Curriculum
Mentor: A. Chandra, MD; A. Limkakeng MD
Summary: Cardiac signs and symptoms are one of the most common conditions which are managed by Emergency Physicians. These conditions require prompt identification by emergency physicians and initiation of time sensitive interventions. These conditions are also the leading source of malpractice litigation. The Duke Emergency Medicine Residency Cardiology Track will introduce the resident to the identification of critical diseases, their treatment, and further risk stratification. They will become familiar with evidence based medicine as it applies to cardiac topics The mentors of this track will also attempt to provide resources to further the individual interests of the residents in this curriculum.
Objectives:
- To improve the resident's fund of knowledge of cardiology
- To gain skills in lecture preparation and presentation
- To gain experience in performance improvement and quality assurance in Cardiology
General Requirements:
PGY1:
• Successful completion of Cardiology rotation (all residents)
• ACLS provider
• Completion of assigned Cardiology readings (see attached for references)
• Simulator experience in Rhythm care and Pacing
• Observe Non-invasive Stress testing (Echo, MRI, Nuclear Stress) for at least one day
• Attend ECG conference a minimum of twice/monthly
•
PGY2:
• Instructor for medical student curriculum on cardiac topics
• EM-Card. interdisciplinary conference: Formal case presentation. Topic must be approved by faculty mentor.
• Perform 10 bedside Echos.
• Present at ECG conference one ECG/month
• Write up 1/year for Emergency Medicine
PGY3:
• EM-Card. interdisciplinary conference: Formal case presentation. Topic must be approved by faculty mentor.
- PI project directed to time-sensitive delivery of cardiac care to ED patients
- ACLS Instructor
- Write up 1/year for Emergency Medicine
PGY2-3:
• Writing projects: Either TWO minor or ONE major
(At the discretion of the mentor)
Writing projects must be initiated during the PGY 2 year and ideally completed the same year. This is in order to provide you with something to put on your résumé.
Scholarly projects opportunities:
See attached research templates
Core Content Lecture Topics:
ACS: Low risk
ACS: NSTEMI - Identification and Treatment
ACS: STEMI - Identification and Treatment
Pericardial Effusion/Tamponade
Myocarditis/Pericarditis/Endocarditis
Valvular Emergencies
CHF
Hypertension
Cocaine Toxicity
Stress Testing
Cardiogenic Shock
ECGs: Tachyarrhythmias
ECGs : Bradyarrhythmias
ECGs ST elevation
ECGs: Non-ACS diagnoses
PI project:
- Door-to Balloon times: Ensure synchronization of times reported in Door-to-balloon reports.
- Develop and implement a medical record template for standardized risk assessment for patients placed in observation for CP protocol using a validated system (TIMI, Goldman, Vancouver, ACC)
- Develop and implement a CHF standing order set.
- Monitor times to EKG, suggest improvements
- Monitor lab turnaround times, suggest improvements
- JCAHO mandates: ASA, B-Blockers
- EKG documentation- rates of documentation, adequacy.
Funding requests: ( Travel, educational projects)
Attend an EMCREG conference at ACEP/SAEM or other satellite symposium
Attend AHA conference
Attend DCRI Cardiac presentation
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Readings:
Goldman NEJM 1988;318:797-803
Selker Med Care 1991 29:1196-1211
TIMI-Pollack 2006; AEM 13:13-18.
Swap and Nagurney History in CP. JAMA 2005; 294:2623-2629.
Jaffe A Biomarkers in ED. 2005 Cardiol Clin 23: 453-465.
Ohman Troponin NEJM 1996 335:1333-1341
Storrow/ Gibler Chest Pain Centers Ann EM 2000 35(5):449-461
Tatum Virginia protocol. Ann EM 1997; 29:116-125
Chandra A. Stress Testing EM Clinic NA. 2001 19(1)
Lindsay Ann EM 1998;32(5): 600-603 Routine Stress Testing?
Meyer Ann EM 2006 47:427-435 role of outpatient stress testing
Limkakeng AT MDCT Am J Emerg Med. 2007 May; 25 (4): 450-8
ACC/AHA 2002 Guideline UA/NSTEMI. J Am Coll Cardiol 2002; 40 (7): pp. 2073-8.
Petersen LMWH JAMA 2004 292 (1): 89-96.
Schriger- 2b-3a Ann EM 2001 38(3):249-255
Rogers CHF Cardiology Clin 2006 24(1) : 115-123.
Sackner-Bernstein nesiritide metaanalysis JAMA 2005; 293(15): 1900-1905.