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INTRODUCTION:Propofol infusion syndrome (PRIS) is characterized by rhabdomyolysis, hyperkalemia, renal, cardiac, and liver dysfunction, and lactic acidosis associated with prolonged infusion or high dosages of propofol. PRIS is due to mitochondrial dysfunction leading to fatty acid oxidation and electron transport chain impairment as well as calcium channel and b-adrenergic receptor blockade. Risk factors include carbohydrate store depletion, critical illness, and co-administration of catecholamines and glucocorticoids. DESCRIPTION:A 46-year-old female with decompensated cirrhosis from primary sclerosing cholangitis underwent liver transplant and was placed on a propofol infusion (up to 50 mcg/kg/min) intra-and post-operatively. On post-operative day (POD) 1, she had runs of ventricular tachycardia with hyperkalemia of 6.1mmol/L and a lactic acidosis of 9.0 mmol/L with no vasopressor requirement. Hemodialysis was initiated. On POD 3, her lactate peaked at 15 mmol/L and a creatinine kinase (CK) was 74,840 U/L on minimal norepinephrine and epinephrine. CT scan revealed postoperative changes with no signs of ischemic bowel. Liver doppler ultrasound was normal. Echocardiogram revealed left ventricular ejection fraction (LVEF) of 35% and severe right ventricular dysfunction. Exploratory laparotomy revealed no anastomotic stenoses, hepatic congestion, or ischemic bowel. Propofol was discontinued at this time due to concern for PRIS. CK peaked on POD 4 at 135,900 U/L, with AST/ ALT at 18,440/4,571 U/L and bilirubin at 6.7 mg/dL. Insulin and 20% dextrose infusions were initiated to optimize glycolysis. Liver biopsy demonstrated 70% parenchymal necrosis, and she was re-listed for transplant. Over the next few days her rhabdomyolysis, liver function and cardiac function began to improve.

Study Objectives: Emergency medical services (EMS) are an integral component of the health care system. Interaction with EMS and transition of patient care is a daily occurrence in emergency medicine (EM). EM learners present to residency with diverse levels of prior exposure and familiarity with EMS. Though the American College of Graduate Medical Education (ACGME) requires EM residents to have experience with EMS, emergency preparedness, and disaster management, there is significant variability in EMS curricula and training among residency programs. The goal of the exercise was to determine if a novel interdisciplinary education event, with focus on simulation and demonstration, increased EM resident and student knowledge of EMS systems and equipment as well as confidence interacting with EMS.Methods: A four-hour interactive, multidisciplinary simulation event was developed and held in the summer of 2020. EM residents and medical students rotated through multiple interactive stations that focused on EMS equipment and operations, online medical control, tactical EMS, and firefighting operations. Prior to the event, participants completed a survey to assess prior experiences, familiarity, and comfort with topics presented. An additional survey was provided at the completion of the event. Survey data was compared pre-and post-event to assess for change in responses. Items on the surveys were analyzed independently, and similar items were compared in aggregate. The post-event survey also assessed participants' perceptions of the exercise including organization and relevance.Results: 38 participants completed the pre-event survey; 27 completed the postevent survey with 23 participants identified and matched as answering both surveys. Composite scores showed a statistically significant improvement in learner confidence using the demonstrated EMS equipment and performing online medical control. Comfort with use of EMS equipment improved from an average of 3 to 4.33 (on a 1-5 Likert scale) after demonstration and practice with equipment. (p<0.0001). Average confidence providing online medical control improved from 1.33 to 2.67 (p<0.0001). Respondents indicated the event increased their familiarity with EMS, tactical EMS, and fire department operations. Post-survey perception data revealed that 100% of participants overall reviewed the event as well organized and enjoyable. 96% stated the exercise was relevant to emergency medicine. 93% stated they would use the knowledge gained in the experience in their future medical practice.Conclusion: This novel interdisciplinary educational event utilizing hands-on training and simulation was effective in increasing familiarity and confidence with EMS operations, equipment use and online medical control. Participants found the event to be a positive educational experience which increased their knowledge base and relevant to future medical practice. Further investigation comparing hands-on simulation exercises to classroom-based didactics would be instructive.

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Study Objectives: Utilization of social media continues to increase among medical professionals, allowing them to be more connected in their personal and professional lives. Users leave comments, post photos, exchange information, buy and browse on the internet while often unknowingly leaving a digital footprint that may be accessible to the public. Facebook is a well-known social media network that allows users to create a profile and showcase their daily lives through photos, comments, and personal posts. Previous studies have shown high usage of Facebook among physicians, as well as high rates of unprofessional behavior in surgeons and surgical residents. The purpose of this study was to determine the frequency and degree of unprofessional conduct that is publicly available on Facebook profiles of emergency medicine residents.Methods: The Society for Academic Emergency Medicine (SAEM) Web site was used to identify 77 emergency medicine residency programs located in the Midwest and central portion of the United States. Resident rosters were obtained from program Web sites and were used to identify which residents had Facebook profiles visible to the public. The content of each profile was evaluated and placed into 1 of 3 categories: professional, potentially unprofessional, and clearly unprofessional based on a scoring system derived from the Accreditation Council for Graduate Medical Education components of professionalism and the American Medical Association report on professionalism in the use of social media. A chisquare test was used to look for significant differences between sex and post graduate year.Results: A total of 77 residency programs were chosen from the SAEM Web site and 67 of those were found to have a publicly available and current resident roster. A total of 2082 emergency medicine residents were identified of which 1346 (64.6%) were confirmed to have publicly viewable Facebook profiles. Of the residents with confirmed profiles, 63.2% had no unprofessional content, 29.7% had potentially unprofessional content, and 7.1% had clearly unprofessional content. Male residents had significantly more clearly unprofessional behavior compared with their female counterparts (8.9 vs 3.8%, p ¼ 0.002.) There was no significant difference in scores when stratified by postgraduate year. Alcohol use was the most frequent potentially unprofessional behavior while expletive use was the most common clearly unprofessional behavior.Conclusion: A majority of emergency medicine residents have confirmed Facebook profiles and many of those have publicly visible potentially or clearly unprofessional content. Unprofessional behavior on Facebook is more common among male residents and is relatively constant across postgraduate years. Such behavior may not only be a detriment to the physician, but may reflect poorly on the residency program and the institution as a whole. Residency programs and training institutions may want to direct additional attention toward education and risk reduction for residents utilizing social ...