A Five-Week-Old Twin With Profound Anemia: A Case Report of Asymmetric Congenital Babesiosis.

We present a case report and review of the literature of congenital transmission of babesiosis in a five-week-old twin neonate evaluated for lethargy and difficulty with feeding. On presentation to the pediatric emergency department, the patient appeared pale and was found to be profoundly anemic with intraerythrocytic ringed parasites consistent with Babesia microti visible on a thin smear. The patient received a blood transfusion and was treated with a regimen of atovaquone and azithromycin with full recovery. The other twin remained asymptomatic with negative Babesia polymerase chain reaction testing.

A Retrospective Cohort Study of Acute Epiglottitis in Adults.

INTRODUCTION: Adult epiglottitis is a disease process distinct from pediatric epiglottitis in microbiology, presentation, and clinical course. While traditionally considered more indolent and benign than in children, adult epiglottitis remains a cause of acute airway compromise with a mortality rate from 1-20%. Our objective was to characterize the disease course and evaluate the rate and type of airway management in this population at a tertiary, academic referral center. METHODS: We conducted a retrospective chart review of all adult patients (age ≥ 18) who were definitively diagnosed with infectious "epiglottitis," "supraglottitis," or "epiglottic abscess" by direct or indirect laryngoscopy during a nine-year period. Double data abstraction and a standardized data collection form were used to assess patient demographic characteristics, presenting features, and clinical course. The primary outcome was airway intervention by intubation, cricothyroidotomy, or tracheostomy, and the secondary outcome was mortality related to the disease. RESULTS: Seventy patients met inclusion criteria. The mean age was 50.2 years (standard deviation ± 16.7), 60% of the patients were male, and 14.3% were diabetic. Fifty percent had symptoms that were present for ≥ 48 hours; 38.6% had voice changes, 13.1% had stridor, 12.9% had fever, 45.7% had odynophagia, and 47.1% had dysphagia noted in the ED. Twelve patients (17.1%) received an acute airway intervention including three who underwent emergent cricothyroidotomy, and one who had a tracheostomy. Two patients died and one suffered anoxic brain injury related to complications following difficult airway management. CONCLUSION: In this case series the majority of patients (82.9%) did not require airway intervention, but a third of those requiring intervention (5.7% of total) had a surgical airway performed with two deaths and one anoxic brain injury. Clinicians must remain vigilant to identify signs of impending airway compromise in acute adult epiglottitis and be familiar with difficult and failed airway algorithms to prevent morbidity and mortality in these patients.

Resource Utilization and Emergency Medicine Advisors' Approach to Video Interview Preparation.

Introduction The Standardized Video Interview (SVI) was a residency application component introduced by the Association of American Medical Colleges (AAMC) as a supplement to the existing process, which aimed to measure knowledge of professional behaviors and interpersonal skills. Given its novelty in both aim and execution, little advice or experience was available to inform preparation strategies. We sought to perform a cross-sectional analysis to explore advisors' practices in guiding students' preparation for the SVI. Methods An electronic questionnaire was developed and piloted for flow and usability, then distributed to all members of the Council of Residency Directors in Emergency Medicine (CORD EM), the professional society for emergency medicine educators, via listserv, comprised of 270 residency programs. Questions were both open- and closed-ended and therefore analyzed in a mixed-method fashion.  Results We received 56 responses from a listserv representing 270 residency programs. Respondents cited personal experience and consensus opinions from national organizations as the primary sources for their advice. The most common resources offered to students were space for completing the SVI (41%) or technical support for completing the SVI (47%). The time committed to student advising specifically for the SVI ranged from zero to 20 hours. Estimated associated costs of preparation ranged from zero up to $10,000 (time plus resources). Two individuals reported recommending commercial preparation resources to students.  Conclusion The SVI was a novel attempt to augment the resident application process. We found variability in resources and advice offered to students, including broad ranges of time dedicated, the monetary value of resources contributed, and the types of resources utilized. As the global COVID-19 pandemic has inspired a wave of innovation and process changes, we present this data for consideration as a snapshot of the variable responses to a single uniform process change.

Advising special population emergency medicine residency applicants: a survey of emergency medicine advisors and residency program leadership.

BACKGROUND: The objective of this study was to determine the advising and emergency medicine (EM) residency selection practices for special population applicant groups for whom traditional advice may not apply. METHODS: A survey was distributed on the Council of Residency Directors in EM and Clerkship Directors in EM Academy listservs. Multiple choice, Likert-type scale, and fill-in-the-blank questions addressed the average EM applicant and special population groups (osteopathic; international medical graduate (IMG); couples; at-risk; re-applicant; dual-accreditation applicant; and military). Percentages and 95% confidence intervals [CI] were calculated. RESULTS: One hundred four surveys were completed. Of respondents involved in the interview process, 2 or more standardized letters of evaluation (SLOEs) were recommended for osteopathic (90.1% [95% CI 84-96]), IMG (82.5% [73-92]), dual-accreditation (46% [19-73]), and average applicants (48.5% [39-58]). Recommendations for numbers of residency applications to submit were 21-30 (50.5% [40.7-60.3]) for the average applicant, 31-40 (41.6% [31.3-51.8]) for osteopathic, and > 50 (50.9% [37.5-64.4]) for IMG. For below-average Step 1 performance, 56.0% [46.3-65.7] were more likely to interview with an average Step 2 score. 88.1% [81.8-94.4] will consider matching an EM-EM couple. The majority were more likely to interview a military applicant with similar competitiveness to a traditional applicant. Respondents felt the best option for re-applicants was to pursue the Supplemental Offer and Acceptance Program (SOAP) for a preliminary residency position. CONCLUSION: Advising and residency selection practices for special population applicants differ from those of traditional EM applicants. These data serve as an important foundation for advising these distinct applicant groups in ways that were previously only speculative. While respondents agree on many advising recommendations, outliers exist.

COVID-19: A Driver for Disruptive Innovation of the Emergency Medicine Residency Application Process.

The coronavirus disease (COVID-19) pandemic has had a significant impact on undergraduate medical education with limitation of patient care activities and disruption to medical licensing examinations. In an effort to promote both safety and equity, the emergency medicine (EM) community has recommended no away rotations for EM applicants and entirely virtual interviews during this year's residency application cycle. These changes affect the components of the EM residency application most highly regarded by program directors - Standardized Letters of Evaluation from EM rotations, board scores, and interactions during the interview. The Council of Residency Directors in Emergency Medicine Application Process Improvement Committee suggests solutions not only for the upcoming year but also to address longstanding difficulties within the process, encouraging residency programs to leverage these challenges as an opportunity for disruptive innovation.

Addressing Challenges in Obtaining Emergency Medicine Away Rotations and Standardized Letters of Evaluation Due to COVID-19 Pandemic.

The Council of Residency Directors in Emergency Medicine (CORD) Advising Students Committee in Emergency Medicine (ASC-EM) anticipates institutional and regional variability in both the spread and response to COVID-19. Travel restrictions and host institution rotation closures will impact the number of emergency medicine (EM) rotations EM-bound medical students can complete in an unprecedented manner. They may prevent students from completing any away rotations this academic cycle, challenging the students' ability to obtain EM Standardized Letters of Evaluation (SLOEs). EM's emphasis on residency group SLOEs over other letter types creates an undue burden on these vulnerable students and makes the application process intrinsically inequitable. This inequity warrants a reevaluation of the current application practice. This article outlines ASC-EM's proposed recommendations for all stakeholders, including EM program leadership, medical schools, and EM-bound medical students, to consider for the upcoming EM application cycle.

Recommendations from the Council of Emergency Medicine Residency Directors: Osteopathic Applicants.

The Council of Emergency Medicine Residency Directors (CORD) Advising Students Committee (ASC-EM) has previously published student advising recommendations for general emergency medicine (EM) applicants in an effort to disseminate standardized information to students and potential advisors. As the shift to a single graduate medical education system occurs by 2020, osteopathic students will continue to represent a larger portion of matched EM applicants, but data shows that their match rate lags that of their allopathic peers, with many citing a lack of access to knowledge EM advisors as a major barrier. Based on available data and experiential information, a sub-group of ASC-EM committee sought to provide quality, evidence-based advising resources for students, their advisors, and medical leadership. The recommendations advise osteopathic students to seek early mentorship and get involved in EM-specific organizations. Students should take Step 1 of the United States Medical Licensing Exam and complete two EM rotations at academic institutions to secure two Standardized Letters of Evaluation and consider regional and program-specific data on percentage of active osteopathic residents.