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Browsing by Author "Lefort, Roxanna"
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Item Naloxone-associated pulmonary edema in a 3-year-old with opioid overdose(Wiley, 2022-05-23) Grout, Sarah; Dave, Madhuri; Lefort, Roxanna; Pediatrics, School of MedicineBackground: Annually, close to 5000 children under age 6 years are treated in emergency departments or admitted for care due to opioid exposures. Naloxone is effectively used to treat opioid overdose in both children and adults. Non-cardiogenic pulmonary edema is a rare but serious adverse effect of naloxone administration that has been reported in adults. Case report: We present the case of a 3-year-old male with suspected opioid overdose who developed acute hypoxia due to pulmonary edema after administration of naloxone following a likely prolonged downtime. Why should an emergency physician be aware of this?: The copious fluid in the airway made for difficult intubation at a pediatric tertiary care center. Given the incidence of opioid exposures in children, clinicians should be aware of this rare, but dangerous adverse effect of naloxone and consider airway precautions and pediatric critical care availability early in the presentation.Item The 2023 Model Core Content of Disaster Medicine(Cambridge University Press, 2023) Wexler, Bryan J.; Schultz, Carl; Biddinger, Paul D.; Ciottone, Gregory; Cornelius, Angela; Fuller, Robert; Lefort, Roxanna; Milsten, Andrew; Phillips, James; Nemeth, Ira; Emergency Medicine, School of MedicineIntroduction: Disaster Medicine (DM) is the clinical specialty whose expertise includes the care and management of patients and populations outside conventional care protocols. While traditional standards of care assume the availability of adequate resources, DM practitioners operate in situations where resources are not adequate, necessitating a modification in practice. While prior academic efforts have succeeded in developing a list of core disaster competencies for emergency medicine residency programs, international fellowships, and affiliated health care providers, no official standardized curriculum or consensus has yet been published to date for DM fellowship programs based in the United States. Study objective: The objective of this work is to define the core curriculum for DM physician fellowships in the United States, drawing consensus among existing DM fellowship directors. Methods: A panel of DM experts was created from the members of the Council of Disaster Medicine Fellowship Directors. This council is an independent group of DM fellowship directors in the United States that have met annually at the American College of Emergency Physicians (ACEP)'s Scientific Assembly for the last eight years with meeting support from the Disaster Preparedness and Response Committee. Using a modified Delphi technique, the panel members revised and expanded on the existing Society of Academic Emergency Medicine (SAEM) DM fellowship curriculum, with the final draft being ratified by an anonymous vote. Multiple publications were reviewed during the process to ensure all potential topics were identified. Results: The results of this effort produced the foundational curriculum, the 2023 Model Core Content of Disaster Medicine. Conclusion: Members from the Council of Disaster Medicine Fellowship Directors have developed the 2023 Model Core Content for Disaster Medicine in the United States. This living document defines the foundational curriculum for DM fellowships, providing the basis of a standardized experience, contributing to the development of a board-certified subspecialty, and informing fellowship directors and DM practitioners of content and topics that may appear on future certification examinations.