(ACEP) organized a multidisciplinary effort to create a clinical practice guideline specific to unscheduled, time-sensitive procedural sedation, which differs in important ways from scheduled, elective procedural sedation. The purpose of this guideline is to serve as a resource for practitioners who perform unscheduled procedural sedation regardless of location or patient age. This document outlines the underlying background and rationale, and issues relating to staffing, practice, and quality improvement. [

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wo percent of emergency department visits can be attributed to ocular conditions, ranging from primary ophthalmologic concerns to infectious or traumatic causes. 1 Although many of these conditions do not require emergent ophthalmologic consultation or intervention in the emergency department, certain conditions must be diagnosed promptly. Because of a combination of environmental limitations, difficulty accessing the necessary equipment, and lack of physician comfort, a comprehensive ophthalmologic examination can be difficult to perform. Ultrasound has become a tool used by both emergency physicians and ophthalmologists in diagnosing ocular emergencies. A recent study of board-certified residents and attending physicians in an emergency department showed that ultrasound examinations had 100% sensitivity and 97.2% specificity for detecting globe rupture, retinal detachment, and vitreous hemorrhage. 2 Simulation training in ultrasound has been shown to improve patient safety in procedures. 3,4 and early diagnosis in a variety of areas.There are currently a few ocular simulation models commercially available, eg, harvested rabbit or porcine eyes and or glass models layered with bovine tissue. 5,6 Given the importance of simulation training and the relative paucity of easily obtainable and financially feasible ocular models, we developed an ocular ultrasound phantom using readily available materials. We were able to, easily and with little expense, create reasonable models of the normal eye as well as the eye with retinal detachment, a foreign body, an increased optic nerve sheath diameter, vitreous hemorrhage, and retrobulbar hematoma. The procedures for creating the phantom are listed in the "Appendix."

Objective: The objectives of this study were 1) to describe the current use of etomidate and other induction agents in patients with sepsis and 2) to compare adverse events between etomidate and ketamine in sepsis. Methods: This was an observational cohort study of the prospective National Emergency Airway Registry (NEAR) data set. Descriptive statistics were used to report the distribution of induction agents used in patients with sepsis. Adverse events were compared using bivariate analysis, and a sensitivity analysis was conducted using a propensity score-adjusted analysis of etomidate versus ketamine. Results: A total of 531 patients were intubated for sepsis, and the majority (71%) were intubated with etomidate as the initial induction agent. Etomidate was less frequently used in sepsis patients than nonsepsis patients (71% vs. 85%, odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.4 to 0.5). Sepsis patients had a greater risk of adverse events, and vasopressor therapy was required for 25% of patients after intubation. Postprocedure hypotension was higher between those intubated for sepsis with ketamine versus etomidate (74% vs. 50%, OR = 2.9, 95% CI = 1.9 to 4.5). After confounding by indication in the propensity score-adjusted analysis was accounted for, ketamine was associated with more postprocedure hypotension (OR = 2.7, 95% CI = 1.1 to 6.7). No difference in emergency department deaths was observed. Conclusions: Etomidate is used less frequently in sepsis patients than nonsepsis patients, with ketamine being the most frequently used alternative. Ketamine was associated with more postprocedural hypotension than etomidate. Future clinical trials are needed to determine the optimal induction agent in patients with sepsis. E tomidate is commonly used as an induction agent for rapid sequence induction in critically ill patients in the emergency department (ED) because of its reliable sedation effect and stable hemodynamic profile. 1 Etomidate also inhibits adrenal steroidogenesis by its transient inhibition of 11 b-hydroxylase, 2-4 which has raised safety concerns in patients with sepsis. 3,5-8 Based on cohort studies and post hoc

IntroductionRecent literature calls for initiatives to improve the quality of education studies and support faculty in approaching educational problems in a scholarly manner. Understanding the emergency medicine (EM) educator workforce is a crucial precursor to developing policies to support educators and promote education scholarship in EM. This study aims to illuminate the current workforce model for the academic EM educator.MethodsProgram leadership at EM training programs completed an online survey consisting of multiple choice, completion, and free-response type items. We calculated and reported descriptive statistics.Results112 programs participated. Mean number of core faculty/program: 16.02 ± 7.83 [14.53–17.5]. Mean number of faculty full-time equivalents (FTEs)/program dedicated to education is 6.92 ± 4.92 [5.87–7.98], including (mean FTE): Vice chair for education (0.25); director of medical education (0.13); education fellowship director (0.2); residency program director (0.83); associate residency director (0.94); assistant residency director (1.1); medical student clerkship director (0.8); assistant/associate clerkship director (0.28); simulation fellowship director (0.11); simulation director (0.42); director of faculty development (0.13). Mean number of FTEs/program for education administrative support is 2.34 ± 1.1 [2.13–2.61]. Determination of clinical hours varied; 38.75% of programs had personnel with education research expertise.ConclusionEducation faculty represent about 43% of the core faculty workforce. Many programs do not have the full spectrum of education leadership roles and educational faculty divide their time among multiple important academic roles. Clinical requirements vary. Many departments lack personnel with expertise in education research. This information may inform interventions to promote education scholarship.

Committee and Subcommittee Revising the Opioid Clinical policy Policy statements and clinical policies are the official policies of the American College of Emergency Physicians and, as such, are not subject to the same peer review process as articles appearing in the journal. Policy statements and clinical policies of ACEP do not necessarily reflect the policies and beliefs of Annals of Emergency Medicine and its editors.

IntroductionEducators and education researchers report that their scholarship is limited by lack of time, funding, mentorship, expertise, and reward. This study aims to evaluate these groups’ perceptions regarding barriers to scholarship and potential strategies for success.MethodsCore emergency medicine (EM) educators and education researchers completed an online survey consisting of multiple-choice, 10-point Likert scale, and free-response items in 2015. Descriptive statistics were reported. We used qualitative analysis applying a thematic approach to free-response items.ResultsA total of 204 educators and 42 education researchers participated. Education researchers were highly productive: 19/42 reported more than 20 peer-reviewed education scholarship publications on their curricula vitae. In contrast, 68/197 educators reported no education publications within five years. Only a minority, 61/197 had formal research training compared to 25/42 education researchers. Barriers to performing research for both groups were lack of time, competing demands, lack of support, lack of funding, and challenges achieving scientifically rigorous methods and publication. The most common motivators identified were dissemination of knowledge, support of evidence-based practices, and promotion. Respondents advised those who seek greater education research involvement to pursue mentorship, formal research training, collaboration, and rigorous methodological standards.ConclusionThe most commonly cited barriers were lack of time and competing demands. Stakeholders were motivated by the desire to disseminate knowledge, support evidence-based practices, and achieve promotion. Suggested strategies for success included formal training, mentorship, and collaboration. This information may inform interventions to support educators in their scholarly pursuits and improve the overall quality of education research in EM.

Medical education fellowships cultivate leaders and communities of trained educators but require participants to balance faculty responsibilities with professional development. Advice of current directors can inform the development of postgraduate programs modeled after accredited clinical specialty fellowships. Programs with the support of strategic partners, financial stability, and well-defined goals may allow new faculty to begin their careers with existing competency in medical education skills.