and principal investigator of each abstract submitted must be either a (1) resident in an ACGME, AOA, or ACGME-I accredited emergency medicine training program or (2) medical student in an LCME/COCA accredited institution with a strong interest in emergency medicine as a future profession, or a medical student with a strong interest in emergency medicine whose country is found within the Directory of Organizations that Recognize/Accredit Medical Schools (DORA). To verify this, you must submit the name of the appropriate designated official (e.g., program director, dean).

2. Submission Deadline • Electronic submissions will be accepted beginning September 11, 2015.

• Abstract receipt deadline for electronic submission is November 13, 2015.

3. There is no fee for submitting an abstract. All abstracts must be submitted and presented in English.

4. You must submit both a blind and formal version of your abstract.

5. If you have questions regarding the abstract submissions for the 22nd Annual Scientific Assembly, please call AAEM at (800) 884-2236 or email Emily DeVillers at edevillers@aaem.org.

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015

Abstract Submission Guidelines

Abstract Formatting

Electronic Submission Deadline: November 13, 2015 Electronic Instructions Abstracts can be submitted electronically at www.aaem.org/AAEM16/ competitions.

Presenting Author Information You will need to submit the presenting author’s name, address, telephone, and fax numbers, as well as an email address. Only the presenting author listed on the submission form will be notified of abstract acceptance.

Funding Indicate what monies have funded the research.

Disclosure of Relevant Financial Relationships In accordance with the essentials and standards set forth by the Accreditation Council for Continuing Medical Education, as well as guidelines proposed by the Food and Drug Administration and endorsed by the American Medical Association, an author with a conflict of interest with the content of their abstract must disclose that conflict prior to presentation. A conflict of interest includes, but is not limited to, any relevant financial relationship in a company, product or procedure mentioned in the abstract or in the presentation to be given at the conference. The authors must complete the disclosure form included in the electronic submission. A conflict in and of itself will not eliminate an abstract from consideration.

Previous Presentations of Abstracts No abstract published as an article on or before October 1, 2015, may be submitted for this competition. Abstracts that have been presented at the national meetings of other organizations should not be submitted for consideration.

Informed Consent Any studies involving human subjects must conform to the principles of the Declaration of Helsinki of the World Medical Association (Clinical Research 1966; 14:103) and must meet all the requirements governing informed consent of the country in which the research was performed.

Abstract Publication All oral abstracts presented at AAEM’s 22nd Annual Scientific Assembly will be published in the May 2016 issue of the Journal of Emergency Medicine.

Ownership of abstracts not accepted reverts to the authors.

Notification of Abstract Selection The presenting author of all abstracts submitted by November 13, 2015, will receive notification of acceptance or rejection by January 13, 2016.

Withdrawals and Revisions Withdrawals and revisions must be received in writing to Emily DeVillers at edevillers@aaem.org by November 16, 2015. No changes can be submitted after that date.

1. Use 12-point Times New Roman (or similar) type. If Times New Roman is unavailable, other options include Helvetica or Arial. Limit text to 2,500 characters, including spaces, and single space all text in the body of the abstract.

Meta-Analysis Of Risk For Serious Bacterial Infection in Febrile Neonates With RSV Infection

2. Do not indent the title. Capitalize only the first letter of each word in the title. List author names using initials only for first and middle names. Underline author names continuously. Include institution, city, and state where research was performed. When submitting the blind copy, omit author names, institution, city, state or any other identifier where research was performed. Omit degrees, titles, institutional appointments, street addresses, and ZIP codes. Single space entire abstract. The left-hand margin of the abstract’s text should be perfectly aligned.

Introduction: The febrile young infant is a common problem managed by pediatric emergency medicine physicians. It is widely recommended that all febrile infants <1 month of age receive a comprehensive sepsis evaluation and hospitalization for empiric antibiotic therapy pending culture results. One might anticipate that certain viral infections [e.g., RSV] should be relatively infrequent during the first weeks of life in healthy term newborns, and that lower rates of +SBI [SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis] would be present in febrile young infants with documented viral infection vs. those without.

3rd Annual Emergency Medicine PA Fellowship Challenge Bowl The Emergency Medicine PA Fellowship Challenge Bowl is a friendly competition amongst emergency medicine PA fellows that will be held the morning of February 18, 2016, prior to the opening sessions of the 22nd Annual Scientific Assembly. This competition is both entertaining and educational for students, residents, allied health professionals and physicians. AAEM is committed to physician assistants to have the opportunity to learn and demonstrate their academic accomplishments in an environment of friendly competition that is fun for all! The winning team will be highlighted on AAEM’s social media pages, have their names announced at the opening day’s plenary sessions, and will be honored with plaques.

CALL FOR PAPERS

22ND ANNUAL SCIENTIFIC ASSEMBLY

New Membership

Official Challenge Bowl Rules For PA Fellows! www.aaem.org/ Team members must be currently enrolled in a allied-health postgraduate EMPA program and have not graduated as of February 17, 2016. Each team must have one sponsoring AAEM physician. All team members must be members of AAEM, and registered for the AAEM Scientific Assembly. Submit your team through the online submission system at www.aaem.org/AAEM16/competitions beginning November 1, 2015. Deadline to sign up is February 1, 2016.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

3. Use of abbreviations — The use of standard abbreviations is desirable. A special or unusual abbreviation should be placed in parentheses after the first appearance of the full word it represents. Numerals rather than words should indicate numbers, except to begin sentences.

4. Use of drug names — Each time a proprietary drug name is used in the abstract, the first letter is capitalized. Nonproprietary (generic) drug names are preferred and are not capitalized.

5. Structuring the abstract — Structured abstracts facilitate explicit presentation of critical information and objective assessment of scientific validity. Each abstract should include the following topic headings. It is not necessary to begin a new line or leave extra space between topic headings.

Objectives: A precise statement of the purpose of the study or the pre-study hypothesis. This may be preceded by a brief introduction summarizing past work or relevant controversies that place the study in perspective.

Methods: A brief statement of the methods used, including pertinent information about the study design, setting, participants, subjects, interventions, and observations.

Results: A summary of the results presented in sufficient detail to support the conclusions.

Conclusions: Conclusions should be succinctly stated and firmly supported by the data presented. Note important limitations.

● SAMPLE ABSTRACT ● F Huang1, W Bonadio,1 S Natesan1, C Okpalaji1, A Kodsi1, S Sokolovsky, MD1 and P Homel1.

1 Maimonides Medical Center, Brooklyn, 11220, United States.

Objectives: To analyze a large group of febrile neonates <28 days of age who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing [NPAT] for respiratory syncytial viral [RSV] infection to determine whether there is a clinically significant association between viral study results and risk for SBI. Methods: We evaluated consecutive febrile neonates <28 days of age presenting to our urban pediatric emergency department [MMC] during a six-year period, all of whom received a sepsis evaluation [CSF, blood, urine cultures] and RSV NPAT testing. To achieve adequate power [80%], the MMC data was combined with similar data reported from a prior prospective PEM-CRC study1 of febrile neonates who received similar evaluation.

Results: From the MMC data of consecutively evaluated cases, the prevalence rate of +RSV in 387 febrile neonates was 5.8%. Of these, 378 [98%] received both a sepsis evaluation and RSV NPAT; +SBI occurred in 4/22 [18.1%] with +RSV vs 58/356 [16.2%] with -RSV [p = 0.77]. Combined with the PEM-CRC1 cohort of 411 febrile neonates <28 days of age who received similar evaluation, a total of 789 cases were analyzed using meta-analysis.

Overall, there were 117 cases of +SBI [14.8%]; and 104 cases of +RSV [13.2%]. The rate of +SBI was 11.5% in those with +RSV vs 15.3% in those with –RSV. Meta-analysis performed showed no significant difference in rates of +SBI between those with and without +RSV [OR = 0.78, 95% CI 0.41 – 1.50; p = 0.46].

Conclusions: Rates of +SBI are not significantly different between febrile neonates <28 days of age with and without +RSV. Respiratory viral infection status is not an accurate clinical determinant in distinguishing SBI risk in febrile neonates.

1. Levine DA, Platt SL, Dayan PS, et al; Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004;113:1728-1734.

“It was an honor to be able to present my research to experts in our specialty. Though I was slightly nervous beforehand, I found I enjoyed fielding their questions in a relaxed setting and they helped make it a fun, rewarding experience!”

— Felix Y. Huang, MD The abstract presented here represents the top abstract from the Journal of Emergency Medicine Resident and Student Research Competition presented February 28 – March 4, 2015, at the Austin Hilton in Austin, TX. The abstract is printed with the permission of the Journal of Emergency Medicine and the American Academy of Emergency Medicine. The winning abstracts were published in the May 2015 issue of the Journal of Emergency Medicine 48(5):641-644, 2015.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

CALL FOR PHOTOS

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015

● SAMPLE PHOTO SUBMISSION ● Joseph J. Bove, DO Chief Complaint: 104 Fever and Chest Pain: Not Just Pneumonia History of Present Illness: 57-year-old Lebanese female with past medical history significant for recurrent bronchitis presents to the ED complaining of fevers chills and chest pain for two days duration. She states her chest pain is intermittent, sharp and located sub-sternal. It radiates to the back and there are no alleviating or aggravating factors. She admits to being short of breath, but denies any cough, abdominal pain, nausea, vomiting, sick contacts, or recent travel.

Physical Exam: VITALS: BP: 117/71, Pulse: 100, Temp: 104.0, RR: 16, Sp02: 100% on room air GENERAL: Mild distress, uncomfortable NEURO: AAOX3 without gross deficits HEENT: NCAT, PERRLA, oropharynx clear, TM intact B/L CHEST: No crepitus. Partially reproducible chest wall pain RESPIRATORY: Equal breath sounds and clear bilaterally CV: Normal S1 S2, regular rhythm, tachycardia, no murmurs rubs or gallops BACK: No midline tenderness, deformity, or swelling ABDOMEN: Soft non-tender non-distended SKIN: warm, dry with no evident rash Questions: 1. What pattern is noted on the EKG? 2. What are the common presentations of this disease?

Answers: 1. Brugada pattern 2. Asymptomatic, syncope, sudden cardiac arrest, nocturnal agonal respirations, and fever Case Discussion: Upon review of the EKG, a STEMI code was activated for concern of anterior MI verses Brugada.

The patient was brought to the cardiac cath lab where no lesions were found. Her lab work showed a white count of 23.9, hb of 13.7, hct 39.2, platelets 281 with segs of 89 and bands of 3. Electrolytes were within normal limits. Troponin was 0.02. X-ray showed left lower lobe pneumonia. The second EKG taken after cath shows

resolved Brugada (Figure 2). Electrophysiology was consulted and further history revealed four siblings who died of sudden death before the age of three with no known etiology and no autopsies done. The patient was brought to the EP lab and an AICD was placed. The patient did well with no complications. The patient was treated for left lower lobe pneumonia and discharged on hospital day three.

Brugada is an autosomal dominant genetic disorder with variable expression characterized by abnormal findings on electrocardiogram together with an increased risk of ventricular tachyarrhythmias and sudden cardiac arrest. Brugada type one pattern as may be seen in Figure 1 is described as an elevated ST segment that descends with an upward convexity to an inverted T wave. Brugada type two pattern is known as the “saddle back” and has an elevated ST segment that descends toward the baseline and then rises again to an upright biphasic T wave. It is unclear why it is up to nine times more common in males than females. Presentation can be at any time but is largely in adulthood and in the fourth decade of life. It may present in asymptomatic individuals or in those with syncope, sudden cardiac arrest, or nocturnal agonal respirations. Central to the workup is excluding drug induced cases found with verapamil, flecainide, amitriptyline, nitrates, cocaine and many others.

There have been many reports of the increased prevalence of Brugada in the setting of fever.

A recent study in 2013 by Adler, et al., showed Brugada to be almost 20 times more common in the setting of fever when compared to afebrile individuals (2% vs 0.1%). Interestingly, all but one did not show a Brugada type pattern on follow up EKG. This highlights the importance of recognizing this potentially transient fever induced Brugada to help risk stratify the patient for AICD placement or conservative management.

To help increase the sensitivity of discovering a Brugada EKG, some have suggested elevating the electrodes one to two intercostal spaces.

Although literature is limited to small studies, one such study of 340 individuals failed to show any type 1 EKG pattern with manipulating the electrodes in this manner. On the contrary, R wave suggesting incomplete right bundle branch block was uncovered quite commonly by raising the leads. This study and others led authors to suggest that incomplete right bundle branch block may not have a true association with conduction abnormalities. Therefore, until more evidence exists, obtaining multiple EKG’s with elevated electrodes is probably not indicated.

Pearls: • A Brugada EKG alone does not indicate the need for AICD. • Recognize fever induced Brugada as a known entity that is often transient.

Although AICD is not indicated in particular low risk scenarios, Brugada is still a cause of sudden death. In 2010, Probst, et. al., followed Brugada patients for 32 months and reported that the cardiac arrest event rate per year may range from 7.7% to 1.9% to 0.5%, depending on the initial Brugada presentation of sudden cardiac arrest, syncope, or asymptomatic respectively.

Risk stratification and the need for AICD placement largely depends on symptoms, EKG, family history, and EPS. For AICD placement, one must Fig. 1 demonstrate a Brugada type 1 pattern plus any of the following: 1) aborted sudden cardiac death, 2) syncope seizure or nocturnal agonal respirations, 3) family history of sudden cardiac death (likely Brugada) AND a positive EPS study, or 4) a positive EPS study. Therefore, those with type two patterns, type three patterns, or an asymptomatic type 1 pattern that has a negative EPS study may fall in to the low risk cohort that would not benefit Fig. 2 from AICD placement.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

18TH ANNUAL AAEM/JEM RESIDENT AND STUDENT RESEARCH COMPETITION

CALL FOR PAPERS

18TH ANNUAL AAEM/JEM RESIDENT AND STUDENT RESEARCH COMPETITION 22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015

The AAEM/JEM Resident and Student Research Competition is designed to recognize outstanding research achievements by residents and students in emergency medicine. To apply, you should submit an abstract summarizing the objectives, methods, results, and conclusions of the research performed according to the instructions detailed in this brochure. Submitted abstracts will be judged by the AAEM Abstract Review Committee, who will select eight for oral presentation at the Resident and Student Research Forum during AAEM’s 22nd Annual Scientific Assembly, February 17-21, 2016, in Las Vegas.

Final judging of the eight oral presentations will take place at the Scientific Assembly. Abstracts not selected for oral presentation will be displayed as 4´ x 8´ vertical poster presentations during the Scientific Assembly. Please do not submit an abstract if you are not prepared to travel to the Scientific Assembly in Las Vegas and present it in the session selected by AAEM. The presenter of the oral abstract judged to represent the most outstanding research achievement will receive a $3,000 honorarium. $1,500 and $500 honoraria will go to the presenters of the second and third place oral abstracts, respectively.

Abstract Submission Instructions Please read the abstract submission instructions carefully. The deadline and space requirements are strictly enforced in order to give all authors an equal opportunity to submit their data in the same amount of space and under the same time constraints.

1. Resident or Medical Student Status ­— In order to be eligible for consideration, the first author and principal investigator of each abstract submitted must be either a (1) resident in an ACGME, AOA, or ACGME-I accredited emergency medicine training program or (2) medical student in an LCME/COCA accredited institution with a strong interest in emergency medicine as a future profession, or a medical student with a strong interest in emergency medicine whose country is found within the Directory of Organizations that Recognize/Accredit Medical Schools (DORA). To verify this, you must submit the name of the appropriate designated official (e.g., program director, dean).

2. Submission Deadline • Electronic submissions will be accepted beginning September 11, 2015.

• Abstract receipt deadline for electronic submission is November 13, 2015.

3. There is no fee for submitting an abstract. All abstracts must be submitted and presented in English.

4. You must submit both a blind and formal version of your abstract.

5. If you have questions regarding the abstract submissions for the 22nd Annual Scientific Assembly, please call AAEM at (800) 884-2236 or email Emily DeVillers at edevillers@aaem.org.

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015

Abstract Submission Guidelines

Abstract Formatting

Electronic Submission Deadline: November 13, 2015 Electronic Instructions Abstracts can be submitted electronically at www.aaem.org/AAEM16/ competitions.

Presenting Author Information You will need to submit the presenting author’s name, address, telephone, and fax numbers, as well as an email address. Only the presenting author listed on the submission form will be notified of abstract acceptance.

Funding Indicate what monies have funded the research.

Disclosure of Relevant Financial Relationships In accordance with the essentials and standards set forth by the Accreditation Council for Continuing Medical Education, as well as guidelines proposed by the Food and Drug Administration and endorsed by the American Medical Association, an author with a conflict of interest with the content of their abstract must disclose that conflict prior to presentation. A conflict of interest includes, but is not limited to, any relevant financial relationship in a company, product or procedure mentioned in the abstract or in the presentation to be given at the conference. The authors must complete the disclosure form included in the electronic submission. A conflict in and of itself will not eliminate an abstract from consideration.

Previous Presentations of Abstracts No abstract published as an article on or before October 1, 2015, may be submitted for this competition. Abstracts that have been presented at the national meetings of other organizations should not be submitted for consideration.

Informed Consent Any studies involving human subjects must conform to the principles of the Declaration of Helsinki of the World Medical Association (Clinical Research 1966; 14:103) and must meet all the requirements governing informed consent of the country in which the research was performed.

Abstract Publication All oral abstracts presented at AAEM’s 22nd Annual Scientific Assembly will be published in the May 2016 issue of the Journal of Emergency Medicine.

Ownership of abstracts not accepted reverts to the authors.

Notification of Abstract Selection The presenting author of all abstracts submitted by November 13, 2015, will receive notification of acceptance or rejection by January 13, 2016.

Withdrawals and Revisions Withdrawals and revisions must be received in writing to Emily DeVillers at edevillers@aaem.org by November 16, 2015. No changes can be submitted after that date.

1. Use 12-point Times New Roman (or similar) type. If Times New Roman is unavailable, other options include Helvetica or Arial. Limit text to 2,500 characters, including spaces, and single space all text in the body of the abstract.

Meta-Analysis Of Risk For Serious Bacterial Infection in Febrile Neonates With RSV Infection

2. Do not indent the title. Capitalize only the first letter of each word in the title. List author names using initials only for first and middle names. Underline author names continuously. Include institution, city, and state where research was performed. When submitting the blind copy, omit author names, institution, city, state or any other identifier where research was performed. Omit degrees, titles, institutional appointments, street addresses, and ZIP codes. Single space entire abstract. The left-hand margin of the abstract’s text should be perfectly aligned.

Introduction: The febrile young infant is a common problem managed by pediatric emergency medicine physicians. It is widely recommended that all febrile infants <1 month of age receive a comprehensive sepsis evaluation and hospitalization for empiric antibiotic therapy pending culture results. One might anticipate that certain viral infections [e.g., RSV] should be relatively infrequent during the first weeks of life in healthy term newborns, and that lower rates of +SBI [SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis] would be present in febrile young infants with documented viral infection vs. those without.

3rd Annual Emergency Medicine PA Fellowship Challenge Bowl The Emergency Medicine PA Fellowship Challenge Bowl is a friendly competition amongst emergency medicine PA fellows that will be held the morning of February 18, 2016, prior to the opening sessions of the 22nd Annual Scientific Assembly. This competition is both entertaining and educational for students, residents, allied health professionals and physicians. AAEM is committed to physician assistants to have the opportunity to learn and demonstrate their academic accomplishments in an environment of friendly competition that is fun for all! The winning team will be highlighted on AAEM’s social media pages, have their names announced at the opening day’s plenary sessions, and will be honored with plaques.

CALL FOR PAPERS

22ND ANNUAL SCIENTIFIC ASSEMBLY

New Membership For PA Fellows!

Official Challenge Bowl Rules Team members must be currently enrolled in a postgraduate EMPA program and have not graduated as of February 17, 2016.

Each team must have one sponsoring AAEM physician. All team members must be members of AAEM, and registered for the AAEM Scientific Assembly. Submit your team through the online submission system at www.aaem.org/AAEM16/ competitions beginning November 1, 2015. Deadline to sign up is February 1, 2016.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

3. Use of abbreviations — The use of standard abbreviations is desirable. A special or unusual abbreviation should be placed in parentheses after the first appearance of the full word it represents. Numerals rather than words should indicate numbers, except to begin sentences.

4. Use of drug names — Each time a proprietary drug name is used in the abstract, the first letter is capitalized. Nonproprietary (generic) drug names are preferred and are not capitalized.

5. Structuring the abstract — Structured abstracts facilitate explicit presentation of critical information and objective assessment of scientific validity. Each abstract should include the following topic headings. It is not necessary to begin a new line or leave extra space between topic headings.

Objectives: A precise statement of the purpose of the study or the pre-study hypothesis. This may be preceded by a brief introduction summarizing past work or relevant controversies that place the study in perspective.

Methods: A brief statement of the methods used, including pertinent information about the study design, setting, participants, subjects, interventions, and observations.

Results: A summary of the results presented in sufficient detail to support the conclusions.

Conclusions: Conclusions should be succinctly stated and firmly supported by the data presented. Note important limitations.

● SAMPLE ABSTRACT ● F Huang1, W Bonadio,1 S Natesan1, C Okpalaji1, A Kodsi1, S Sokolovsky, MD1 and P Homel1.

1 Maimonides Medical Center, Brooklyn, 11220, United States.

Objectives: To analyze a large group of febrile neonates <28 days of age who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing [NPAT] for respiratory syncytial viral [RSV] infection to determine whether there is a clinically significant association between viral study results and risk for SBI. Methods: We evaluated consecutive febrile neonates <28 days of age presenting to our urban pediatric emergency department [MMC] during a six-year period, all of whom received a sepsis evaluation [CSF, blood, urine cultures] and RSV NPAT testing. To achieve adequate power [80%], the MMC data was combined with similar data reported from a prior prospective PEM-CRC study1 of febrile neonates who received similar evaluation.

Results: From the MMC data of consecutively evaluated cases, the prevalence rate of +RSV in 387 febrile neonates was 5.8%. Of these, 378 [98%] received both a sepsis evaluation and RSV NPAT; +SBI occurred in 4/22 [18.1%] with +RSV vs 58/356 [16.2%] with -RSV [p = 0.77]. Combined with the PEM-CRC1 cohort of 411 febrile neonates <28 days of age who received similar evaluation, a total of 789 cases were analyzed using meta-analysis.

Overall, there were 117 cases of +SBI [14.8%]; and 104 cases of +RSV [13.2%]. The rate of +SBI was 11.5% in those with +RSV vs 15.3% in those with –RSV. Meta-analysis performed showed no significant difference in rates of +SBI between those with and without +RSV [OR = 0.78, 95% CI 0.41 – 1.50; p = 0.46].

Conclusions: Rates of +SBI are not significantly different between febrile neonates <28 days of age with and without +RSV. Respiratory viral infection status is not an accurate clinical determinant in distinguishing SBI risk in febrile neonates.

1. Levine DA, Platt SL, Dayan PS, et al; Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004;113:1728-1734.

“It was an honor to be able to present my research to experts in our specialty. Though I was slightly nervous beforehand, I found I enjoyed fielding their questions in a relaxed setting and they helped make it a fun, rewarding experience!”

— Felix Y. Huang, MD The abstract presented here represents the top abstract from the Journal of Emergency Medicine Resident and Student Research Competition presented February 28 – March 4, 2015, at the Austin Hilton in Austin, TX. The abstract is printed with the permission of the Journal of Emergency Medicine and the American Academy of Emergency Medicine. The winning abstracts were published in the May 2015 issue of the Journal of Emergency Medicine 48(5):641-644, 2015.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

CALL FOR PHOTOS

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2016

● SAMPLE PHOTO SUBMISSION ● Joseph J. Bove, DO Chief Complaint: 104 Fever and Chest Pain: Not Just Pneumonia History of Present Illness: 57-year-old Lebanese female with past medical history significant for recurrent bronchitis presents to the ED complaining of fevers chills and chest pain for two days duration. She states her chest pain is intermittent, sharp and located sub-sternal. It radiates to the back and there are no alleviating or aggravating factors. She admits to being short of breath, but denies any cough, abdominal pain, nausea, vomiting, sick contacts, or recent travel.

Physical Exam: VITALS: BP: 117/71, Pulse: 100, Temp: 104.0, RR: 16, Sp02: 100% on room air GENERAL: Mild distress, uncomfortable NEURO: AAOX3 without gross deficits HEENT: NCAT, PERRLA, oropharynx clear, TM intact B/L CHEST: No crepitus. Partially reproducible chest wall pain RESPIRATORY: Equal breath sounds and clear bilaterally CV: Normal S1 S2, regular rhythm, tachycardia, no murmurs rubs or gallops BACK: No midline tenderness, deformity, or swelling ABDOMEN: Soft non-tender non-distended SKIN: warm, dry with no evident rash Questions: 1. What pattern is noted on the EKG? 2. What are the common presentations of this disease?

Answers: 1. Brugada pattern 2. Asymptomatic, syncope, sudden cardiac arrest, nocturnal agonal respirations, and fever Case Discussion: Upon review of the EKG, a STEMI code was activated for concern of anterior MI verses Brugada.

The patient was brought to the cardiac cath lab where no lesions were found. Her lab work showed a white count of 23.9, hb of 13.7, hct 39.2, platelets 281 with segs of 89 and bands of 3. Electrolytes were within normal limits. Troponin was 0.02. X-ray showed left lower lobe pneumonia. The second EKG taken after cath shows

resolved Brugada (Figure 2). Electrophysiology was consulted and further history revealed four siblings who died of sudden death before the age of three with no known etiology and no autopsies done. The patient was brought to the EP lab and an AICD was placed. The patient did well with no complications. The patient was treated for left lower lobe pneumonia and discharged on hospital day three.

Brugada is an autosomal dominant genetic disorder with variable expression characterized by abnormal findings on electrocardiogram together with an increased risk of ventricular tachyarrhythmias and sudden cardiac arrest. Brugada type one pattern as may be seen in Figure 1 is described as an elevated ST segment that descends with an upward convexity to an inverted T wave. Brugada type two pattern is known as the “saddle back” and has an elevated ST segment that descends toward the baseline and then rises again to an upright biphasic T wave. It is unclear why it is up to nine times more common in males than females. Presentation can be at any time but is largely in adulthood and in the fourth decade of life. It may present in asymptomatic individuals or in those with syncope, sudden cardiac arrest, or nocturnal agonal respirations. Central to the workup is excluding drug induced cases found with verapamil, flecainide, amitriptyline, nitrates, cocaine and many others.

There have been many reports of the increased prevalence of Brugada in the setting of fever.

A recent study in 2013 by Adler, et al., showed Brugada to be almost 20 times more common in the setting of fever when compared to afebrile individuals (2% vs 0.1%). Interestingly, all but one did not show a Brugada type pattern on follow up EKG. This highlights the importance of recognizing this potentially transient fever induced Brugada to help risk stratify the patient for AICD placement or conservative management.

To help increase the sensitivity of discovering a Brugada EKG, some have suggested elevating the electrodes one to two intercostal spaces.

Although literature is limited to small studies, one such study of 340 individuals failed to show any type 1 EKG pattern with manipulating the electrodes in this manner. On the contrary, R wave suggesting incomplete right bundle branch block was uncovered quite commonly by raising the leads. This study and others led authors to suggest that incomplete right bundle branch block may not have a true association with conduction abnormalities. Therefore, until more evidence exists, obtaining multiple EKG’s with elevated electrodes is probably not indicated.

Pearls: • A Brugada EKG alone does not indicate the need for AICD. • Recognize fever induced Brugada as a known entity that is often transient.

Although AICD is not indicated in particular low risk scenarios, Brugada is still a cause of sudden death. In 2010, Probst, et. al., followed Brugada patients for 32 months and reported that the cardiac arrest event rate per year may range from 7.7% to 1.9% to 0.5%, depending on the initial Brugada presentation of sudden cardiac arrest, syncope, or asymptomatic respectively.

Risk stratification and the need for AICD placement largely depends on symptoms, EKG, family history, and EPS. For AICD placement, one must Fig. 1 demonstrate a Brugada type 1 pattern plus any of the following: 1) aborted sudden cardiac death, 2) syncope seizure or nocturnal agonal respirations, 3) family history of sudden cardiac death (likely Brugada) AND a positive EPS study, or 4) a positive EPS study. Therefore, those with type two patterns, type three patterns, or an asymptomatic type 1 pattern that has a negative EPS study may fall in to the low risk cohort that would not benefit Fig. 2 from AICD placement.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

18TH ANNUAL AAEM/JEM RESIDENT AND STUDENT RESEARCH COMPETITION

CALL FOR PAPERS

18TH ANNUAL AAEM/JEM RESIDENT AND STUDENT RESEARCH COMPETITION 22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015

The AAEM/JEM Resident and Student Research Competition is designed to recognize outstanding research achievements by residents and students in emergency medicine. To apply, you should submit an abstract summarizing the objectives, methods, results, and conclusions of the research performed according to the instructions detailed in this brochure. Submitted abstracts will be judged by the AAEM Abstract Review Committee, who will select eight for oral presentation at the Resident and Student Research Forum during AAEM’s 22nd Annual Scientific Assembly, February 17-21, 2016, in Las Vegas.

Final judging of the eight oral presentations will take place at the Scientific Assembly. Abstracts not selected for oral presentation will be displayed as 4´ x 8´ vertical poster presentations during the Scientific Assembly. Please do not submit an abstract if you are not prepared to travel to the Scientific Assembly in Las Vegas and present it in the session selected by AAEM. The presenter of the oral abstract judged to represent the most outstanding research achievement will receive a $3,000 honorarium. $1,500 and $500 honoraria will go to the presenters of the second and third place oral abstracts, respectively.

Abstract Submission Instructions Please read the abstract submission instructions carefully. The deadline and space requirements are strictly enforced in order to give all authors an equal opportunity to submit their data in the same amount of space and under the same time constraints.

1. Resident or Medical Student Status ­— In order to be eligible for consideration, the first author and principal investigator of each abstract submitted must be either a (1) resident in an ACGME, AOA, or ACGME-I accredited emergency medicine training program or (2) medical student in an LCME/COCA accredited institution with a strong interest in emergency medicine as a future profession, or a medical student with a strong interest in emergency medicine whose country is found within the Directory of Organizations that Recognize/Accredit Medical Schools (DORA). To verify this, you must submit the name of the appropriate designated official (e.g., program director, dean).

2. Submission Deadline • Electronic submissions will be accepted beginning September 11, 2015.

• Abstract receipt deadline for electronic submission is November 13, 2015.

3. There is no fee for submitting an abstract. All abstracts must be submitted and presented in English.

4. You must submit both a blind and formal version of your abstract.

5. If you have questions regarding the abstract submissions for the 22nd Annual Scientific Assembly, please call AAEM at (800) 884-2236 or email Emily DeVillers at edevillers@aaem.org.

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015

Abstract Submission Guidelines

Abstract Formatting

Electronic Submission Deadline: November 13, 2015 Electronic Instructions Abstracts can be submitted electronically at www.aaem.org/AAEM16/ competitions.

Presenting Author Information You will need to submit the presenting author’s name, address, telephone, and fax numbers, as well as an email address. Only the presenting author listed on the submission form will be notified of abstract acceptance.

Funding Indicate what monies have funded the research.

Disclosure of Relevant Financial Relationships In accordance with the essentials and standards set forth by the Accreditation Council for Continuing Medical Education, as well as guidelines proposed by the Food and Drug Administration and endorsed by the American Medical Association, an author with a conflict of interest with the content of their abstract must disclose that conflict prior to presentation. A conflict of interest includes, but is not limited to, any relevant financial relationship in a company, product or procedure mentioned in the abstract or in the presentation to be given at the conference. The authors must complete the disclosure form included in the electronic submission. A conflict in and of itself will not eliminate an abstract from consideration.

Previous Presentations of Abstracts No abstract published as an article on or before October 1, 2015, may be submitted for this competition. Abstracts that have been presented at the national meetings of other organizations should not be submitted for consideration.

Informed Consent Any studies involving human subjects must conform to the principles of the Declaration of Helsinki of the World Medical Association (Clinical Research 1966; 14:103) and must meet all the requirements governing informed consent of the country in which the research was performed.

Abstract Publication All oral abstracts presented at AAEM’s 22nd Annual Scientific Assembly will be published in the May 2016 issue of the Journal of Emergency Medicine.

Ownership of abstracts not accepted reverts to the authors.

Notification of Abstract Selection The presenting author of all abstracts submitted by November 13, 2015, will receive notification of acceptance or rejection by January 13, 2016.

Withdrawals and Revisions Withdrawals and revisions must be received in writing to Emily DeVillers at edevillers@aaem.org by November 16, 2015. No changes can be submitted after that date.

1. Use 12-point Times New Roman (or similar) type. If Times New Roman is unavailable, other options include Helvetica or Arial. Limit text to 2,500 characters, including spaces, and single space all text in the body of the abstract.

Meta-Analysis Of Risk For Serious Bacterial Infection in Febrile Neonates With RSV Infection

2. Do not indent the title. Capitalize only the first letter of each word in the title. List author names using initials only for first and middle names. Underline author names continuously. Include institution, city, and state where research was performed. When submitting the blind copy, omit author names, institution, city, state or any other identifier where research was performed. Omit degrees, titles, institutional appointments, street addresses, and ZIP codes. Single space entire abstract. The left-hand margin of the abstract’s text should be perfectly aligned.

Introduction: The febrile young infant is a common problem managed by pediatric emergency medicine physicians. It is widely recommended that all febrile infants <1 month of age receive a comprehensive sepsis evaluation and hospitalization for empiric antibiotic therapy pending culture results. One might anticipate that certain viral infections [e.g., RSV] should be relatively infrequent during the first weeks of life in healthy term newborns, and that lower rates of +SBI [SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis] would be present in febrile young infants with documented viral infection vs. those without.

3rd Annual Emergency Medicine PA Fellowship Challenge Bowl The Emergency Medicine PA Fellowship Challenge Bowl is a friendly competition amongst emergency medicine PA fellows that will be held the morning of February 18, 2016, prior to the opening sessions of the 22nd Annual Scientific Assembly. This competition is both entertaining and educational for students, residents, allied health professionals and physicians. AAEM is committed to physician assistants to have the opportunity to learn and demonstrate their academic accomplishments in an environment of friendly competition that is fun for all! The winning team will be highlighted on AAEM’s social media pages, have their names announced at the opening day’s plenary sessions, and will be honored with plaques.

CALL FOR PAPERS

22ND ANNUAL SCIENTIFIC ASSEMBLY

New Membership For PA Fellows!

Official Challenge Bowl Rules Team members must be currently enrolled in a postgraduate EMPA program and have not graduated as of February 17, 2016.

Each team must have one sponsoring AAEM physician. All team members must be members of AAEM, and registered for the AAEM Scientific Assembly. Submit your team through the online submission system at www.aaem.org/AAEM16/ competitions beginning November 1, 2015. Deadline to sign up is February 1, 2016.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

3. Use of abbreviations — The use of standard abbreviations is desirable. A special or unusual abbreviation should be placed in parentheses after the first appearance of the full word it represents. Numerals rather than words should indicate numbers, except to begin sentences.

4. Use of drug names — Each time a proprietary drug name is used in the abstract, the first letter is capitalized. Nonproprietary (generic) drug names are preferred and are not capitalized.

5. Structuring the abstract — Structured abstracts facilitate explicit presentation of critical information and objective assessment of scientific validity. Each abstract should include the following topic headings. It is not necessary to begin a new line or leave extra space between topic headings.

Objectives: A precise statement of the purpose of the study or the pre-study hypothesis. This may be preceded by a brief introduction summarizing past work or relevant controversies that place the study in perspective.

Methods: A brief statement of the methods used, including pertinent information about the study design, setting, participants, subjects, interventions, and observations.

Results: A summary of the results presented in sufficient detail to support the conclusions.

Conclusions: Conclusions should be succinctly stated and firmly supported by the data presented. Note important limitations.

● SAMPLE ABSTRACT ● F Huang1, W Bonadio,1 S Natesan1, C Okpalaji1, A Kodsi1, S Sokolovsky, MD1 and P Homel1.

1 Maimonides Medical Center, Brooklyn, 11220, United States.

Objectives: To analyze a large group of febrile neonates <28 days of age who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing [NPAT] for respiratory syncytial viral [RSV] infection to determine whether there is a clinically significant association between viral study results and risk for SBI. Methods: We evaluated consecutive febrile neonates <28 days of age presenting to our urban pediatric emergency department [MMC] during a six-year period, all of whom received a sepsis evaluation [CSF, blood, urine cultures] and RSV NPAT testing. To achieve adequate power [80%], the MMC data was combined with similar data reported from a prior prospective PEM-CRC study1 of febrile neonates who received similar evaluation.

Results: From the MMC data of consecutively evaluated cases, the prevalence rate of +RSV in 387 febrile neonates was 5.8%. Of these, 378 [98%] received both a sepsis evaluation and RSV NPAT; +SBI occurred in 4/22 [18.1%] with +RSV vs 58/356 [16.2%] with -RSV [p = 0.77]. Combined with the PEM-CRC1 cohort of 411 febrile neonates <28 days of age who received similar evaluation, a total of 789 cases were analyzed using meta-analysis.

Overall, there were 117 cases of +SBI [14.8%]; and 104 cases of +RSV [13.2%]. The rate of +SBI was 11.5% in those with +RSV vs 15.3% in those with –RSV. Meta-analysis performed showed no significant difference in rates of +SBI between those with and without +RSV [OR = 0.78, 95% CI 0.41 – 1.50; p = 0.46].

Conclusions: Rates of +SBI are not significantly different between febrile neonates <28 days of age with and without +RSV. Respiratory viral infection status is not an accurate clinical determinant in distinguishing SBI risk in febrile neonates.

1. Levine DA, Platt SL, Dayan PS, et al; Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004;113:1728-1734.

“It was an honor to be able to present my research to experts in our specialty. Though I was slightly nervous beforehand, I found I enjoyed fielding their questions in a relaxed setting and they helped make it a fun, rewarding experience!”

— Felix Y. Huang, MD The abstract presented here represents the top abstract from the Journal of Emergency Medicine Resident and Student Research Competition presented February 28 – March 4, 2015, at the Austin Hilton in Austin, TX. The abstract is printed with the permission of the Journal of Emergency Medicine and the American Academy of Emergency Medicine. The winning abstracts were published in the May 2015 issue of the Journal of Emergency Medicine 48(5):641-644, 2015.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

CALL FOR PHOTOS

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015

● SAMPLE PHOTO SUBMISSION ● Joseph J. Bove, DO Chief Complaint: 104 Fever and Chest Pain: Not Just Pneumonia History of Present Illness: 57-year-old Lebanese female with past medical history significant for recurrent bronchitis presents to the ED complaining of fevers chills and chest pain for two days duration. She states her chest pain is intermittent, sharp and located sub-sternal. It radiates to the back and there are no alleviating or aggravating factors. She admits to being short of breath, but denies any cough, abdominal pain, nausea, vomiting, sick contacts, or recent travel.

Physical Exam: VITALS: BP: 117/71, Pulse: 100, Temp: 104.0, RR: 16, Sp02: 100% on room air GENERAL: Mild distress, uncomfortable NEURO: AAOX3 without gross deficits HEENT: NCAT, PERRLA, oropharynx clear, TM intact B/L CHEST: No crepitus. Partially reproducible chest wall pain RESPIRATORY: Equal breath sounds and clear bilaterally CV: Normal S1 S2, regular rhythm, tachycardia, no murmurs rubs or gallops BACK: No midline tenderness, deformity, or swelling ABDOMEN: Soft non-tender non-distended SKIN: warm, dry with no evident rash Questions: 1. What pattern is noted on the EKG? 2. What are the common presentations of this disease?

Answers: 1. Brugada pattern 2. Asymptomatic, syncope, sudden cardiac arrest, nocturnal agonal respirations, and fever Case Discussion: Upon review of the EKG, a STEMI code was activated for concern of anterior MI verses Brugada.

The patient was brought to the cardiac cath lab where no lesions were found. Her lab work showed a white count of 23.9, hb of 13.7, hct 39.2, platelets 281 with segs of 89 and bands of 3. Electrolytes were within normal limits. Troponin was 0.02. X-ray showed left lower lobe pneumonia. The second EKG taken after cath shows

resolved Brugada (Figure 2). Electrophysiology was consulted and further history revealed four siblings who died of sudden death before the age of three with no known etiology and no autopsies done. The patient was brought to the EP lab and an AICD was placed. The patient did well with no complications. The patient was treated for left lower lobe pneumonia and discharged on hospital day three.

Brugada is an autosomal dominant genetic disorder with variable expression characterized by abnormal findings on electrocardiogram together with an increased risk of ventricular tachyarrhythmias and sudden cardiac arrest. Brugada type one pattern as may be seen in Figure 1 is described as an elevated ST segment that descends with an upward convexity to an inverted T wave. Brugada type two pattern is known as the “saddle back” and has an elevated ST segment that descends toward the baseline and then rises again to an upright biphasic T wave. It is unclear why it is up to nine times more common in males than females. Presentation can be at any time but is largely in adulthood and in the fourth decade of life. It may present in asymptomatic individuals or in those with syncope, sudden cardiac arrest, or nocturnal agonal respirations. Central to the workup is excluding drug induced cases found with verapamil, flecainide, amitriptyline, nitrates, cocaine and many others.

There have been many reports of the increased prevalence of Brugada in the setting of fever.

A recent study in 2013 by Adler, et al., showed Brugada to be almost 20 times more common in the setting of fever when compared to afebrile individuals (2% vs 0.1%). Interestingly, all but one did not show a Brugada type pattern on follow up EKG. This highlights the importance of recognizing this potentially transient fever induced Brugada to help risk stratify the patient for AICD placement or conservative management.

To help increase the sensitivity of discovering a Brugada EKG, some have suggested elevating the electrodes one to two intercostal spaces.

Although literature is limited to small studies, one such study of 340 individuals failed to show any type 1 EKG pattern with manipulating the electrodes in this manner. On the contrary, R wave suggesting incomplete right bundle branch block was uncovered quite commonly by raising the leads. This study and others led authors to suggest that incomplete right bundle branch block may not have a true association with conduction abnormalities. Therefore, until more evidence exists, obtaining multiple EKG’s with elevated electrodes is probably not indicated.

Pearls: • A Brugada EKG alone does not indicate the need for AICD. • Recognize fever induced Brugada as a known entity that is often transient.

Although AICD is not indicated in particular low risk scenarios, Brugada is still a cause of sudden death. In 2010, Probst, et. al., followed Brugada patients for 32 months and reported that the cardiac arrest event rate per year may range from 7.7% to 1.9% to 0.5%, depending on the initial Brugada presentation of sudden cardiac arrest, syncope, or asymptomatic respectively.

Risk stratification and the need for AICD placement largely depends on symptoms, EKG, family history, and EPS. For AICD placement, one must Fig. 1 demonstrate a Brugada type 1 pattern plus any of the following: 1) aborted sudden cardiac death, 2) syncope seizure or nocturnal agonal respirations, 3) family history of sudden cardiac death (likely Brugada) AND a positive EPS study, or 4) a positive EPS study. Therefore, those with type two patterns, type three patterns, or an asymptomatic type 1 pattern that has a negative EPS study may fall in to the low risk cohort that would not benefit Fig. 2 from AICD placement.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

DIAGNOSTIC CASES & CHALLENGE BOWL

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015 Call for Photographs

3rd Annual Diagnostic Case Competition

You are invited to submit original photographs for presentation at the AAEM 22nd Annual Scientific Assembly in Las Vegas. Photographs of patients, pathology specimens, Gram stains, EKGs, and radiographic studies or other visual data may be submitted. Your submission should depict clear examples of findings that are relevant to the practice of emergency medicine or findings of unusual interest that have educational value. If your submission is accepted, you must mount it for viewing.

22nd Annual AAEM Scientific Assembly, Las Vegas, NV

No more than three different photos may be submitted for any one case.

Please submit digital copies in JPEG or TIFF format through the online submission system at www.aaem.org/AAEM16/competitions.

Photo submissions must be accompanied by a brief case history written as an “unknown” in the following format: 1) chief complaint, 2) history of present illness, 3) pertinent physical exam (other than what is depicted in the photo), 4) pertinent laboratory data, 5) one or two questions asking the viewer to identify the diagnosis or pertinent finding. In a separate MS Word document, please list the following information: 6) answer(s) and brief discussion of the case, including an explanation of the findings in the photo, and 7) one to three bulleted take home points or “pearls.” Please submit only blind copies, omitting your name, institution, city, state, or any other identifier.

The case history is limited to no more than 250 words. If accepted for display, AAEM reserves the right to edit the submitted case history.

Submissions are selected based on educational merit, relevance to emergency medicine, quality of the photograph, the case history, and appropriateness for public display. If your photograph is accepted, you will be notified and informed of set-up and dismantle times. Patients and patient identifiers must be appropriately masked. Additionally, you must attest that written consent and release of responsibility have been obtained for all photos EXCEPT for isolated diagnostic studies such as EKGs, radiographs, Gram stains, etc.

Responsibility for bringing photo and case submission(s) to the Scientific Assembly rests with the submitter. A 4´ x 8´ vertical area will be available for each submission.

Photo competition participants who submit by November 15, 2015, will receive notification of acceptance or rejection by January 13, 2016.

8 feet wide Option 1 8x4 vertical poster

Option 2 4x4 vertical poster

4 feet wide

Pre-sorted Standard Mail US Postage PAID Milwaukee, WI Permit No. 1310

555 East Wells Street, Suite 1100 Milwaukee, WI 53202-3823

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS

Eligible Participants • AAEM Full Voting Members • AAEM Associate Members • AAEM Fellow-in-Training Members Participant Guidelines — General Overview The PRESENTER has five minutes to describe the case as it appeared in the emergency department. Only the information provided to the discussant when the case was submitted may be presented at the diagnostic case competition.

Presenters must not surprise the discussant with information not previously provided.

Planet Hollywood Resort & Casino

Following the presenter’s five-minute presentation, the DISCUSSANT has 20 minutes to discuss the case, emphasizing the emergency medicine approach to the diagnostic reasoning that leads to a final diagnosis. Generally, the salient features of the case are highlighted, a differential diagnosis is offered, and a logical discussion is provided to argue to a final diagnosis. Although an accurate final diagnosis is important, the majority of the judging focuses on the discussion and presentation.

The discussant should not utilize the time to discuss the final diagnosis; this will be done by the presenter.

The PRESENTER then has 10 minutes to give the final diagnosis and discuss the disease process, its relevance to emergency medicine, and describe the elements in the ED encounter that support the final diagnosis.

The presentation time frames (5, 20, & 10 minutes) are rigidly set and observed.

Timers will be utilized to assist the speakers. Substantial scoring penalties will be imposed for exceeding the prescribed time limits.

All diagnostic cases will be presented using the provided laptop computer and LCD projector. A laser pointer, microphone, and handheld slide advancer will also be provided. All presentation files will be preloaded onto the laptop at the podium prior to the onset of the conference. No personal flash drives will be used on the day of the competition.

Please organize or facilitate another person to be available to present on your behalf in the case of any unforeseen circumstances that would prevent you from presenting on the day of the competition. If a backup is needed, he or she must be on staff at your hospital.

Presentation Guidelines • All slides must be created using PowerPoint® software and must be in Windows® format.

• Slides may contain text and static images but no video clips, audio clips, hyperlinks to the web, nor embedded files or links to other files. Violating this rule will result in a substantial scoring penalty.

• Moving “slide transitions” between slides are permitted. Using the slide show “animation” feature within PowerPoint® is permitted.

• Speaker notes within the PowerPoint® presentations are not permitted.

• The slides will be shown using the slide show feature in PowerPoint® 2007 on a Windows®-based computer.

• The “Presenter View” option will not be utilized on the day of the competition.

• This is not an interactive presentation. Please do not solicit audience participation.

• Please only submit a blinded version of your PowerPoint.

Deadline for case submission is November 13, 2015, with notification of acceptance or rejection by February 13, 2016.

For additional information about the Diagnostic Case Competition including submission questions, competition/registration questions, and discussant questions, please visit: www.aaem.org/education/scientific-assembly/competitions.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

American Academy of Emergency Medicine

AAEM-0515-611

Call for Papers & Photos

• Diagnostic Cases • Emergency Medicine PA Fellowship Challenge Bowl

Call for Papers & Photos

Submission Deadline: November 13, 2015

• Diagnostic Cases • Emergency Medicine PA Fellowship Challenge Bowl Submission Deadline: November 13, 2015

American Academy of Emergency Medicine

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

FEBRUARY 17-21, 2016

FEBRUARY 17-21, 2016 www.aaem.org/AAEM16

DIAGNOSTIC CASES & CHALLENGE BOWL

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

Submission Deadline: November 13, 2015 Call for Photographs

3rd Annual Diagnostic Case Competition

You are invited to submit original photographs for presentation at the AAEM 22nd Annual Scientific Assembly in Las Vegas. Photographs of patients, pathology specimens, Gram stains, EKGs, and radiographic studies or other visual data may be submitted. Your submission should depict clear examples of findings that are relevant to the practice of emergency medicine or findings of unusual interest that have educational value. If your submission is accepted, you must mount it for viewing.

22nd Annual AAEM Scientific Assembly, Las Vegas, NV

No more than three different photos may be submitted for any one case.

Please submit digital copies in JPEG or TIFF format through the online submission system at www.aaem.org/AAEM16/competitions.

Photo submissions must be accompanied by a brief case history written as an “unknown” in the following format: 1) chief complaint, 2) history of present illness, 3) pertinent physical exam (other than what is depicted in the photo), 4) pertinent laboratory data, 5) one or two questions asking the viewer to identify the diagnosis or pertinent finding. In a separate MS Word document, please list the following information: 6) answer(s) and brief discussion of the case, including an explanation of the findings in the photo, and 7) one to three bulleted take home points or “pearls.” Please submit only blind copies, omitting your name, institution, city, state, or any other identifier.

The case history is limited to no more than 250 words. If accepted for display, AAEM reserves the right to edit the submitted case history.

Submissions are selected based on educational merit, relevance to emergency medicine, quality of the photograph, the case history, and appropriateness for public display. If your photograph is accepted, you will be notified and informed of set-up and dismantle times. Patients and patient identifiers must be appropriately masked. Additionally, you must attest that written consent and release of responsibility have been obtained for all photos EXCEPT for isolated diagnostic studies such as EKGs, radiographs, Gram stains, etc.

Responsibility for bringing photo and case submission(s) to the Scientific Assembly rests with the submitter. A 4´ x 8´ vertical area will be available for each submission.

Photo competition participants who submit by November 15, 2015, will receive notification of acceptance or rejection by January 13, 2016.

8 feet wide Option 1 8x4 vertical poster

Option 2 4x4 vertical poster

4 feet wide

Pre-sorted Standard Mail US Postage PAID Milwaukee, WI Permit No. 1310

555 East Wells Street, Suite 1100 Milwaukee, WI 53202-3823

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS

Eligible Participants • AAEM Full Voting Members • AAEM Associate Members • AAEM Fellow-in-Training Members Participant Guidelines — General Overview The PRESENTER has five minutes to describe the case as it appeared in the emergency department. Only the information provided to the discussant when the case was submitted may be presented at the diagnostic case competition.

Presenters must not surprise the discussant with information not previously provided.

Planet Hollywood Resort & Casino

Following the presenter’s five-minute presentation, the DISCUSSANT has 20 minutes to discuss the case, emphasizing the emergency medicine approach to the diagnostic reasoning that leads to a final diagnosis. Generally, the salient features of the case are highlighted, a differential diagnosis is offered, and a logical discussion is provided to argue to a final diagnosis. Although an accurate final diagnosis is important, the majority of the judging focuses on the discussion and presentation.

The discussant should not utilize the time to discuss the final diagnosis; this will be done by the presenter.

The PRESENTER then has 10 minutes to give the final diagnosis and discuss the disease process, its relevance to emergency medicine, and describe the elements in the ED encounter that support the final diagnosis.

The presentation time frames (5, 20, & 10 minutes) are rigidly set and observed.

Timers will be utilized to assist the speakers. Substantial scoring penalties will be imposed for exceeding the prescribed time limits.

All diagnostic cases will be presented using the provided laptop computer and LCD projector. A laser pointer, microphone, and handheld slide advancer will also be provided. All presentation files will be preloaded onto the laptop at the podium prior to the onset of the conference. No personal flash drives will be used on the day of the competition.

Please organize or facilitate another person to be available to present on your behalf in the case of any unforeseen circumstances that would prevent you from presenting on the day of the competition. If a backup is needed, he or she must be on staff at your hospital.

Presentation Guidelines • All slides must be created using PowerPoint® software and must be in Windows® format.

• Slides may contain text and static images but no video clips, audio clips, hyperlinks to the web, nor embedded files or links to other files. Violating this rule will result in a substantial scoring penalty.

• Moving “slide transitions” between slides are permitted. Using the slide show “animation” feature within PowerPoint® is permitted.

• Speaker notes within the PowerPoint® presentations are not permitted.

• The slides will be shown using the slide show feature in PowerPoint® 2007 on a Windows®-based computer.

• The “Presenter View” option will not be utilized on the day of the competition.

• This is not an interactive presentation. Please do not solicit audience participation.

• Please only submit a blinded version of your PowerPoint.

Deadline for case submission is November 13, 2015, with notification of acceptance or rejection by February 13, 2016.

For additional information about the Diagnostic Case Competition including submission questions, competition/registration questions, and discussant questions, please visit: www.aaem.org/education/scientific-assembly/competitions.

FEBRUARY 17-21, 2016 ● PLANET HOLLYWOOD ● LAS VEGAS, NV

American Academy of Emergency Medicine

AAEM-0515-611

Call for Papers & Photos

• Diagnostic Cases • Emergency Medicine PA Fellowship Challenge Bowl

Call for Papers & Photos

Submission Deadline: November 13, 2015

• Diagnostic Cases • Emergency Medicine PA Fellowship Challenge Bowl Submission Deadline: November 13, 2015

American Academy of Emergency Medicine

22ND ANNUAL SCIENTIFIC ASSEMBLY

LAS VEGAS Planet Hollywood Resort & Casino

FEBRUARY 17-21, 2016

FEBRUARY 17-21, 2016 www.aaem.org/AAEM16