The 2019 Lifelong Learning And Self-Assessment Study Guide - LLSA
About this review
The 2019 LLSA Study Guide includes all of the resources you need to prep for the ABEM LLSA exam: a full reprint of every article on the 2019 LLSA reading list; a review of each article, with key points identified for efficient exam prep. CME credit for this resource has expired
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Associate Professor; Director, Process & Quality Improvement Program, Harbor-UCLA Medical Center, Torrance, CA
Rowen O. Jin, MD
Department of Emergency Medicine, LAC+USC, Los Angeles, CA
Kaushal H. Shah, MD
Associate Professor and Residency Director, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Angela Chen, MD
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Suzanne Bentley, MD, MPH, FACEP
Associate Professor, Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY; Medical Director, Simulation Center at Elmhurst Hospital Center, Elmhurst, NY
Jillian Nickerson, MD, MS
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Benjamin H. Schnapp, MD
Assistant Professor, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, Madison, WI
Daniel J. Ritter, MD
BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, Madison, WI
Angela Hua, MD
Assistant Professor, Hofstra University; Department of Emergency Medicine, Northwell Long Island Jewish Hospital, New Hyde Park, NY
Luke B. Berry, MD
Department of Emergency Medicine, Northwell Long Island Jewish Hospital, New Hyde Park, NY
Joby Thoppil, MD, PhD
Department of Emergency Medicine, Northwell Long Island Jewish Hospital, New Hyde Park, NY
Mark Andreae, MD
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Rosalia Holzman, MD
BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, Madison, WI
Taylor McCormick, MD, MS
Attending Physician, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Assistant Professor, University of Colorado School of Medicine, Aurora, CO
Patrick Joynt, MD, MA
Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, CO
Jacqueline Paulis, MD
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Leila L. PoSaw, MD, MPH, FACEP
Emergency Ultrasound Director, Jackson Memorial Hospital, Miami, FL
Alok Harwani, MD
BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, Madison, WI
Information on the ABEM LLSA examination
The LLSA examination is one of the 3 components required for maintenance of certification (MOC) with the American Board of Emergency Medicine (ABEM).
The primary goal of the LLSA examination is to promote continuous learning by diplomates.
ABEM facilitates this learning by identifying an annual set of LLSA readings to guide diplomates in self-study of recent EM literature. Readings are intended to address issues relevant to current clinical practice.
This study guide is created each year for emergency medicine physicians preparing for the ABEM examination required for maintenance of their certification.
CME Information
35 AMA PRA Category 1 CreditsTM or 35 ACEP Category I Credits included at no extra charge with your LLSA Study Guide
Specialty CME credits: Included as part of the 35 credits, this CME activity is eligible for 3 Critical Care credits, 3 Ethics credits, 6 Neurology credits, 6 Obstetrics/Gynecology credits, 4 Pharmacology credits, and 3 Trauma credits, subject to your state and institutional requirements.
Table of Contents
Review 1: Clinical Practice Guideline: Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants: Executive Summary
Article Citation
Synopsis
Discussion
Definition of a Brief Resolved Unexplained Event
Suggested Clinical Approach
Risk Stratification
Concerning History and Physical Examination Findings
Management of Lower-Risk Patients
Critique
Key Points
Editor’s Note
Original Article
Review 2: Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout
Article Citation
Synopsis
Discussion
Strategy 1: Acknowledge and Assess the Problem
Strategy 2: Harness the Power of Leadership
Strategy 3: Develop and Implement Targeted Interventions
Strategy 4: Cultivate Community at Work
Strategy 5: Use Rewards and Incentives Wisely
Strategy 6: Align Values and Strengthen Culture
Strategy 7: Promote Flexibility and Work-Life Integration
Strategy 8: Provide Resources to Promote Resilience and Care
Strategy 9: Facilitate and Fund Organizational Science
Summary
Critique
Key Points
Original Article
Review 3: Management of an Unexpected Delivery in the Emergency Department
Article Citation
Synopsis
Discussion
Delayed Cord Clamping
Thermoregulation
Elements of Neonatal Resuscitation
Airway
Breathing
Circulation
Medications and Fluids
Postresuscitation Monitoring and Evaluation
Thermoregulation
Glucose Monitoring
Laboratory Testing
Medications
Apgar Scoring
Critique
Key Points
Original Article
Review 4: Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A Systematic Review
Article Citation
Synopsis
Discussion
Critique
Key Points
Original Article
Review 5: Fire-Related Inhalation Injury
Article Citation
Synopsis
Discussion
Pathophysiology
Diagnosis
Clinical Course and Management
Critique
Editor’s Note
Key Points
Original Article
Review 6: Managing Initial Mechanical Ventilation in the Emergency Department
Article Citation
Synopsis
Discussion
Lung-Protective Strategy
Obstructive Strategy
Critique
Editor’s Note
Key Points
Original Article
Review 7: Mesenteric Ischemia
Article Citation
Synopsis
Discussion
Etiology and Pathophysiology
Acute Arterial Occlusion and Insufficiency
Venous Occlusion
Chronic Mesenteric Ischemia
Diagnostic Approach
Treatment
Initial Resuscitation
Anticoagulation
Surgical and Endovascular Approaches
Critique
References
Key Points
Original Article
Review 8: Managing Migraine
Article Citation
Synopsis
Discussion
Diagnosis and Workup
Treatment
Disposition
Critique
Key Points
Original Article
Review 9: Pediatric Nontraumatic Hip Pathology
Article Citation
Synopsis
Discussion
Pathology
Suggested Clinical Approach
History and Physical Examination
Imaging
Laboratory Investigations
Differential Diagnosis
Transient Synovitis
Legg-Calve-Perthes Disease
Slipped Capital Femoral Epiphysis
Septic Arthritis and Osteomyelitis
Lyme Arthritis
Malignancy
Critique
Key Points
Original Article
Review 10: Current Controversies in Thrombolytic Use in Acute Pulmonary Embolism
Article Citation
Synopsis
Discussion
Overview of Management of Pulmonary Embolism
Analysis of Thrombolytic Use in Submassive Pulmonary Embolism
MAPPET-3 (Management Strategies and Prognosis of Pulmonary Embolism Trial-3)
MOPPET (Moderate Pulmonary Embolism Treated with Thrombolysis)
PEITHO (Pulmonary Embolism Thrombolysis) Trial
TOPCOAT (Treatment of Submassive Pulmonary Embolism with Tenecteplase or Placebo: Cardiopulmonary Outcomes at 3 months) Trial
Additional Studies Evaluating Thrombolytic Use in Submassive Pulmonary Embolism
Summary of Management of Pulmonary Embolism
Critique
References
Editor’s Note
Key Points
Original Article
Review 11: New-Onset Seizure in Adults and Adolescents: A Review
Article Citation
Synopsis
Discussion
Definitions
Systematic Approach to Patients With New-Onset Seizure
Step 1: Did the Patient Have a Seizure?
Step 2: Was This an Acute Symptomatic Seizure?
Step 3: Was This an Unprovoked Seizure?
Epidemiology
Risk Factors
Differential Diagnosis
Assessment and Diagnosis
History and Physical Examination
Brain Imaging
Chemistry Panel
Prolactin Level
Lumbar Puncture
Risk of Seizure Recurrence
Acute Symptomatic Seizures
Unprovoked Seizures
Treatment
Step 1: Who Gets Treated?
Step 2: Is the Epilepsy Focal or Generalized?
Step 3: Are the Seizures Controlled?
Step 4: What is the Duration of Treatment?
Antiepileptic Medications
Special Considerations
Generic Formulations
Comparative Trials
Adverse Effects
Antiepileptic Medication Use in Women
Use in Older Patients
Response Rates
Patient Counseling
Duration of Therapy
Critique
Editor’s Note
Key Points
Original Article
Review 12: Clinical Policy: Critical Issues in the Evaluation of Adult Patients With Suspected Transient Ischemic Attack in the Emergency Department