Shoot Up or Ship Out
What is the most common life-threatening infection in IVDU patients?
infective endocarditis
What immunosuppressant class increases risk for nephrotoxicity and neurotoxicity?
Calcineurin inhibitors (e.g., cyclosporine, tacrolimus)
What does the acronym ‘GOALS’ stand for in palliative conversations?
Goals, Options, Affirmation, Limits, Support
What is the most important first step in a death notification?
Ensure privacy and sit down before delivering the news
True or False: Informed consent is always required before treating a minor.
False – exceptions include emergencies and emancipated minors
What vascular complication, often seen in IDU patients, presents as a pulsatile mass and can mimic an abscess?
Mycotic aneurysm or pseudoaneurysm
Which organ transplant has the highest risk of infection post-op?
Lung
What medication class is commonly used for terminal secretions (“death rattle”)?
Anticholinergics (e.g., glycopyrrolate, scopolamine)
True or False: You should avoid using the word "died" to soften the message.
False – use clear language like “died” or “death” to prevent confusion
Which law allows EDs to stabilize and treat all patients regardless of insurance status?
EMTALA
Which antibiotic should you avoid in opioid users due to QT prolongation?
Methadone + macrolides/fluoroquinolones combo (esp. azithromycin)
What vaccine should be avoided in transplant patients?
Live vaccines (e.g., MMR, varicella)
What is the ethical principle behind withdrawing life-sustaining treatment in alignment with a patient’s wishes?
Autonomy
What document outlines a patient’s wishes for end-of-life care?
Advance directive / living will
What must be documented when a patient refuses a test or procedure?
Capacity, risks discussed, alternatives, and that refusal was voluntary
What is the first-line treatment for acute opioid withdrawal in the ED?
Buprenorphine (or clonidine if not available)
Which opportunistic infection are transplant patients commonly prophylaxed for with TMP-SMX?
Pneumocystis jirovecii pneumonia (PJP)
What is the difference between palliative care and hospice?
Palliative care can be given at any stage of illness; hospice is for end-of-life (usually <6 months prognosis)
Who is legally responsible for honoring advance directives in the ED?
The treating physician
What should you document to legally protect against missed MI or PE?
Thorough risk stratification, shared decision-making, and follow-up instructions
Which skin infection in IDU patients may require surgical debridement?
What is the most common cause of graft failure within the first week post-transplant?
Hyperacute rejection
True or False: You must wait for palliative care or hospice teams before initiating comfort-focused care in the ED.
False – ED providers can and should initiate palliative interventions when appropriate
What is the SPIKES protocol used for?
Delivering bad news (Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary)
In the ED, who can legally override an advance directive in a life-threatening emergency?
No one