Instructions• The general template in several formats is provided for your use.• The slide is set for a 36 X 48 inch poster. If you need to change sizes go up to

“File” and “Page Setup” and change the size.• Select the template you need, complete it, and then delete all of the extra slides

and instruction slides so that you are left with one slide in the presentation. This can be submitted or printed.

• Do not change the top bar graphics. They are VCU branded• General poster tips

– Review submission guidelines to ensure you use the correct headers/format for the specific submission.

– Use brief, bulletted points, not complete sentences– Only main points on poster…you can discuss the rest in person– Graphs/figures should not be overly complicated and should highlight important data– Use references if required. Cite in the poster like a paper. May eliminate this box if needed– Boxes may have to be moved around and resized to make the poster look better– If you add photos make sure they are high resolution. See “Image size” slide later.

Resizing Boxes1. Click on the text box and drag to new size 2. Double click on the top gold band

until the box is highlighted

3. Right click and select “Format Shape” 4. Highlight “Text Box” on the left and thenclick “Resize shape to fit text”. Click it even if it is already selected. Then click OK.

5. The gold band should be sized correctly.

Image Size• This is some great guidance from our VCU Brand Standards people…

The resolution of each image in your poster should be 150 dpi (or pixels per inch) at the final printing size. Resolution below 150 dpi will result in a pixelated image. Note that an image that looks good on the computer screen will not necessarily print well. The steps below will ensure that your images will look good when printed. (Elements drawn with PowerPoint’s drawing tools will retain their sharpness at any size. Most Microsoft clipart will as well.)

Determine the maximum size at which your image can be printed.Many image editing programs can help you determine this. One example is Gimp, a free program for Macs and PCs (available at http://www.gimp.org/downloads or http://gimp.cp-dev.com/)1) Open the image in Gimp2) From the menu, choose Image > Print size3) Change the X and Y resolution to 150 pixels/inch4) The resulting print size is the maximum size that will print well

Insert your image in your PowerPoint slide and set it to the maximum print size or smaller.• Insert your image in the slide and select your imageo PC users: Go to the Format menu and the print size of image will display.o Mac users: Go to the View menu, select “formatting palette” and the print size of the image will display under the “size, rotation and ordering” tab.• If necessary, change the image size. As long as the print size within PowerPoint is the same or smaller than the maximum print size (step 4 above), you are good to go!

Standard Research Report Title Goes Here

• Type a few bulleted points here.

Discussion

• Type a few bulleted points here.

Introduction

• Type a few bulleted points here.

Results

• Type a few bulleted points here.

Methods

• Type a few bulleted points here.

References

• Type a few bulleted points here.

Figures

AuthorsDepartment of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA

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Case Report Title Goes Here

• Type a few bulleted points here.

Discussion

• Type a few bulleted points here.

Background

• Type a few bulleted points here.

Case Presentation

• Type a few bulleted points here.

Conclusions

• Type a few bulleted points here.

Figures

AuthorsDepartment of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA

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• Type a few bulleted points here.

References

Samples/Examples

Intravenous Ondansetron and Adult Emergency Department Patients: An Observational Study

• QTc prolongation does occur (between 6-14 minutes) but clinical significance is unlikely.

• Small study but zero serious adverse electrical cardiac events.

• First prospective study, but larger prospective study warranted.

Conclusions/Clinical Implications

• Ondansetron is known to cause QT interval prolongation but the effect and clinical significance in adult emergency department patients is unknown.

• Primary Objective: Determine mean maximal corrected QT (QTc) after intravenous administration of 4mg ondansetron.

• Secondary Objective: Report serious adverse cardiac electrical events.

Purpose

• Twenty-two adult emergency department patients enrolled

• Mean QTc prolongation of 19.7 ms (95% CI 14.0-25.5) (Table 1)

• Mean proportion change of QTc from baseline 5.2% (95% 3.8%-6.6%)

• Zero serious adverse cardiac electrical events (95% CI 0-13%)

• Statistically significant QTc prolongation from baseline occurred at minutes 6, 12, and 14 (Table 2)

Results

• Prospective, observational, single center cohort study

• Adult emergency department patients receiving 4mg of IV ondansetron

• 6-lead EKG recorded at baseline and every 2 minutes for 20 minutes

• QTc calculated using Bazett formula

• Serious adverse cardiac electrical events recorded including: non-sinus rhythm, severe bradycardia, and sudden cardiac death

• Mean maximal QTc, proportion change from baseline, and serious adverse electrical events described with 95% CI

Methods

Tables

Peter Moffett MD1, Laquisha Cartwright Pharm.D2, Dustin O’Keefe MD2, Elizabeth Grossart MD3, Christopher Kang MD4

1Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA2Department of Emergency Medicine, Darnall Army Medical Center, Fort Hood, TX, 3Department of Emergency Medicine, Blanchfield Army Community Hospital, Fort

Campbell, KY, 4Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA

Baseline QTc mean (SD)

Max QTc mean (SD)

Maximum QTc Prolongation mean (95% CI)

P-value

Primary Analysis (n=22)

395.1 ms (20.2) 414.8 ms (22.8) 19.7 ms (14.0-25.5)

<.0001*

Table 1: Primary Outcome- Mean Maximal Prolongation of QTc

* Paired Student T-Test

Time Point Mean (95% CI) P-value*

Baseline 395 ms (386 ms - 404 ms) NA

2 min 394 ms (380 ms - 408 ms) 0.75

4 min 399 ms (388 ms – 410 ms) 0.43

6 min 404 ms (395 ms – 413 ms) 0.02

8 min 397 ms (385 ms – 409 ms) 0.60

10 min 400 ms (388 ms – 411 ms) 0.30

12 min 401 ms (390 ms – 412 ms) 0.01

14 min 401 ms(391 ms – 410 ms) 0.02

16 min 400 ms (388 ms – 412 ms) 0.66

18 min 402 ms (392 ms – 413 ms) 0.10

20 min 396 ms (384 ms – 408 ms) 0.94

Table 2: Pairwise comparison of mean QTc prolongation at each time point from baseline

* One-way MANOVA for repeated measures

The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.

A novel apprenticeship model that provides progressive educational responsibility and individual development to

emergency medicine residents

• All learners felt their development was emphasized and most would keep the curriculum in the future

• This is a viable model for development of EM3 teaching skills and EM1 instruction

• Continued refinement of apprenticeship model will continue with long term data collection

Discussion

• Many busy clinical environments diminish the educational opportunities of two distinct groups of learners

• Interns lose direct mentorship and individual instruction

• Senior residents do not have progressive teaching responsibilities

• We developed an apprenticeship model to accomplish both

Introduction

• All residents felt their development was emphasized on the rotation.

• EM3 residents uniformly felt this was a positive addition to the curriculum and would recommend keeping the rotation

• 80% of the EM1 residents would keep the rotation and felt it was a positive addition with only 20% neutral

• 20% of EM1 residents did not feel the low volume aided their eduction

Results

• EM 1 residents were paired directly with EM3 (3 year EM program) for 2 weeks

• 25,000 visits per year moderate acuity Veterans Administration emergency department

• EM3 received adult learning theory education

• EM3 had no individual patient care responsibility but performed bedside teaching, standardized observation, and all evaluations on the EM1 resident

• A survey of both EM1 and EM3 residents was performed after implementation

Methods

We appreciate the emergency medicine residents at VCU and emergency medicine faculty at Hunter Holmes McGuire VA Medical Center, in Richmond VA who pioneered the rotation.

Acknowledgements

Figures

Joel Moll MD1, Michelle Troendle MD1, Frank Zwemer MD2, Peter Moffett MD1

1Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA2 Hunter Holmes McGuire VA Medical Center, Richmond VA

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0 10 20 30 40 50 60 70 80 90 100

AgreeNeutralDisagree

I understand goals/objectives of the rotation

There is benefit to the lower volume environment for this rotation

I would recommend keeping this rotation

I feel this emphasized my development as an EM1

This was a positive addition to our curriculum

0 10 20 30 40 50 60 70 80 90 100

AgreeNeutralDisagree

I understand goals/objectives of the rotation

There is benefit to the lower volume environment for this rotation

I would recommend keeping this rotation

I feel this emphasized my teaching skills as an EM3

This was a positive addition to our curriculum

Figure 1: EM1 survey results

Figure 2: EM3 survey results

Severe Poisoning Following Self-Reported Use Of 25-I, A Novel Substituted Amphetamine

• 25-I (25I-NBOMe) is a (n-benzyl) phenethylamine in the 2C “family”

• The n-benzyl moiety reportedly increases hallucinogenic properties over other potent 2C compounds.

• The majority of patients snorted the 25-I, thoug in two cases the drug was allegedly made into a tablet

• Benzodiazepines were effective in treating symptomatic tachycardia and agitation

• Duration of toxicity was usually < 24 hours in uncomplicated cases

• Laboratory confirmation of 25-I was only made in one case, though two other cases with similar effects presented at the same time from the same “party”

Discussion

• The abuse of psychoactive congeners of amphetamine & cathinone has increased in recent years

• They are often sold as disguised commercial products such as bath salts, plant food, glass scratch or stain removers

• Diagnosis is usually made on a clinical basis since rapid identification is often not available

• We report of series of young patients who reportedly ingested or snorted 25-I, a novel amphetamine derivative allegedly manufactured in a local makeshift laboratory

Background•Ten patients with a mean age of 17 y (range: 14-20 y) presented to local ED’s in Richmond, VA after ingestion and/or insufflation of a drug referred to as “25-I”

• Six of 10 patients used 25-I alone; other substances reportedly used by the remaining patients included ethanol, 2-CE (another synthetic amphetamine derivative), THC and ketamine

• Two patients had documented tonic-clonic seizure activity, one of whom had multiple, discrete intraparenchymal hemorrhages (Figure)

• Serum was analyzed in an 18 y/o male patient who presented with agitation, hallucinations, and a heart rate in the 150s. He responded to 4mg IV lorazepam.

• His urine drug screen was positive for only ethanol and THC. High pressure liquid chromatography with tandem mass spectrometry (HPLC/MS/MS) revealed a serum 25I-NBOMe concentration of 0.76 ng/ml.

Case Presentation

• The abuse of synthetic amphetamine congeners continues to cause significant morbidity in the US, particularly among teenagers and young adults

• Sources of synthetic amphetamine congeners may be local clandestine labs in addition to the internet and retail outlets

Conclusions

Figures

SR Rose Pharm. D., KL Cumpston D.O., PE Stromberg M.D., BK Wills D.O.Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA

Data available N % Mean Range

Tachycardia 10 9 90 126 bmp 99 - 155 bpmHypertension 10 9 90 155/96 mmHg 138/76 - 183/160Hyperglycemia 10 9 90 181 mg% 96 - 297 mg%Leukocytosis 8 7 88 20,000 10,700 - 29,400Agitation 10 7 70Hallucinations 10 5 50Seizures 10 2 20Intracranial hemorrhage

10 1 10

Endotracheal intubation 10 3 30

Figure. MRI on HD 2

Table. Clinical Data

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