The speech given by Dr. Goldfrank at the 2020 NYU / Bellevue Emergency Medicine Graduation Ceremony

Graduation 2020

Lewis R. Goldfrank, MD

June 17, 2020

WELCOME TO THE GRADUATES

Congratulations to a wonderful group of physicians. It is a pleasure to recognize your great accomplishments in the presence of your friends, families, loved ones and the residents and faculty who have learned so much from and with you. I would first like to recognize those of you who are members of the Gold Humanism Honor Society.

There are a remarkable number of awardees in our graduating class of 2020.

CLASS OF 2020

Joe Bennett (R)

Max Berger (R)

Ashley Miller (R)

Leigh Nesheiwat (S)

Kristen Ng (R)

Emily Unks (S)

AND

Arie Francis (R)

Nisha Narayanan (S)

FUTURE PGY-4

Elena Dimiceli (S)

Kamini Doobay (S)

Mark Iscoe (R)

FUTURE PGY-3

Stasha O’Callaghan (S)

Nicholus Warstadt (S)

FUTURE PGY-1

Aaron Bola (S)

Alison (Ali) Graebner (S)

Aron Siegelson (S)

Melissa Socarras (S)

Sarah Spiegel (S)

Thomas Sullivan (S)

Christy Williams (S)

GOLD HUMANISM CORE VALUES

Integrity, Excellence, Compassion, Altruism, Respect, Empathy, Service

These are the values you want as a doctor for yourself or a loved one,

These values are what brought all of you to NYU-Bellevue and that you have honed throughout your training. The remainder of this talk shows how all of you have been successful and demonstrated these values some of you were elected to the Gold Humanism—all of you have achieved humanistic success.

Your personal efforts in the face of uncertainty of the evolution of the pandemic, the inadequate supplies, the hospital and governmental problematic decisions are remarkable. In our country, the President did not mourn the loss of more than a 100,000 human beings and the needs of society. Nor did he provide the leadership and moral support that the country desperately needed to optimally handle this unprecedented crisis. You, in contrast, demonstrate unflappable commitment to address and overcome obstacles to care for your patients, assist your peers, educate and care for your families and friends, while also caring for yourselves. This is a tribute to your humanism. You created essential ways to help patients who were isolated from families and friends during the critical phases of COVID-19. You utilized new tools to communicate your sorrow, your compassion and love, to maintain essential humanistic traditions of medicine while you could not talk, touch or utilize other essential skills to the fullest extent of a physician.

When you recognized that all your knowledge of the social determinants of medicine was playing out as COVID-19 assaulted the poorest in our country, the people of color, the people with essential jobs without personal protective equipment, the people crowded in apartments and subways and buses, you spoke up and acted with appreciation and understanding of these disparities. You recognized that our system of using medicine to correct the societal social institutionally entrenched disparities was inadequate. George Floyd’s  death, and that of Breonna Taylor and innumerable others document the racism in America that destroys a part of us each and every day and by extension reinforces and normalizes white privilege. The ever increasing body of video evidence of the horrors of systemic racism is indisputable. You recognized that the American system of criminalization of social determinants is unacceptable. You spoke up and demonstrated that you saw our blind spots on policing and race. You protested to demand change in America.

Change for equity and justice must occur throughout our society. “Black Lives Matter” will only be realized when the social determinants are truly addressed through changes that impact every vulnerable person. We must recognize that person, institutional and societal failures will not be corrected by medicalizing or criminalizing of socially determined inequities. Racism is systemic. Today you are seeking to create essential changes in medicine that will only occur when all the workplaces and governmental sites across the country, are enriched to allow a full representation of all the voices of all the people.

You are leaders in the response to COVID-19 and the fight against racism. You will not only be remembered for having been present, but particularly for how you have responded. Thank you for your courage, creativity, resiliency and ability to transition and advance under duress. It was a privilege to watch you demonstrate the importance of your core values and the impact that your training here at NYU/Bellevue has had on your ability to integrate them into your practice.

You are truly individuals of immense potential, ideal for advancing our world. How you keep these values and grow them in the next developmental stage of your careers will be critical. Each of you will contribute according to your talent, resources and priorities whether in clinical practice, academics, advocacy or public health. Always in every encounter with patients and their families “Be the change that you wish to see in the world” Mahatma Ghandi.

THANK YOU AND CONGRATULATIONS!

An overview and management tips of hemoptysis in the ED.

Hosts:

OVERVIEW:

WORKUP:

MANAGEMENT:

DISPOSITION:

REFERENCES:

We go over the recent updates in the workup and management of pneumonia.

Hosts:

2007 Infectious Diseases Society of America/American Thoracic Society Criteria for Defining Severe Community-acquired Pneumonia

Validated definition includes either one major criterion or three or more minor criteria

A special thanks to our Infectious Diseases Editor:

Angelica Cifuentes Kottkamp, MD

Diagnosing and managing one of our critical diagnoses - posterior stroke.

Hosts:

Mukul Ramakrishnan, MD

See Dr. Newman-Toker demonstrate the HINTS exam here

Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009 Nov;40(11):3504-10

We discuss one of the most complex problems we face – Homelessness

Hosts:

Special Thanks To:

Dr. Kelly Doran, MD MHS

Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health, NYC Health + Hospitals/ Bellevue

___________________________

References:

Doran, K.M.  Commentary: How Can Emergency Departments Help End Homelessness?  A Challenge to Social Emergency Medicine. Ann Emerg Med. 2019;74:S41-S44.

Doran, K.M., Raven, M.C. Homelessness and Emergency Medicine: Where Do We Go From Here? Acad Emerg Med. 2018;25:598-600.

Salhi, B.A., et al. Homelessness and Emergency Medicine: A Review of the Literature. Acad Emerg Med. 2018;25:577-93.

U.S. Department of Housing and Urban Development, Annual Homeless Assessment Report to Congress. Available at: https://www.hudexchange.info/resource/5783/2018-ahar-part-1-pit-estimates-of-homelessness-in-the-us/

U.S. Interagency Council on Homelessness. Home, Together Federal Strategic Plan to Prevent and End Homelessness. https://www.usich.gov/resources/uploads/asset_library/Home-Together-Federal-Strategic-Plan-to-Prevent-and-End-Homelessness.pdf

We go into one of the more complex injuries – blunt neck trauma.

Hosts:

Overview

Mechanism

Initial Management/Primary Survey

Secondary Survey

Types of Injuries

Tintinalli 2016

Tintinalli 2018

Tintinalli 2018

Disposition

Take Home Points

References

Special thanks to Sana Maheshwari, MD 

NYU Bellevue Emergency Medicine Residency PGY3

We dissect one of the most common injuries we see in the ER -- ankle sprains

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Background

Anatomy

Mechanism of Injury

Examination

Diagnostics

Treatments

Prognosis

An overview of Vaping Associated Lung Injury (VALI)

Hosts:

Why this matters

4 main ingredients in solvent

CDC definition of VALI (Vaping Associated Lung Injury)

*Dabbing allows the user to ingest a high concentration of THC.  Butane Hash Oil (BHO), an oil or wax-like substance extracted from the marijuana plant, is placed on a “nail” attached to a specialized glass bong called a “rig.” A blow torch is used to heat the wax, which produces a vapor that can then be inhaled to supposedly produce an instantaneous effect.

Pathophysiology

Long-term Effects

Presentation

Workup

Management

Special Thanks To:

Dr. Larissa Laskowski, DO

Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health, NYC Health + Hospitals/ Bellevue

New York City Poison Control Center

References:

Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping.  https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

Carlos WG, Crotty Alexander LE, Gross JE, Dela Cruz CS, Keller JM, Pasnick SP, Jamil S.  Vaping-associated Pulmonary Illness (VAPI). Public Health Information Series. Am J Respir Crit Care Med Vol. 200, 13-15, 2019.  www.atsjournals.org/doi/pdf/10.1164/rccm.2007P13

Henry TS, Kanne JP, Kilgerman SJ.  Images of Vaping-Associated Lung Disease — Correspondence.  N Engl J Med. 2019 Oct 10; 381;15.  

Layden JE, Ghana I, Pray I, Kimball A, Layer M, Tenforde M, Navon L, Hoots B, Salvatore PP, Elderbrook M, Haupt T, Kanne J, Patel MT, Saathaff-Huber L, King BA, Schier JG, Mikosz CA, Meiman J.  Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Preliminary Report.  N Engl J Med. 2019 Sep 6. doi: 10.1056/NEJMoa1911614. [Epub ahead of print].  https://www.ncbi.nlm.nih.gov/pubmed/31491072?dopt=AbstractPlus

Siegel DA, Jatlaoui TC, Koumans EH, et al. Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019. MMWR Morb Mortal Wkly Rep 2019;68:919–927. DOI: http://dx.doi.org/10.15585/mmwr.mm6841e3external icon.

https://www.health.ny.gov/press/releases/2019/2019-09-05_vaping.htm

An overview of septic arthritis.

Hosts:

Episode Produced by Audrey Bree Tse, MD

Background

Etiology

Presentation

Diagnostics

Arthrocentesis: 

Labs:

Imaging:

Differential

Treatment

Take-Home Points

References

Carpenter CR, Schuur JD, Everett WW, et al.  Evidence-based diagnostics: Adult septic arthritis.  Acad Emerg Med.  2011;18:781-796.

Jones D, Clements C.  Physical exam and bloodwork do not adequately differentiate infectious from inflammatory arthritis.  In: Mattu A, Chanmugam A, Swadron S, Woolridge D, Winters M.  Avoiding Common Errors in the Emergency Department. 2nd Edition.  Philadelphia, PA: Wolters Kluwer; 2017; 412-414.  

Kazzi A, Zaghrini E.  Septic Arthritis.  In: Schaider J, Barkin R, Hayden S, Wolfe R, Barkin A, Shayne P, Rosen P.  Rosen and Barkin’s 5-Minute Emergency Medicine Consult.  5th Edition.  Philadelphia, PA: Wolters Kluwer; 2015; 102-103.

Osmon D, Berbari E, Berendt A, Lew D, Zimmerli W, Steckelberg J, Rao N, Hanssen A, Wilson W.  

Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 56, Issue 1, 1 January 2013, Pages e1–e25, https://doi.org/10.1093/cid/cis803

Mlynarek C, Sullivan A.  Arthrocentesis Tips.  In: Mattu A, Chanmugam A, Swadron S, Woolridge D, Winters M.  Avoiding Common Errors in the Emergency Department. 2nd Edition.  Philadelphia, PA: Wolters Kluwer; 2017; 684-686.

Purcell D, Terry B, Sharp B.  Joint Arthrocentesis.  In: Purcell D, Chinai S, Allen B, Davenport M.  Emergency Orthopedics Handbook. 1st Edition. Cham, Switzerland: Springer; 2019; 87-104.

Sheth U, Moore D.  Septic Arthritis — Adult.  OrthoBullets.  [https://www.orthobullets.com/trauma/1058/septic-arthritis–adult].  Updated 1/9/19.  Accessed 8/2/19.  

A special thanks to our Infectious Diseases Editor:

Angelica Cifuentes Kottkamp, MD

Infectious Diseases & Immunology

NYU School of Medicine

A special thanks to our Orthopedics Editor:

Daniel Purcell, MD

Emergency Medicine

NYU Langone Brooklyn

A look at the most common type of seizures in the young pediatric population.

Hosts:

Background

Diagnostics / Workup

Treatment

Prognosis

References

Chin RF, Neville BG, Scott RC. Meningitis is a common cause of convulsive status epilepticus with fever. Arch Dis Child. 2005;90(1):66-9.

Kimia A, Ben-Joseph EP, Rudloe T, Capraro A, Sarco D, Hummel D, et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics. 2010;126(1):62-9.

Murata S, Okasora K, Tanabe T, Ogino M, Yamazaki S, Oba C, et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. 2018;142(5).

Patel N, Ram D, Swiderska N, Mewasingh LD, Newton RW, Offringa M. Febrile seizures. BMJ. 2015;351:h4240.

Pavlidou E, Panteliadis C. Prognostic factors for subsequent epilepsy in children with febrile seizures. Epilepsia. 2013;54(12):2101-7.

Stapczynski, J. S., & Tintinalli, J. E. (2016). Tintinalli’s emergency medicine: A comprehensive study guide, 8th Edition. New York: McGraw-Hill Education.

Subcommittee on Febrile S, American Academy of P. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127(2):389-94.

Teng D, Dayan P, Tyler S, Hauser WA, Chan S, Leary L, et al. Risk of intracranial pathologic conditions requiring emergency intervention after a first complex febrile seizure episode among children. Pediatrics. 2006;117(2):304-8.

Warden CR, Zibulewsky J, Mace S, Gold C, Gausche-Hill M. Evaluation and management of febrile seizures in the out-of-hospital and emergency department settings. Ann Emerg Med. 2003;41(2):215-22.

A special thanks to our editors:

Michael A. Mojica, MD

Director, Pediatric Emergency Medicine Fellowship

Christie M. Gutierrez, MD 

Pediatric Emergency Medicine Fellow