SGEM Xtra: New York ACEP Scientific Assembly 2019

Date: July 10th, 2019

I had the pleasure of presenting at the New York ACEP Scientific Assembly in upper state New York. It was at held at the beautiful Sagamore Resort on Lake George. Thank you to Dr. Penny Lema and the organizing committee for inviting me to present.

I was asked to present three talks at the conference. The first talk was called the Medical Myth Menace and I discussed five medical myths:

Myth – All out-of-hospital cardiac arrest (OHCA) patients need an endotracheal tube (SGEM#247)
Myth – All critically ill patients need an oxygen saturation of 100% (SGEM#243)
Myth – All rapid atrial fibrillation patients need to be cardioverted early (SGEM#260)
Myth – Probiotics can help in pediatric gastroenteritis (SGEM#254)
Myth – Resuscitative endovascular occlusion of the aorta (REBOA) is proven to save lives (SGEM#258)

The second talk addressed the use of acupuncture in the ED for pain control. Acupuncture is part of Traditional Chinese Medicine that has been around for thousands of years. It is based on the idea that the body has a life force flowing through meridians that is called chi/qi. The claim is disease and illness are result of chi/qi being blocked. Acupuncture is a method of setting of needles into the skin to unblock the flow of chi/qi through the meridians to restore balance to the body.

There has been a great deal of research done on acupuncture to treat a variety of conditions. No convincing high-quality evidence has been published demonstrating its efficacy. This talk presented three trials looking at the use of acupuncture in the emergency department:

Cohen et al. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. MJA 2017

SGEM #187 Bottom Line: There is no high-quality evidence that acupuncture works for patients presenting to the emergency department with back pain, ankle sprains or migraines.

Beltaief K et al. Acupuncture versus titrated morphine in acute renal colic: a randomized controlled trial. J Pain Res. 2018

SGEM#220 Bottom Line: This trial does not support the claim that acupuncture works or is superior to morphine for adult patients presenting to the emergency department.

Fox LM et al. Battlefield acupuncture to treat low back pain in the emergency department. Am J EM 2018

SGEM#224 Bottom Line: Based on this study, battlefield acupuncture cannot be recommended to treat pain in the emergency department.

The acupuncture presentation also went through a number of logical fallacies. A number of these fallacies have been used in support of the use of acupuncture. A logical fallacy is an error in reasoning. There are formal and informal logical fallacies. We should try to avoid logical fallacies when advocating for a position.

The third presentation was an hour session with talented Dr. Anand Swaminathan (EM Swami) from EM:RAP. I gave a 15 minute talk on evidence based medicine and Swami gave a 15 minute talk on free-open access to medical education (FOAMed). Together we did a live recording of SGEM episode #262.

You can download a copy of our slides (Skeptic #EBM and Swami #FOAMed) and watch our presentation on Youtube. The podcast will be available in a few days.

Two amazing physicians, who I am honoured to know, received awards at the NYACEP 2019 Scientific Assembly. It was wonderful to be there when they were both recognized for their contribution to emergency medicine.

Dr. Dara Kass

Advancing Emergency Care: This award recognizes a New York ACEP member for a significant contribution in advancing emergency care in New York State. Contributions to be considered include; Patient Care (improved delivery modes, quality care improvement, cost containment); EMS (organization, service, public education, disaster plan); Education (new or improved teaching methods, publication(s), education programs, evaluation mechanisms); Research or major contribution to a New York ACEP priority objective.

This year the award was given to Dr. Dara Kass who has been on the SGEM twice (FeminEM and FIX19 You Up).

Dr. Penny Lema

Physician of the Year: This award is conferred in recognition of contributions to the advancement of emergency medicine in New York State. The recipient has demonstrated outstanding dedication and commitment to the improvement of quality patient care and the advancement of emergency medicine in New York through clinical, research, educational and/or administrative activities. The achievements of this individual have enhanced the state’s health care system and have advanced the profession of emergency medicine.

This year it was awarded to Dr. Penelope Lema. Dr. Lema had invited me to Buffalo in 2016 and we recorded SGEM#163.

The SGEM will be back next episode with a structured critical review of a recent publication. Cutting the knowledge translation window down from over ten years to less than one year with power of social media. The SGEM’s ultimate goal continues to be that patients get best care on best evidence.