You’ve Called 911, Now What? A Simplified, Evidence-based Approach to Six Life-Threatening Office Emergencies

Internet Enduring Material Sponsored by the Stanford University School of Medicine. Presented by the Department of Emergency Medicine at the Stanford University School of Medicine.

This CME activity will present a practical approach to several high-risk emergency conditions that can present to office-based practices. The course instructors will describe the immediate recognition and management of these complex patients through a discussion of specific video case-based scenarios and a review of current, evidence-based practice interspersed with interactive self assessments. By learning and applying these high-yield principles, course participants will be able to optimize patient outcomes.

This course is designed for family physicians, primary care physicians, general surgeons, oncologists, and psychiatrists.

• Release Date: September 4, 2015
• Expiration Date: August 31, 2017
• Estimated Time to Complete: 2 Hours
• CME Credits Offered: 2.00
• Registration Fee: FREE

• Review the information below and complete the entire activity.
• Complete the CME Post-test, CME Assessment Survey, and CME Activity Completion Statement at the end of the activity.
• You must receive a score of 75% or higher on the post-test in order to receive a certificate. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
• Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
• Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

At the conclusion of this activity, participants should be able to:

• Administer high quality CPR in the first moments of recognizing a patient in cardiac arrest.
• Identify and effectively manage patients with anaphylaxis.
• Effectively manage patients presenting with severe asthma prior to transfer to the emergency department.
• Appropriately risk-stratify acute chest pain patients to reduce misdiagnosis and delays in evaluation and treatment.
• Identify and effectively manage patients in status epilepticus.
• Conduct rapid, bedside evaluations to evaluate and differentiate patients with low, moderate, and high risk syncope presentations.
• Conduct a clinical office space assessment of the essential equipment and operational improvements necessary for managing emergencies.
• Effectively communicate with EMS and Emergency Physicians while managing emergencies.

1. Introduction
2. Basic Life Support
3. Anaphylaxis
4. Asthma
5. Chest Pain
6. Seizure
7. Syncope
8. Office Emergencies
9. Effective Communication
10. Course Wrap-up
11. Resources and References
12. Help!

The following planners, speakers and authors have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Swaminatha Mahadevan, MD
Associate Professor of Surgery, Emergency Medicine
Stanford Univeristy School of Medicine
Course Director
Author/Presenter

Matthew Strehlow, MD
Clinical Associate Professor of Surgery, Emergency Medicine
Stanford Univeristy School of Medicine
Course Director
Author/Presenter

Mike McAuliffe
Stanford EdTech

Kimberly Walker, PhD
Stanford EdTech

Greg Bruhns
Stanford Online

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The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 2.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity received no commercial support.

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.

You are encouraged to visit the portal: http://lane.stanford.edu/portals/cultural.html

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If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team. If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu

High-Quality CPR
Meaney PA, et al. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128:417-35.

Preparing Your Office for Emergencies
Toback, SL. Medical Emergency Preparedness in Office Practice. Am Fam Physician. 2007;75:1679-84.

Syncope
Costantino G. et al. Syncope Risk Stratification Tools vs Clinical Judgment: An Individual Patient Data Meta-analysis. Am J Med. 2014:127;1126.e13-1126e25.

Costantino G, Furlan R. Syncope Risk Stratification in the Emergency Department. ­­­ Cardiol Clin. 2013:31;27-38.

Benditt D, Adkisson WO. Approach to the Patient with Syncope. Cardiol Clin. 2013:31;9-25.

Anaphylaxis
Simons FE, et al. World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis. WAO Journal. 2011:4;413-37.

Chest Pain
O’Gara PT, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol. 2013;61:e78-140.

Asthma
Okelo SO, et al. Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review. Pediatrics.  2013;132:517-34.

Cates CJ, et al. Holding Chambers (Spacers) Versus Nebulisers for Beta-Agonist Treatment of Acute Asthma. Cochrane Database Syst Rev. 2013; Sep 13;9.

Seizures
Claassen J, et al. Emergency Neurological Life Support: Status Epilepticus. Neurocrit Care. 2012:Suppl1:S73-8.

Silbergleit R, et al. Intramuscular Versus Intravenous Therapy for Prehospital Status Epilepticus. N Engl J Med. 2012;366:591-600.

Communication
Shamji H, et al. Improving the Quality of Care and Communicaiton During Patient Transitions: Best Practices for Urgent Care Centers. Jt Comm J Qual Patient Saf. 2014:40;319-24.