Calcium Channel Blocker Intoxication: A Critical Care Transport Perspective.

Calcium channel blockers (CCBs) have seen an increase in rate of non-therapeutic exposure that is both accidental and intentional in nature. Patients experiencing the toxic effects of a CCB overdose are resource intensive and can quickly outstrip the capabilities of local health systems, necessitating transfer to larger tertiary or quaternary care centers. We present a case of intentional non-dihydropyridine CCB overdose and toxicity in a 20-year-old patient requiring initial stabilization at a referring critical access emergency department with continuation of treatment and support during a 60-minute rotor wing transport from the referring hospital to an academic quaternary care center. Emphasis is placed on the unique challenges in resuscitation and ongoing critical care administration during the transport phase of care. Proper stabilization of patients, planning, and consideration of potential problems associated with transport can help minimize stresses and risk of the transport, improving the outcome of extremely ill patients even under challenging circumstances.

Air Medical Curricula in Emergency Medicine Residencies: A National Survey.

OBJECTIVE: The aim of this study was to determine if a common air medical curriculum exists among Accreditation Council for Graduate Medical Education (ACGME) emergency medicine (EM) residencies. METHODS: Institutional review board exemption was obtained. A cross-sectional survey study design was used. All ACGME-approved EM residencies as of February 2013 were identified, and the program directors were e-mailed a 3-question survey. Descriptive statistics were calculated for each response, and a response bias analysis was completed. RESULTS: All 160 ACGME EM residencies were contacted by e-mail. One hundred six (66%) programs responded. Sixty-nine (65%) of the respondents offered an air medical experience. Only 25 of the 69 (36%) stated that they had a formal air medical curriculum, and 15 programs provided a copy of their curriculum. Protocol education was present in 80% of programs. Safety training was present in 60% of the programs. Financial education was present in 7% of programs. There was no statistically significant difference between responders and nonresponders except for residency class size. CONCLUSION: After 30 years of published articles and position statements calling for standardized air medical resident crew member training, there is still no standardized training program among emergency medicine residencies.