User`s Manual for PEER VIII (print edition) Online
Contents
1. Vilke GM Ufberg JW Harrigan RA et al Evaluation and treatment of acute urinary retention J Emerg Med 2008 35 2 193 198 Vital FM Saconato H Ladeira MT et al Non invasive positive pressure ventilation CPAP or bilevel NPPV for cardiogenic pulmonary edema Cochrane Database Syst Rev 2008 3 CD005351 Wallach EE Vlahos NF Uterine myomas an overview of development clinical features and management Obstet Gynecol 2004 104 2 393 406 Wang CS FitzGerald JM Schulzer M et al Does this dyspneic patient in the emergency department have congestive heart failure JAMA 2005 294 15 1944 1956 Wenzel RP Fowler AA 3rd Clinical practice Acute bronchitis N Engl J Med 2006 355 20 2125 2130 World Health Organization WHO global influenza preparedness plan The role of WHO and recommendations for national measures before and during pandemics Switzerland World Health Organization 2005 WHO Web site http www who int csr resources publications influenza WHO_CDS_CSR_GIP_2005_5 pdf Accessed January 2 2011 Wolff K Johnson R eds Fitzpatrick s Color Atlas amp Synopsis of Clinical Dermatology 6th ed New York NY McGraw Hill 2009 Wolfson AB Hendey GW Ling LJ et al eds Harwood Nuss Clinical Practice of Emergency Medicine 5th ed Philadelphia PA Lippincott Williams Wilkins 2010 Wood JP Shufeldt JJ Rapp MT eds Contract Issues for Emergency Physicians Irving TX Emergency Medicine Residents Association 202. Rachel Weiselberg MD Residents from the Synergy Medical Education Alliance Michigan State University Emergency Medicine Residency Program Edris Afzali MD Abdulaziz Alburaih MD Adel Alghamdi MD Page 9 of 18 Khaled Alghamdi MD William A Bishop MD Thomas Charlton MD Mathias Christianson MD Stacey Clark MD Jonathon Deibel MD Angela Gregory MD Roman Hill MD Marisa Homer MD Ervin Hunt MD Charles Keersmaekers MD Corrine Kvamme MD Neil Malhotra MD Nicole McCadie DO Heather Merrill MD Eric Minnihan MD James Mlejnek MD Adam Nofziger MD Dilnaz Panjwani MD Peri Penman DO Sameh Sejiney MD Saleem Sheikh DO Philip Sloan MD Kristy Smith MD Dalkeith Tucker DO Tiffany Weiss Feldkamp DO Diana Yandell MD Additionally developed Questions book index Residents from the University of lowa Emergency Medicine Residency Program Sara Burnham DO David Dierks DO Kathryn Szajna DO Amy Walsh MD Residents from the University of South Florida Emergency Medicine Residency Program Nadia Abrahamsen MD James Bartlett MD Phillip Ryan Coker MD Kara Lynn Dahl MD Matthew Daniel Fucarino MD Tamas Gaspar MD Nicholas Nathaniel Healy DO Melinda Henry MD Lindsay A Lyon MD Molly McIntyre MD Raymond Lee Merritt DO Deborah Marie Luiken Repaskey MD John Elliott Reynolds IV DO Nathaniel Ronning MD Kant Shah MD Kristopher Ryan Sutherly MD Sarah Temple MD Kimbe
3. American College of Emergency Physicians Mattu A Tabas JA Barish RA eds Electrocardiography in Emergency Medicine Dallas TX American College of Emergency Physicians 2007 www acep org bookstore and Nora Goldschlager MD Figures 14 50 Loren Yamamoto MD MPH MBA FAAP FACEP http www hawaii edu medicine pediatrics pemxray pemxray html Figures 15 24 44 48 57 59 60 Jeffrey A Tabas MD FACEP Figures 17 35 American College of Emergency Physicians Mattu A Tabas JA Barish RA eds Electrocardiography in Emergency Medicine Dallas TX American College of Emergency Physicians 2007 www acep org bookstore Page 13 of 18 Figures 19 32 Tracy Sanson MD FACEP Figure 22 Craig Smollin MD Figures 25 42 New Zealand Dermatological Society Incorporated http www dermnetnz org Figures 27 31 49 Linda Regan MD FACEP Figure 29 G Patrick Daubert MD Figure 30 Mike Cadogan MB ChB FACEM www lifeinthefastlane com Figure 36 Christopher Ross MD Figures 38 52 56 John Bailitz MD RDMS FACEP Figure 41 Centers for Disease Control and Prevention Public Health Image Library and Dr Thomas F Sellers Emory University http phil cdc gov phil home asp Figure 43 Robert A Rosen MD FACEP Figure 45 Rianne Page MD Figure 46 Interactive Medical Media LLC http www dermnet com Figure 47 University of lowa Department of Ophthalmology and EyeRounds org http webeye ophth uiowa edu eyeforum atlas pages C
4. Subscriber may not sell publish distribute retransmit or otherwise provide access to the Materials to a third party and iii Subscriber does not acquire any right title or interest in or to the Materials except the limited and temporary right to use them as necessary for Subscriber s use of the Subscription IP in General ACEP retains all right title and interest in and to the Subscription including without limitation all software used to provide the Subscription and all logos and trademarks reproduced through the Subscription and this Agreement does not grant Subscriber any intellectual property rights in or to the Subscription or any of its components Online Policies TOU Subscriber will comply with the TOU In the event of Subscriber s material breach of the TOU including without limitation any copyright infringement ACEP may suspend or terminate Subscriber s access to the Subscription in addition to such other remedies as ACEP may have at law or pursuant to this Agreement Neither this Agreement nor the TOU requires that ACEP take any action against Subscriber or any other customer for violating the TOU but ACEP is free to take any such action it sees fit Privacy Policy The Privacy Policy applies only to the Subscription and all other ACEP websites and does not apply to any third party site or service linked to the Subscription or recommended or referred to through the Subscription or by ACEP s employees Each Party s
5. defibrillation cardioversion and pacing 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation 2010 122 18 Suppl 3 S706 S719 Liu C Bayer A Cosgrove SE et al Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin resistant Staphylococcus aureus infections in adults and children Clin Infect Dis 2011 52 3 e18 e55 http cid oxfordjournals org content early 2011 01 04 cid ciq146 full pdf html Accessed April 21 2011 Ma OJ Mateer JR Blaivas M eds Emergency Ultrasound New York NY McGraw Hill 2008 MacFarlane C Benn C Evaluation of emergency medical services systems a classification to assist in determination of indicators Emerg Med J 2003 20 2 188 191 Mahmood AR Narang AT Diagnosis and management of the acute red eye Emerg Med Clin North Am 2008 26 1 35 55 vi Mandell LA Wunderink RG Anzueto A et al Infectious Diseases Society of America American Thoracic Society consensus guidelines on the management of community acquired pneumonia in adults Clin Infect Dis 2007 44 Suppl 2 S27 S72 Marco CA Schoenfeld CN Hansen KN et al Fever in geriatric emergency patients clinical features associated with serious illness Ann Emerg Med 1995 26 1 18 24 Marik PE Plante LA Venous thromboembolic disease and pregnancy N Engl J Med 2008 359 19 2025 2033 Maron BJ Estes NA 3rd Commotio cordis N Engl J
6. 2010 Nelson LS Lewin NA Howland MA et al eds Goldfrank s Toxicologic Emergencies 9th ed New York NY McGraw Hill 2010 Neumar RW Otto CW Link MS et al Part 8 adult advanced cardiovascular life support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation 2010 122 18 Suppl 3 S729 S767 Nishimura RA Carabello BA Faxon DP et al ACC AHA 2008 Guideline update on valvular heart disease focused update on infective endocarditis J Am Coll Cardiol 2008 52 8 676 685 O Connor RE Brady W Brooks SC et al Part 10 acute coronary syndromes 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation 2010 122 18 Suppl 3 S787 S817 Quinlan DJ McQuillan A Eikelboom JW Low molecular weight heparin compared with intravenous unfractionated heparin for treatment of pulmonary embolism a meta analysis of randomized controlled trials Ann Intern Med 2004 140 3 175 183 Roberts JR Hedges JR eds Clinical Procedures in Emergency Medicine 5th ed St Louis MO WB Saunders 2010 Roy CL Minor MA Brookhart MA et al Does this patient with a pericardial effusion have cardiac tamponade JAMA 2007 297 16 1810 1818 Santora TA Rukstalis DB Fournier gangrene eMedicine Web site http emedicine medscape com article 438994 overview Accessed February 15 2011 Schlosser RJ Clinical practice Epistaxis
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8. Med 2010 362 10 917 927 Marx JA Hockberger RS Walls RM eds Rosen s Emergency Medicine Concepts and Clinical Practice 7th ed St Louis MO Elsevier 2009 Page 16 of 18 Mathur VS Lindberg J Germain M et al A longitudinal study of uremic pruritus in hemodialysis patients Clin J Am Soc Nephrol 2010 5 8 1410 1419 Mattu A Barish RA Tabas JA eds Electrocardiography in Emergency Medicine Dallas TX American College of Emergency Physicians 2007 McMullan J Valento M Attari M et al Care of the pacemaker implantable cardioverter defibrillator patient in the ED Am J Emerg Med 2007 25 7 812 822 Medeiros Saconato H Antibiotic prophylaxis for mammalian bites Cochrane Database Syst Rev 2001 2 CD001738 Mercer BM Miodovnik M Thurnau GR et al Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes A randomized controlled trial JAMA 1997 278 12 989 995 Miner JR Burton JH Clinical practice advisory emergency department procedural sedation with propofol Ann Emerg Med 2007 50 2 182 187 Moran GJ Krishnadasan A Gorwitz RJ et al Methicillin resistant S aureus infections among patients in the emergency department N Engl J Med 2006 355 7 666 674 Nabel EG Federman DD eds ACP Medicine New York NY BC Decker 2010 National Highway Traffic Safety Administration NHTSA Emergency Medical Services NHTSA EMS Web site http www ems gov Accessed January 25
9. N Engl J Med 2009 360 8 784 789 Schwartz DT Emergency Radiology Case Studies New York NY McGraw Hill 2008 Sgarbossa EB Pinski SL Barbagelata A et al Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle branch block GUSTO 1 Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries Investigators N Engl J Med 1996 334 8 481 487 Shah R Sabanathan S Mearns AJ et al Traumatic rupture of diaphragm Ann Thorac Surg 1995 60 5 1444 1449 Silvers SM Howell JM Kosowsky JM et al American College of Emergency Physicians Clinical Policies Subcommittee Writing Committee on Acute Heart Failure Syndromes Clinical policy critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes Ann Emerg Med 2007 49 5 627 669 Simon RP Greenberg DA Aminoff MJ et al Clinical Neurology 7th ed New York NY McGraw Hill 2008 Singh A Alter HJ Littlepage A A systematic review of medical therapy to facilitate passage of ureteral calculi Ann Emerg Med 2007 50 5 552 563 Slovis CM Reddi AS Increased blood pressure without evidence of acute end organ damage Ann Emerg Med 2008 51 3 Suppl S7 S9 Spiro DM Tay KY Arnold DH et al Wait and see prescription for the treatment of acute otitis media a randomized controlled trail JAMA 2006 296 10 1235 1241 Statement on sarc
10. Pursuant to 47 U S C Section 230 d ACEP hereby notifies Subscriber that parental control protections such as computer hardware software or filtering services are commercially available that may assist in limiting access to material that is harmful to minors Information regarding providers of such protections may be found on the Internet by searching parental control protection or similar terms e Government Restricted Rights The Services are provided with RESTRICTED RIGHTS Use duplication or disclosure by the U S Government is subject to restrictions as set forth in FAR52 227 14 and DFAR252 227 7013 et seq or its successor Use of the Services by the U S Government constitutes acknowledgment of ACEP s proprietary rights therein e Export Certain Services are subject to export controls of the United States and other countries Export Controls Export or diversion contrary to U S law is prohibited U S law prohibits export or re export of the software or technology to specified countries or to a resident or national of those countries Prohibited Country or Prohibited Countries It also prohibits export or re export of the software or technology to any person or entity on the U S Department of Commerce Denied Persons List Entities List or Unverified List the U S Department of State Debarred List or any of the lists administered by the U S Department of Treasury including lists of Specially Designated Nation
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12. are Methicillin resistant Staphylococcus aureus NSAID sere aceite eee Se ehe S Nonsteroidal anti inflammatory drug PAG Hes angen o Pash tard Posteroanterior PEER IE cata da bie etched betas e dr Peak expiratory flow rate PE da phases Picogram PPD coi abe ie als Purified protein derivative Plas gras Gas seepiate na Dasara Prothrombin time PEs iste is aa Partial thromboplastin time Rocio iaa Ae Ss Red blood cell SAGs hie eed thse tone dian Sinoatrial node TPA oh Sana A Tissue plasminogen activator WBC eee uertat eG eae Rs White blood cell PEER VIII Image Credits The images used for visual stimuli in PEER VIII were provided by members of the editorial board ACEP faculty members and other educators and educational resources as listed below Reproduction of these images without permission of their owners is strictly prohibited To request permission to use an image from PEER VIII send an e mail to ACEPBookstore acep org Figures 1 26 37 54 64 65 Mary Jo Wagner MD FACEP Figures 2 4 5 7 8 18 20 33 34 39 51 55 61 63 Joshua Broder MD FACEP www EMPACS org Figure 3 Tiffany Weiss Feldkamp DO Figure 6 American College of Emergency Physicians Mattu A Tabas JA Barish RA eds Electrocardiography in Emergency Medicine Dallas TX American College of Emergency Physicians 2007 www acep org bookstore and Jeffrey Tabas MD FACEP Figures 9 11 12 13 16 21 23 28 Michele Dorfsman MD FACEP Figure 10
13. closed book Read the stem and answer set choose one best answer click its letter then click OK o You don t have to answer all 90 questions in one sitting Every question screen has a button that says Quit and Return to Main Menu If you want to stop click it o When you want to start again log in You ll go to the Main Menu Scroll down to the grid and click the green Resume icon for Pretest to pick up where you left off Or click Phase 1 in the black navigation bar at the top of the screen o After you answer all 90 Pretest questions your score report will appear Your overall score will be at the top followed by your results by category followed by your results by acuity and age modifier You can save your results as a PDF You can also look at them anytime from the Main Menu e Click Main Menu or Phase 2 Menu to proceed If you re an ACEP member taking the free PEER VIII Pretest you can purchase PEER VIII or go to Main Menu or exit by closing your browser How to Do Phase 2 e Read the instructions on the screen e Put your mouse over the words Phase 2 Study and Practice in the black navigation bar to get the drop down menu e Pick a category and click it to begin o How should you pick a category You can go through them in the order they appear Or you can start with the category you did best in on the Pretest or the worst The purpose is to study and practice in each category
14. community acquired pneumonia N Engl J Med 1997 336 4 243 250 Fleisher GR Ludwig S eds Textbook of Pediatric Emergency Medicine 6th ed Philadelphia PA Lippincott Williams amp Wilkins 2010 Geetha D Glomerulonephritis poststreptococcal eMedicine Web site http emedicine medscape com article 240337 overview Accessed February 17 2011 Gerber MA Baltimore RS Eaton CB et al Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis a scientific statement from the American Heart Association Rheumatic Fever Endocarditis and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young the Interdisciplinary Council on Functional Genomics and Translational Biology and the Interdisciplinary Council on Quality of Care and Outcomes Research endorsed by the American Academy of Pediatrics Circulation 2009 119 11 1541 1551 Gillette v Tucker 65 NE 865 1972 Godwin SA Caro DA Wolf SJ et al American College of Emergency Physicians Clinical policy procedural sedation and analgesia in the emergency department Ann Emerg Med 2005 45 2 177 196 Goldman L Ausiello DA Cecil Medicine 23rd ed Philadelphia PA Saunders 2008 Grimes DA Jones LB Lopez LM et al Oral contraceptives for functional ovarian cysts Cochrane Database Syst Rev 2009 2 CD006134 Grissom CK Roach RC Sarnquist FH et al Acetazolamide in the treatment of acute mountain sickness clinical efficacy an
15. override anything you click or save If you don t like a practice test score your only recourse is to retake it After you answer all 450 Post Test questions your score report will appear It will show you how you did overall in each category and in the acuity frames and age modifiers It will also show you how you did compared to your Pretest results Remember you must score 75 or higher to get the CME credit certificate o Ifyou want to save this test as your final result click Save as Final Post Test and Go to Phase 4 Evaluation Remember final means final if you save this result we can t un save it or reset it for you o If you do not want to save this test as your final result click Save as Practice Post Test and Return to Main Menu Remember you can take a practice post test as many times as you want from the Main Menu by clicking the Retake icon but you can take your Final Post Test only once After you save your Final Post Test you ll go to the evaluation How to Do Phase 4 Answer all 10 questions Read the instructions at the end of the evaluation and click Submit Read the recap of your Final Post Test and the information that will appear on your CME certificate To get your CME certificate click Generate CME Certificate then follow the instructions in the ACEP CME Tracker Terms of Subscription Read these Terms of Subscription carefully By attesting that you have read the User s Manual and
16. scroll down to see it From there you can review retake and resume your Phase 2 practice tests as many times as you want even after you finish PEER VIII and or PEER VIII Online and generate your CME certificate e After you ve been through all 20 categories and you re ready to try the Post Test click Phase 3 Post Test from the black navigation bar on the Main Menu How to Do Phase 3 e Read the instructions on the screen e Click the attestation statement o If you purchased both the PEER VIII print edition and PEER VIII Online choose which activity s Post Test you want to work on e Answer the questions closed book Page 2 of 18 o You ll see whether you re right when you click OK but don t hit the Back button on your browser it will lower your score and we can t fix it Just click Next to move to the next question o You don t have to answer all 450 questions in one sitting Every question screen has a button that says Quit and Return to Main Menu If you want to stop click it o When you want to start again log in You ll go to the Main Menu Scroll down to the grid then click the Resume icon next to the Practice Post Test you were working on to pick up where you left off If you want to start over from question 1 click the Retake icon o Be sure to read and understand the Retake and Resume commands before you click them we can t reset any of your test results or
17. test If you score 75 correct or better you can generate your CME certificate If you do not then you can continue practicing and studying and take the post test again to achieve the passing grade You will do the pretest practice tests and post tests via computer with the format being a close match to the real ABEM computer based qualifying and certification examinations PEER VIII comprises 450 questions which is 40 more than we developed for PEER VII As with the last edition of PEER all questions and images are completely new to allow those of you who used PEER VII to find this edition a new experience This is a major undertaking for the Editorial Board but hope you agree with us that it is well worth the effort As emergency medicine becomes more facile and dependent on advanced imaging modalities the national boards and associations are expecting more competence in reading basic pathology on both CT cans and ultrasound images These have been included here with explanations in the answers to help identify key image components Finally we have redesigned all the answers so that the discussion of the key component of the topic appears within the first few sentences of the answer explanation We hope this will help you use the answer book during a quick review before an examination and focus your learning This will also help us as we move forward in the future with mobile formats for PEER We hope this edition of PEER continues to provide
18. 07 Wu MH Chang YC Wu CH et al Acute gastric volvulus a rare but real surgical emergency Am J Emerg Med 2010 28 1 118 e5 e7 Page 18 of 18
19. LDH 100 200 units L Lipas s m0 Gan Oo yaa cance amet 0 160 units L Magnesium 0 ec eee e eee 1 8 3 mg dL Partial thromboplastin time PTT 25 35 seconds PCO 2a ath iaee hat ie bat oe E a aaa 35 45 mm Hg O 7 35 7 45 Phosphorus 00ccceeeee eee 2 5 5 mg dL Platelets inoan ees a heed 150 450 103 mcL PO 28 3 ei ias 80 100 mm Hg Pots sorn oo foe te Sea ee 3 5 5 mEq L Prothrombin time PT 10 13 seconds A A 135 145 mEq L Troponin ccc cece eee eee lt 0 6 ng mL White blood cells WBCs 3 500 9 800 mcL Abbreviations ABG Wii oo wee ees eee Arterial blood gas AGEs aparma anaana e AY aie BR Angiotensin converting enzyme AIDS bois pisada Acquired immunodeficiency syndrome ALS oe ie ea wie wees Advanced life support Ai Saas aes eee Sake Alanine aminotransferase DRS crite ots sh nee Mire ters ty yonte aie Anteroposterior ARDS coa int Adult respiratory distress syndrome ASA cre Aspartate aminotransferase AMA ad a Beetle AG os Atrioventricular A dt tie has oe Aad Basic life support BNP ios pated Saad day a B type natriuretic peptide BUN ici sd ban ees Blood urea nitrogen Cointra ta 3 Centigrade A even syste dee Sethpavess dears eed Complete blood cell O A fea oe Se oes ec ee Creatine kinase CKEMB ee ate scr tack eae cits he Aes eels Creatine kinase myocardial band Mie Satay aera veh eee Centimeter CNS wa aaa 34 ogee eS Central nervous system COPD aaa Chro
20. User s Manual for PEER VIII print edition Online Testing Site and PEER VIII Online July 11 2012 Questions Read the User s Manual Read Frequently Asked Questions here and here Call the ACEP Member Care Center Monday through Friday 8 to 5 Central 800 798 1822 E mail us at ACEPBookstore acep org Here s the ACEP Privacy Policy Computer system requirements a computer or mobile device with an Internet connection and a standard browser Internet Explorer Safari Firefox Chrome also Adobe Reader and connection to a printer if you want to view and print your reports or CME certificates CME Credit Information for PEER VIII Online e Date of review by CME provider April 11 2012 e Release date July 11 2012 e Expiration date October 14 2014 e Learner Objective On completion of PEER VIII Online you should be able to demonstrate cognitive expertise on topics from The Model of the Clinical Practice of Emergency Medicine and preparation sufficient to pass an emergency medicine written certification examination e Accreditation Statement The American College of Emergency Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians e Designation Statement The American College of Emergency Physicians designates this enduring material for a maximum of 55 AMA PRA Category 1 Credit s Physicians should claim only the credit commensura
21. a comprehensive format for reviewing the essentials of emergency medicine As our residents have praised in the past the Editorial Board and all our contributors have worked hard to make this the closest thing to taking the Boards Mary Jo Wagner MD FACEP Editor in Chief September 2011 Page 11 of 18 Reference Ranges for Selected Laboratory Test Results Alanine aminotransferase ALT 10 40 units L ALBUM react cacti eee ee ed PES 3 5 5 g dL Alkaline phosphatase 30 120 units L Aspartate aminotransferase AST 10 35 units L B type natriuretic peptide BNP lt 100 pg mL Bicarbonate 0 cece eee 22 28 mEq L Bilirubin direct conjugated 0 1 0 3 mg dL Bilirubin total 0 3 1 2 mg dL Blood urea nitrogen BUN 8 20 mg dL Calcium e S ci 8 8 10 2 mg dL Carbon dioxide o o ooo oo 22 28 mEq L Chloride oh daras rar do 95 105 mEq L Creatine kinase CK 40 150 units L Creatine kinase MB fraction CK MB 0 6 of total CK Creatinine 0 eee eee 0 6 1 2 mg dL d dimer ooo lt 500 mcg mL Erythrocyte sedimentation rate ESR 0 20 mm hr G UCOSO 0 cc ees 70 110 mg dL Hematocrit Hct 33 43 female 39 49 male Hemoglobin Hgb 12 15 g dL female 13 5 16 5 g dL male E sce eat alee bet wal tarot 5 15 mg dL Lactate dehydrogenase
22. acknowledge the following individuals and organizations who contributed to PEER VIII by donating images participating in item testing and providing and reviewing information Joshua Broder MD FACEP Mike Cadogen MB ChB FACEM Esther H Chen MD Antonio Cummings MD G Patrick Daubert MD David Duong MD Mark A Hostetler MD MPH FACEP Christian Jacobus MD Timothy H Kaufman MD Tina Latimer MD MPH Edwin Lopez MD Amal Mattu MD FACEP Kelly P O Keefe MD FACEP Rianne Page MD Robert A Rosen MD FACEP Christopher Ross MD Robert C Satonik MD FACEP Craig Smollin MD Loren Yamamoto MD MPH MBA FAAP FACEP Instructor of Emergency Medicine at the University of Pittsburgh School of Medicine Adam Z Tobias MD MPH Resident from the Denver Health Medical Center Emergency Medicine Residency Program Todd Guth MD Resident from the Johns Hopkins Medical Institutions Residency Program Sneha Shah MD Resident from the Loma Linda University Medical Center Residency Program Vi Am Dinh MD Resident from the Naval Medical Center San Diego Emergency Medicine Residency Program Steve Tantama MD Resident from the Regions Hospital Emergency Medicine Residency Program Autumn Erwin MD Resident from the University of Maryland Emergency Medicine Residency Program Joshua Moskovitz MD MPH Residents from the Cook County Emergency Medicine Residency Program Tamara Espinoza MD Roderick Roxas MD Michael Nelson MD
23. agree to all terms in it or by using the Subscription you Subscriber agree to these Terms of Subscription You are a Subscriber if you are authorized to use PEER VIII Online or the online testing site for the PEER VIII print edition These Terms of Subscription constitute an agreement Agreement by and between the American College of Emergency Physicians ACEP and each Subscriber of the online testing site for the PEER VIII print edition and of PEER VIII Online Definitions Account refers to the Subscription plans and features selected by Subscriber through the ACEP Bookstore or Member Care Center at the time of purchase and accepted by ACEP as such plans and features may change as set forth herein as recorded by ACEP Effective Date refers to the purchase date of the Subscription as listed in Subscriber s Account Materials refers to written and graphical content provided by or through the Subscription including without limitation text photographs illustrations and designs whether provided by ACEP or any other third party Subscriber Data refers to data in electronic form input or collected through the Subscription by or from Subscriber Privacy Policy refers to ACEP s privacy policy posted at www acep org as such policy may change from time to time Subscription refers to the online testing site for the PEER VIII print edition or to PEER VIII Online or both as purchased by Subscr
24. als Specially Designated Terrorists or Specially Designated Narcotics Traffickers collectively the Lists U S law also prohibits use of the software or technology with chemical biological or nuclear weapons or with missiles Prohibited Uses Subscriber represents and warrants that it is not located in or a resident or national of any Prohibited Country that it is not on any Lists that it will not use the software or technology for any Prohibited Uses and that it will comply with Export Controls e Conflicts among Attachments In the event of any conflict between the terms of this main body of this Agreement and those of the TOU or Privacy Policy the terms of this main body will govern In the event of any conflict between this Agreement and any ACEP policy posted online including without limitation the TOU and Privacy Policy the terms of this Agreement will govern e Entire Agreement This Agreement and other terms set forth in the User s Manual set forth the entire agreement of the parties and supersedes all prior or contemporaneous writings negotiations and discussions with respect to the subject matter hereof Neither party has relied upon any such prior or contemporaneous communications PEER VIII Physician s Evaluation and Educational Review in Emergency Medicine Volume 8 Mary Jo Wagner MD FACEP Editor in Chief Program Director Synergy Medical Education Alliance Emergency Medicine Residency Program Saginaw Mic
25. any means or stored in a database or retrieval system without prior written permission of the publisher Additional copies can be ordered from the ACEP Bookstore 800 798 1822 ext 4 or 972 550 0911 or online http bookstore acep org or by fax 972 580 2816 or by mail PO Box 619911 Dallas TX 75261 9911 Your comments and suggestions are always welcome Direct your e mails to PEERVIIIEditor acep org Method of Participation How to Use PEER VIII Online Page 6 of 18 The PEER VIII Online instructional design is based on four phases self assessment study and practice post test and evaluation To complete PEER Vill Online as designed and earn AMA PRA Category 1 Credit you will have to complete all four Self Assessment A key component of the PEER VIII Online design is self assessment so your learning experience will begin with a Pretest The purpose of the Pretest is to determine your baseline score answering questions drawn from all categories of The Model of the Clinical Practice of Emergency Medicine or EM Model as well as a few additional topics from the Table of Specificity We strongly recommend that you answer the Pretest questions closed book to get an accurate preactivity score After you answer the 90 Pretest questions you will get a score report It will show you how you did overall but it will also show you how you did in each category in each age modifier and in each acuity frame Your results wil
26. any prior or subsequent breach of this Agreement Force Majeure To the extent caused by force majeure no delay failure or default will constitute a breach of this Agreement Assignment amp Successors Neither party may assign this Agreement or any of its rights or obligations hereunder without the other s express written consent except that either party may assign this Agreement to the surviving party in a merger of that party into another entity Except to the extent forbidden in the previous sentence this Agreement will be binding upon and inure to the benefit of the respective successors and assigns of the parties Choice of Law amp Jurisdiction This Agreement will be governed solely by the internal laws of the State of Texas without reference to such State s principles of conflicts of law The parties consent to the personal and exclusive jurisdiction of the federal and state courts of Dallas County Texas Severability To the extent permitted by applicable law the parties hereby waive any provision of law that would render any clause of this Agreement invalid or otherwise unenforceable in any respect In the event that a provision of this Agreement is held to be invalid or otherwise unenforceable such provision will be interpreted to fulfill its Page 5 of 18 intended purpose to the maximum extent permitted by applicable law and the remaining provisions of this Agreement will continue in full force and effect e Certain Notices
27. at least once to improve your cognitive expertise e Read the stem and answer set choose one best answer click its letter then click OK Look below the answer set and below the image if there is one to see whether you re right o Don t hit the Back button on your browser it will lower your score Remember this is study and practice a low score in this phase won t keep you from getting CME credit e Study the answer explanations This is a key component of the educational activity each explanation is an essay on the topic It explains the correct answer but it also explains why the foils are not correct This will better prepare you to answer other questions on the same topic whether later in PEER VIII or on an actual exam o If you purchased the PEER VIII print edition the explanations are in your Answers book the number in parentheses in the blue bar on the screen corresponds to the answer number in the text To see which questions are in each category go to the Question Numbers by Category key in the Testing Information tab o If you purchased PEER VIII Online the explanations appear on the screen If there s an image you ll have to scroll past it to read the explanation e Click Next to move to the next question e Click Quit and Return to Main Menu to stop answering questions o Remember to check the Main Menu to see which tests you ve started you ll probably have to
28. atients presenting to the emergency department with syncope Ann Emerg Med 2007 49 4 431 444 Hustey FM Meldon SW The prevalence and documentation of impaired mental status in elderly emergency department patients Ann Emerg Med 2002 39 3 248 253 James AH Jamison MG Biswas MS et al Acute myocardial infarction in pregnancy a United States population based study Circulation 2006 113 12 1564 1571 Jones DW Hall JE Seventh report of the Joint National Committee on Prevention Detection Evaluation and Treatment of High Blood Pressure and evidence from new hypertension trials Hypertension 2004 43 1 1 3 Jurkovich GJ Environmental cold induced injury Surg Clin North Am 2007 87 1 247 267 viii Katz VL Dotters DJ Droegemueller W Perimortem cesarean delivery Obstet Gynecol 1986 68 4 571 576 Kenyon SL Taylor DJ Tarnow Mordi W et al Broad spectrum antibiotics for preterm prelabour rupture of fetal membranes the ORACLE randomised trial ORACLE Collaborative Group Lancet 2001 357 9261 979 988 Kitabchi AE Umpierrez GE Murphy MB et al Hyperglycemic crisis in adult patients with diabetes a consensus statement from the American Diabetes Association Diabetes Care 2006 29 12 2739 2748 Kittner SJ Stern BJ Feeser BR et al Pregnancy and the risk of stroke N Engl J Med 1996 335 11 767 769 Kleinman ME Chameides L Schexnayder SM et al Part 14 pediatric advanced life support 2010 American Heart Association Guid
29. atment Ann Emerg Med 2008 52 2 S27 S39 Darouiche RO Spinal epidural abscess N Engl J Med 2006 355 19 2012 2020 Delacr taz E Clinical practice Supraventricular tachycardia N Engl J Med 2006 354 10 1039 1051 Duhaime AC Evaluation and management of shunt infections in children with hydrocephalus Clin Pediatr Phila 2006 45 8 705 713 Duong DK Leo MM Mitchell EL Neuro ophthalmology Emerg Med Clin North Am 2008 26 1 137 180 vii Edlow JA Malek AM Ogilvy CS Aneurysmal subarachnoid hemorrhage update for emergency physicians J Emerg Med 2008 34 3 237 251 Edlow JA Panagos PD Godwin SA et al American College of Emergency Physicians Clinical policy critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache Ann Emerg Med 2008 52 4 407 436 Eren S Kantarci M Okur A Imaging of diaphragmatic rupture after trauma Clin Radiol 2006 61 6 467 477 Evans HJ Wollin TA The management of urinary calculi in pregnancy Curr Opin Urol 2001 11 4 379 384 Fesmire FM Decker WW Diercks DB et al ACEP Clinical Policies Subcommittee Writing Committee on non ST segment elevation acute coronary syndromes Clinical policy critical issues in the evaluation and management of adult patients with non ST segment elevation acute coronary syndromes Ann Emerg Med 2006 48 3 270 301 Fine MJ Auble TE Yealy DM et al A prediction rule to identify low risk patients with
30. atric Emergency Medicine Fellowship Medical Director Pediatric Advanced Life Support Atlantic Attending Physician Pediatric Emergency Medicine Morristown New Jersey John Bailitz MD RDMS FACEP Emergency Ultrasound Director Cook County Hospital Stroger Assistant Professor of Emergency Medicine Page 7 of 18 Rush University Medical School Chicago Illinois Lance Brown MD MPH FACEP Chief Division of Pediatric Emergency Medicine Associate Professor of Emergency Medicine and Pediatrics Loma Linda University Medical Center and Children s Hospital Loma Linda California Lynda Daniel Underwood MD MS FACEP Assistant Dean for Clinical Site Recruitment Loma Linda University School of Medicine Loma Linda California Michele Dorfsman MD FACEP Associate Professor of Emergency Medicine University of Pittsburgh Medical Center Presbyterian Hospital Assistant Program Director University of Pittsburgh Residency in Emergency Medicine Pittsburgh Pennsylvania Jonathan Fisher MD MPH FACEP Assistant Professor Harvard Medical School Director of Undergraduate Education Harvard Affiliated Emergency Medicine Residency Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston Massachusetts Hans R House MD MACM DTMH FACEP Associate Chair for Education Assistant Professor of Emergency Medicine University of lowa Carver College of Medicine lowa City lowa Linda Regan MD FACEP Program Di
31. d effect on gas exchange Ann Intern Med 1992 116 6 461 465 Hackett PH Roach RC Medical therapy of altitude illness Ann Emerg Med 1987 16 9 980 986 Hall JB Schmidt GA Wood LDH eds Principles of Critical Care New York NY McGraw Hill 2005 Han JH Zimmerman EE Cutler N et al Delirium in older emergency department patients recognition risk factors and psychomotor subtypes Acad Emerg Med 2009 16 3 193 200 Harrington L Schneider JI Atraumatic joint and limb pain in the elderly Emerg Med Clin North Am 2006 24 2 389 412 vii Page 15 of 18 Hirtz D Ashwal S Berg A et al Practice parameter evaluating a first nonfebrile seizure in children report of the Quality Standards Subcommittee of the American Academy of Neurology The Child Neurology Society and The American Epilepsy Society Neurology 2000 55 5 616 623 Honigman B Theis MK Koziol McLain J et al Acute mountain sickness in a general tourist population at moderate altitudes Ann Intern Med 1993 118 8 587 592 Howell JM Eddy OL Lukens TW et al American College of Emergency Physicians Clinical policy critical issues in the evaluation and management of emergency department patients with suspected appendicitis Ann Emerg Med 2010 55 1 71 116 Huff JS Decker WW Quinn JV et al American College of Emergency Physicians Clinical Policies Subcommittee Writing Committee on Syncope Clinical policy critical issues in the evaluation and management of adult p
32. dicine 5th ed Philadelphia PA Mosby Inc 2007 Barretti P Montelli AC Batalha JE et al The role of virulence factors in the outcome of staphylococcal peritonitis in CAPD patients BMC Infect Dis 2009 9 212 Bates SM Ginsberg JS Clinical practice Treatment of deep vein thrombosis N Engl J Med 2004 351 3 268 277 Bitterman RA Providing Emergency Care Under Federal Law EMTALA Dallas TX American College of Emergency Physicians 2001 2004 Bonow RO Carabello BA Chatterjee K et al 2008 Focused update incorporated into the ACC AHA 2006 guidelines for the management of patients with valvular heart disease Circulation 2008 118 15 e523 e661 Bosch X Poch E Grau JM Rhabdomyolysis and acute kidney injury N Engl J Med 2009 361 1 62 72 Botma M Bader R Kubba H A parent s kiss evaluating an unusual method for removing nasal foreign bodies in children J Laryngol Otol 2000 114 598 600 Page 14 of 18 Brenner BM Brenner and Rector s The Kidney 8th ed Philadelphia PA Saunders 2008 Cainzos M Gonzalez Rodriguez FJ Necrotizing soft tissue infections Curr Opin Crit Care 2007 13 4 433 439 Cangemi JR Picco MF Intestinal ischemia in the elderly Gastroenterol Clin North Am 2009 38 3 527 540 Centers for Disease Control and Prevention Anthrax CDC Web site http www bt cdc gov agent anthrax Accessed November 15 2010 Centers for Disease Control and Prevention Guideline for prevention of catheter assoc
33. e Your score will be printed on your CME certificate along with the number of hours you claim Evaluation When you save your Final Post Test the scoring program will direct you to an evaluation It comprises 10 demographic and evaluation questions and you have to answer all of them to generate a CME certificate Your responses are very important to us They help us make future editions better learning tools You will also have to tell us how many hours you spent in the activity that is the number of AMA PRA Category 1 Credits you can claim up to a maximum of 55 PEER VIII Editorial Board The American College of Emergency Physicians gratefully acknowledges the contributions of the PEER VIII Editorial Board in the development and writing of the PEER VIII questions and answer explanations Mary Jo Wagner MD FACEP Editor in Chief Program Director Synergy Medical Education Alliance Emergency Medicine Residency Program Saginaw Michigan Professor Division of Emergency Medicine Michigan State University College of Human Medicine East Lansing Michigan Fredrick M Abrahamian DO FACEP Associate Professor of Medicine David Geffen School of Medicine at UCLA Los Angeles California Director of Education Department of Emergency Medicine Olive View UCLA Medical Center Sylmar California Christopher S Amato MD FAAP FACEP Assistant Professor Department of Emergency Medicine Mount Sinai School of Medicine Director Pedi
34. elines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation 2010 122 18 suppl 3 S876 S908 Kline JA Courtney DM Kabrhel C et al Prospective multicenter evaluation of the pulmonary embolism rule out criteria J Thromb Haemost 2008 6 5 772 780 Knoop KJ Stack LB Storrow AB et al Atlas of Emergency Medicine 3rd ed New York NY McGraw Hill 2010 Koenig KL Schultz CH eds Koenig and Schultz s Disaster Medicine Comprehensive Principles and Practices New York NY Cambridge University Press 2010 Kohn LT Corrigan JM Donaldson MS eds To Err Is Human Building a Safer Health System Washington DC The National Academies Press 2000 http books nap edu openbook php record id 9728 Accessed February 9 2011 Konstantinides S Clinical practice Acute pulmonary embolism N Engl J Med 2008 359 26 2804 2813 Laughlin TJ Armstrong DG Caporusso J et al Soft tissue and bone infections from puncture wounds in children West J Med 1997 166 2 126 128 Levine BD Yoshimura K Kobayashi T et al Dexamethasone in the treatment of acute mountain sickness N Engl J Med 1989 321 25 1707 1713 Levine MS Scheiner JD Rubesin SE et al Diagnosis of pneumoperitoneum on supine abdominal radiographs AJR Am J Roentgenol 1991 156 4 731 735 Lin MG Umbilical cord prolapse Obstet Gynecol Surv 2006 61 4 269 277 Link MS Atkins DL Passman RS et al Part 6 electrical therapies automated external defibrillators
35. entral Retinal Vein Occlusion CRVO 2 html Figure 58 Centers for Disease Control and Prevention Public Health Image Library and Dr James Gathany http phil cdc gov phil home asp Figure 62 Hans House MD FACEP Bibliography Abraham M Ahlman JT Boudreau AJ et al 2011 Current Procedural Terminology CPT Chicago IL American Medical Association 2010 ACEP Task Force Report on Boarding Emergency department crowding high impact solutions ACEP Web site http www acep org crowding Accessed January 18 2010 Aci n P Quereda F Abdominal myomectomy results of a simple operative technique Fertil Steril 1996 65 1 41 51 Adams JG Barton ED Collings J et al eds Emergency Medicine Philadelphia PA Saunders 2008 Aguilar C Vichinsky E Neumayr L Bone and joint disease in sickle cell disease Hematol Oncol Clin North Am 2005 19 5 929 941 Albers GW Amarenco P Easton JD et al Antithrombotic and thrombolytic therapy for ischemic stroke the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest 2004 126 3 Suppl 483S 512S American College of Emergency Physicians 1995 Documentation guidelines for evaluation and management services ACEP Web site http www acep org content aspx id 32168 amp list 1 amp fid 912 Accessed February 24 2011 American College of Emergency Physicians Clinical policy critical issues in the evaluation and management of adult patients presenting to the emergency department with
36. higan Professor Division of Emergency Medicine Michigan State University College of Human Medicine East Lansing Michigan Publisher s Notice The American College of Emergency Physicians ACEP makes every effort to ensure that contributors to its publications are knowledgeable subject matter experts Readers are nevertheless advised that the statements and opinions expressed in this publication are provided as the contributors recommendations at the time of publication and should not be construed as official College policy ACEP recognizes the complexity of emergency medicine and makes no representation that this publication serves as an authoritative resource for the prevention diagnosis treatment or intervention for any medical condition nor should it be the basis for the definition of or standard of care that should be practiced by all health care providers at any particular time or place To the fullest extent permitted by law and without limitation ACEP expressly disclaims all liability for errors or omissions contained within this publication and for damages of any kind or nature arising out of use reference to reliance on or performance of such information Copyright 2012 American College of Emergency Physicians Dallas Texas All rights reserved Printed in the United States of America Except as permitted under the United States Copyright Act of 1976 no part of this publication may be reproduced or distributed in any form or by
37. iated urinary tract infections 2009 CDC Web site www cdc gov hicpac pdf CAUTI CAUTIguideline2009final pdf Accessed January 2 2011 Centers for Disease Control and Prevention Preventing tetanus diphtheria and pertussis among adolescents use of tetanus toxoid reduced diphtheria toxoid and acellular pertussis vaccines MMWR Morb Mortal Wkly Rep 2006 55 3 1 34 http www cdc gov mmwr preview mmwrhtml rr5503a1 htm Accessed January 19 2011 Centers for Disease Control and Prevention Sexually transmitted diseases treatment guidelines 2010 MMWR Morb Mortal Wkly Rep 2010 59 12 1 110 http www cdc gov std treatment 2010 STD Treatment 2010 RR5912 pdf Accessed January 19 2011 With erratum for pages 50 51 57 Centers for Disease Control and Prevention Updated U S Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis MMWR Morb Mortal Wkly Rep 2005 54 RR 9 1 17 http www cdc gov mmwr PDF rr rr5409 pdf Accessed January 4 2011 Centor RM Witherspoon JM Dalton HP et al The diagnosis of strep throat in adults in the emergency room Med Decis Making 1981 1 3 239 246 Chau B Dufel S Gastric volvulus Emerg Med J 2007 24 6 446 447 Chiu YH Chen JD Tiu CM et al Reappraisal of radiographic signs of pneumoperitoneum at emergency department Am J Emerg Med 2009 27 3 320 327 Cucchiara B Ross M Transient ischemic attack risk stratification and tre
38. iber or listed in Subscriber s Account The Subscription includes such features as ACEP may change from time to time in its sole discretion TOU refers to ACEP s Terms of Use Policy posted at www acep org as such policy may change from time to time Subscription amp Payment Subscription ACEP will provide the Subscription to Subscriber pursuant to its standard policies and procedures then in effect Only one individual may access the Subscription at the same time using the same username or password You may not share your username or password with any other party for the purposes of accessing the Subscription Payment Subscriber will pay ACEP such Subscription fees as are required in advance of activation of the Subscription Page 3 of 18 Service Level Agreement During the Term of this Agreement ACEP will make its best effort to ensure that the Subscription is operational and available to Subscriber at least 99 9 of the time Telephone support 8 00 A M to 5 00 P M Monday Friday 800 798 1822 E mail support Monitored 8 00 A M to 5 00 P M Monday Friday ACEPBookstore acep org E mails received outside of office hours will be collected however no action can be guaranteed until the next working day Materials Software amp IP Materials Subscriber recognizes and agrees that i the Materials are the property of ACEP or its licensors and are protected by copyright trademark and other intellectual property laws ii
39. kka R High risk chief complaints III abdomen and extremities Emerg Med Clin North Am 2009 27 4 747 765 x Thomsen TW Shaffer RW White B et al Videos in clinical medicine Paracentesis N Engl J Med 2006 355 19 e21 Tintinalli JE Stapczynski JS Ma OJ et al eds Tintinalli s Emergency Medicine A Comprehensive Study Guide 7 ed New York NY McGraw Hill 2010 Townsend CM Beauchamp RD Evers BM et al Sabiston Textbook of Surgery 18th ed Philadelphia PA Saunders Elsevier 2008 van Beeck EF Branche CM Szpilman D et al A new definition of drowning towards documentation and prevention of a global public health problem Bull World Health Organ 2005 83 11 853 856 van Belle A Buller HR Huisman MV et al Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability D dimer testing and computed tomography JAMA 2006 295 2 172 179 Vanden Hoek TL Morrison LJ Shuster M et al Part 12 cardiac arrest in special situations 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care Circulation 2010 122 suppl 3 S829 S861 Venkat A Piontkowsky DM Cooney RR et al Care of the HIV positive patient in the emergency department in the era of highly active antiretroviral therapy Ann Emerg Med 2008 52 3 274 285 Venkat KK Venkat A Care of the renal transplant recipient in the emergency department Ann Emerg Med 2004 44 4 330 341
40. l give you a good idea of how you need to approach the next phase of the activity Completing the Pretest is required you will not be able to start the practice tests or the Post Test until you have answered all 90 Pretest questions Study and Practice The next phase of the PEER VIII Online activity is to practice answering questions and study the questions and answer explanations together In Phase 2 you will practice answering questions and study the explanations by category perhaps to focus on an area that had a lower Pretest score There are 20 categories You can spend as much time in each category as you need to based on your Pretest results there is no limit to how many times you can take a practice test Make note of your score each time you finish a category Your studying and continuing practice should result in improved scores each time Post Test When you are satisfied with your study effort and believe that you have improved your cognitive expertise sufficiently to achieve a passing score on a written board exam go ahead and take the full 450 question Post Test You will see your scores when you finish If you are satisfied with your score remember you have to make 75 or better to get the CME credit certificate then save that version as your Final Post Test Otherwise go back to the study and practice phase for as long as you need to The AMA PRA Category 1 Credit for PEER VIII Online is good until the expiration dat
41. nic obstructive pulmonary disease COR do pan sald Cardiopulmonary resuscitation CS Fes des dinee eas dca died rains Stee Cerebrospinal fluid Chat A aden aan A aha BS Computed tomography tt te balk los Al Deciliter ECG ast Je cian ae ee Electrocardiogram Page 12 of 18 EEG aa Electroencephalogram EMS ssos t chest austen Aare ape cen EEA Emergency medical services EMT es seee tala Emergency medical technician ENG es be chenille AS ets Ear nose and throat ESR iria O S Erythrocyte sedimentation rate EE E EEEE Fahrenheit FASTA E E oe TOOU OR Ea Focused assessment with sonography for trauma Odia ir ri is Fraction of inspired oxygen a ts ia Gram A pcb eee EEE Human chorionic gonadotropin ake 2 Shee ike Sena a Re le als Hematocrit ABD ie seis sa Bi nadas nda Hemoglobin FIN iii bod Bas Human immunodeficiency virus A oe tas ERRE High power field A date cats aad Intensive care unit Messi ad Inches AA O ON International normalized ratio A Sib arene de E eee es G Intravenous pyelogram E eN Shader Kilogram A E gale ee eee Liter LD Hees iia ds Lactate dehydrogenase MN Meter MEE an Wan ey Microgram Mit Microliter MENS AE Milliequivalent Meta taa od ot Su os Milligram Mi alada nia oct vee ol Myocardial infarction ITV sc need a and ates ate amp aE TA oad Minute Mii E alas Beales Milliliter IMM ABE setts erate vette eae eed Sa Millimeters of mercury MIR griat Beier det itn ha Rea cratic Magnetic resonance imaging MRSA coc
42. oidosis Joint Statement of the American Thoracic Society ATS the European Respiratory Society ERS and the World Association of Sarcoidosis and Other Granulomatous Disorders WASOG adopted by the ATS Board of Directors and by the ERS Executive Committee February 1999 Am J Respir Crit Care Med 1999 160 2 736 755 Stein PD Fowler SE Goodman LR et al Multidetector computed tomography for acute pulmonary embolism N Engl J Med 2006 354 22 2317 2327 Strange GR Ahrens WR Schafermeyer RW et al eds Pediatric Emergency Medicine 3rd ed New York NY McGraw Hill 2009 Straus SE Richardson WS Glasziou P et al Evidence Based Medicine How to Practice and Teach EBM 3rd ed London England BMJ Publishing Group 2003 Straus SE Thorpe KE Holroyd Leduc J How do perform a lumbar puncture and analyze the results to diagnose bacterial meningitis JAMA 2006 296 16 2012 2022 Stringer JR Beard CB Miller RF Spelling Pneumocystis jirovecii letter Emerg Infect Dis serial online 2009 http www cdc gov ElD content 15 3 506a htm Accessed May 6 2011 Stringer JR Beard CB Miller RF et al A new name Pneumocystis jiroveci for Pneumocystis from humans Emerg Infect Dis 2002 8 9 891 896 Page 17 of 18 Tabas JA Rodriguez RM Seligman HK et al Electrocardiographic criteria for detecting acute myocardial infarction in patients with left bundle branch block a meta analysis Ann Emerg Med 2008 52 4 329 336 e1 Tekwani K Si
43. ontest such required disclosure at Subscriber s expense Subscriber s Rights Subscriber possesses and retains all right title and interest in and to Subscriber Data and ACEP s use and possession thereof is solely as Subscriber s agent Retention amp Deletion ACEP will retain all Subscriber Data until erased pursuant its policies which may be in effect from time to time Injunction ACEP agrees that violation of the provisions of this Section might cause Subscriber irreparable injury for which monetary damages would not provide adequate compensation and that in addition to any other remedy Subscriber will be entitled to injunctive relief against such breach or threatened breach Term amp Termination Term This Agreement will continue from the Effective Date until October 14 2014 at which time ACEP will notify Subscriber regarding continuation of the subscription whether for an additional fee or as part of the original purchase price Subscriber may cancel the subscription at any time by e mail Subscriber will be entitled to a refund if ACEP receives the cancellation within 30 days of Subscription activation and if no CME certificate has been issued for the Subscriber The amount of the refund will be prorated depending on the Subscriber s progress within the program Effects of Termination The following provisions will survive termination of this Agreement i any obligation of Subscriber to pay for Subscription rendered bef
44. ore termination ii Sections 4 5 b 6 c and 7 of this Agreement and iii any other provision of this Agreement that must survive termination to fulfill its essential purpose Miscellaneous Notices ACEP may send notices pursuant to this Agreement to Subscriber s e mail address and such notices will be deemed received one day after they are sent Subscriber may send notices pursuant to this Agreement to ACEPBookstore acep org and such notices will be deemed received one day after they are sent Amendment ACEP may amend this Agreement including the TOU and Privacy Policy from time to time by notifying you of the change in writing or electronically including without limitation by e mail or by posting a notice on the login page that the terms have been updated or using similar words The changes will also appear in this document which you can access at any time by going to your User s Manual Subscriber s continued use of the Subscription following the effective date of an amendment Independent Contractors The parties are independent contractors and will so represent themselves in all regards Neither party is the agent of the other and neither may bind the other in any way No Waiver Neither party will be deemed to have waived any of its rights under this Agreement by lapse of time or by any statement or representation other than an explicit written waiver No waiver of a breach of this Agreement will constitute a waiver of
45. oughout the text The questions now contain only four selections for answers a change that has already been made on the ABEM in training exam and is being implemented over time for the qualifying and continuous certification examinations When selecting topics the Editorial Board chose conditions presentations and physician tasks from The Model of the Clinical Practice of Emergency Medicine as well as from the Table of Specificity developed by the American Osteopathic Board of Emergency Medicine With only a few exceptions all answer explanations in PEER VIII are supported by and then referenced to at least two of the most up to date resources including textbooks journal articles and guidelines developed by national organizations Although we have worked very hard to ensure that the answers and explanations are as accurate as possible information in this publication should not be used to make decisions regarding standard of care New guidelines from the Accreditation Council for Continuing Medical Education for obtaining CME credit helped guide the development of a different method of using PEER VIII as a testing tool To obtain up to 55 AMA PRA Category 1 Credits you will first have to take a 90 question Pretest to establish a baseline score and determine your topic specific study needs After that you will use the books and the online practice tests by category to study and when you are ready you will take the full 450 question post
46. rector Emergency Medicine Residency Program Assistant Professor Department of Emergency Medicine Johns Hopkins Medical Institutions Baltimore Maryland Tracy Sanson MD FACEP Education Director University of South Florida Emergency Medicine Program Associate Professor University of South Florida Director University of South Florida Division of Global and Emergency Medical Sciences Director TeamHealth Professional Emergency Medicine Liaison Division Tampa Florida Aaron Schneir MD FACEP FACMT Associate Professor Division of Medical Toxicology Department of Emergency Medicine University of California San Diego Medical Center San Diego Division California Poison Control System San Diego California Jeffrey Tabas MD FACEP Professor Department of Emergency Medicine Page 8 of 18 Office of Continuing Medical Education UCSF School of Medicine San Francisco California Katren R Tyler BMBS FACEM FACEP Associate Residency Director Associate Professor Department of Emergency Medicine University of California Davis Sacramento California Andrew R Zinkel MD FACEP Section Head Department of Emergency Medicine Assistant Professor of Emergency Medicine University of Minnesota Medical School Director Medical Quality Management and Patient Safety Fellowship Emergency Medical Director of Quality Regions Hospital St Paul Minnesota Contributors Dr Wagner and the PEER VIII Editorial Board gratefully
47. rly Norman Thivierge MD Veronica Theresa Tucci MD Andrew Brent Wilson MD ACEP Educational Products Marta Foster Director and Senior Editor Mike C Goodwin Creative Services Manager Jessica Hamilton Publications Assistant Mary Anne Mitchell Editor Page 10 of 18 Lexi Schwartz Publications Sales and Service Representative Nicole Tidwell Publications Sales and Marketing Manager Robert Heard MBA CAE Associate Executive Director Membership and Education Division National Education Representative Linda Robinson MD FACEP Proofreading Lori Cavanaugh Allison Frank Esposito Kathleen Wildasin MA Disclosures In accordance with Accreditation Council for Continuing Medical Education ACCME Standards and ACEP policy all persons who were in a position to control the content of this enduring material must disclose to participants the existence of significant financial relationships with commercial interests that might have a direct interest in the subject matter Dr House disclosed that he received consulting fees from Glaxo SmithKline No other individuals in control of content have significant financial interests or relationships to disclose ACEP expects all Editorial Board members and contributors to present information in an objective unbiased manner without endorsement or criticism of specific products or services ACEP also expects that the relationships they disclose will not influence their contributions In PEER VIII in mo
48. seizures Ann Emerg Med 2004 43 605 625 American Thoracic Society Infectious Diseases Society of America Guidelines for the management of adults with hospital acquired ventilator associated and healthcare associated pneumonia Am J Respir Crit Care Med 2005 171 388 416 Amoco Chemical Corp v Hill 318 A2d 614 Del Super Ct 1974 Anderson JL Adams CD Antman EM et al ACC AHA 2007 guidelines for the management of patients with unstable angina non ST elevation myocardial infarction Circulation 2007 116 7 e148 e304 Anderson JL Adams CD Antman EM et al ACC AHA 2007 guidelines for the management of patients with unstable angina non ST elevation myocardial infarction a report of the American College of Cardiology American Heart Association Task Force on Practice Guidelines Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina Non ST Elevation Myocardial Infarction developed in collaboration with the American College of Emergency Physicians the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J Am Coll Cardiol 2007 50 7 e1 e157 Antman EM Anbe DT Armstrong PW et al ACC AHA guidelines for the management of patients with ST elevation myocardial infarction Circulation 2004 110 5 588 636 Auerbach PS Wilderness Me
49. st cases drugs and devices are referred to by their generic names In a few cases however brand names do appear for the sole purpose of clarification or easier recognition Brand names were obtained from a variety of sources including the National Center for Biotechnology Information of the U S National Library of Medicine http www ncbi nlm nih gov If more than one brand name was found they are listed up to three In no instance is a drug or device listed by a brand name for a commercial purpose PEER VIII received no commercial support PEER VIII is not affiliated with the American Board of Emergency Medicine From the Editor as published in the print edition third printing May 2012 Thank you very much for purchasing the eighth edition of the Physician s Evaluation and Educational Review in Emergency Medicine PEER series This self assessment educational product has been used by tens of thousands of emergency physicians since 1974 to review the clinical practice of emergency medicine For more than 30 years it has served as a guide to physicians studying for the national board examinations including the in training qualifying and continuous certification exams Over the past 5 years the emergency medicine board examinations and the technology used to study and take these exams have been changing As we strive to continue to model PEER after the American Board of Emergency Medicine ABEM examinations we have made changes thr
50. te with the extent of their participation in the activity e Approval Statement Approved by the American College of Emergency Physicians for 55 hours of ACEP Category credit e Approved by the American Osteopathic Association for 55 hours of AOA Category 2 B credit requires passing grade of 70 or better e Target Audience PEER VIII Online is designed for emergency physicians e Please note CME credit can be claimed for the PEER VIII print edition and PEER VIII Online only once per subscriber per format There is no CME credit for the free PEER VIII Pretest How to Get Started Go to www acep org PEERVIlITesting Log in with your ACEP Username and Password If you don t know what they are follow the links or call 800 798 1822 Go through all four phases of the educational activity in this order o Phase 1 Self Assessment Pretest The first time you log in you ll go to Pretest You ll do Pretest only once even if you purchase both the PEER VIII print edition and PEER VIII Online On subsequent logins you ll go to the Main Menu If you re an ACEP member taking the free PEER VIII Pretest you ll have access to Phase 1 only If you purchase PEER VIII your Pretest scores will be retained o Phase 2 Study and Practice Phase 3 Post Test o Phase 4 Evaluation O Page 1 of 18 How to Do Phase 1 e Read the instructions on the screen e Click both attestation statements after reading the User s Manual e Answer the questions
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