poster making 2002 resident research course adam schlichting c:\windows\desktop last update:...

$: Poster Making 2002 Resident Research Course Adam Schlichting C:\WINDOWS\Desktop Last Update: 10-21-02$
Poster MakingPoster Making2002 Resident Research Course

Adam Schlichting

C:\WINDOWS\Desktop

Last Update: 10-21-02

Overview: ProgramsOverview: Programs

• Printing a poster from MS Word

• Printing a poster from MS Publisher

MS WordMS Word

• Producing a 2’ X 3’ Poster • Open Word Document

• From the File menu select Page Setup…

• “Page Size” tab input 7.23” X 11”

• Create Poster

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MS WordMS Word

• Printing a 2’ X 3’ Poster • From the File menu, select “Print”

• Select the Design Jet 755CM (C3198B) printer from the drop-down menu

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MS WordMS Word

• Printing a 2’ X 3’ Poster (continued)• Select “Properties”

• Select “Fit to this page…”

• Click “More sizes” and input 24” X 36”

• Select Application page size

• Click “More sizes” and input 7.23” X 11”

• Select Paper source as 36” roll

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MS WordMS Word

• Printing a 2’ X 3’ Poster (continued)• In the Advanced tab, select Autorotate

• Click “OK”

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MS WordMS Word

• Printing a 2’ X 3’ Poster (continued)• In the print menu, click “OK”

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MS PublisherMS Publisher

• Producing a 36” X 72” Poster• Create PowerPoint slides • Choose a MS Publisher template that

best correlates number of slides with number of spaces in the template, from C:\WINDOWS\Desktop\desktop items\Poster Templates\Blank templates• Currently we have poster templates for 15,

16, 18, 21, and 25 slides; title and authors should be on additional slides

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• Producing a 36” X 72” Poster (continued)• From the “View” menu in PowerPoint,

select “Slide Sorter”

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• Producing a 36” X 72” Poster (continued)• Copy each slide from PowerPoint into the

corresponding space in MS Publisher

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• Producing a 36” X 72” Poster (continued)• Type the poster title, authors, and

institutions into the banner at the top of the poster

• ACEP Recommendations:• Title: 72 point, Bold, Italicized• Names of Authors: 48 point, Bold, Italicized• Name of Institution(s): 36 point, Bold, Italicized

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In tro d u c tio n :S tu d y Q u e s tio n s

• In a b d o m in a l p a in p ts vs . o th e r E D p a in p ts : – H o w d o e s p a in in itia l s e ve rity c o m p a re ?

– W h a t m e d s a re u s e d to R x p a in ? W h e n ?

– Is p a in s u c c e s s fu lly re d u c e d ? H o w m u c h ?

– W h a t o u tc o m e s fo r th e s e a b d p a in p ts ?

• W h a t fa c to rs lin k to p a in R x , p t s a tis fa c tio n ?

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Pain Med None


• Unique backgrounds• Highlight the blue background and hit

delete

• From the “Insert” menu in Publisher, click “Picture”…. “From file”

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• Unique Background• Locate the picture and click insert

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• Unique Background• Manually resize the picture

• From the “Arrange” menu click “Send to back”

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PicturePicturePreparing International Relief Workers for the Field: An Evaluation of Organizational Practices Rachel T Moresky, MD1; M. James Eliades, MD2; M.A.Bhimani, MD2; Michael J. VanRooyen,MD, MPH2 ; E. Bradshaw Bunney, MD1;

1University of Illinois at Chicago and 2Johns Hopkins University, Baltimore, Maryland

Introduction:Current Issues

• There is an increased need for hum anitarian assistance around the w orld

• The safety of health care w orkers sent into area of conflict is alw ays a concern

• The tim ing of intervention w ith assistance is unpredictible

• Evaluate Effectiveness 25 (64%)

• Post-field debriefing 36 (92%)

Results:Teaching evaluation:

Results:Organizations

• 214 NGOs listed

• 95 excluded, 119 eligible

• 2 – 3 phone attempts made

• 39 (32%) responded

Conclusions:Personnel:

• Nearly 1/3 use em ergency physicians

• Half require board certification

• Little clinical or international experience is required

Introduction:Current Issues

• Two types of agencies exist: government organizations and non-government organizations (NGO)

• NGOs make up the majority humanitarian assistance

Results: N = 39W ho is sent:

• 24 (62%) send workers to acute humanitarian emergencies

• 12 (31%) send EM physicians

Conclusions:Teaching:

• Methods of teaching vary greatly

• Major topics are taught by less than half of the organizations

• Nearly all provide post-field debriefing

Introduction:Study Questions

• What are the skills required by NGOs?

• What type of training is provided before going into the field

• What is the overall preparedness of healthcare workers going overseas

Results:How Trained:

• Manuals 27 (69%)

• Rec Books 25 (64%)

• Classroom 15 (39%)

Recom m endations:

• Provide courses (Teach the Teacher) to educate NGO personnel about how to educate new volunteers

• Encourage EM participation in NGOs

Methods:Exclusion Criteria

• NGOs that do not provide either:– Health Care– Disaster Relief– Family Planning– W ater Sanitation– Human Rights Assistance

• NGOs that only provide:– Supplies– Funding – Business Development

Results:Topics of teaching:

• HIV 19 (48%)• Nutrition/dehydration 19 (48%)• W om en’s health 15 (39%)• Disaster relief 12 (30%)• Tropical m ed 11 (28%)• Fam ily planning 11 (28%)• ACLS/ATLS 7 (18%)

Recom m endations:

• Develop accepted basic standardized educational program s

• Provide topic specific related m aterial to be incorporated into the basic program depending on the needs of a specific relief effort

Methods:Design:

• Telephone survey of NGOs

• All NGOs registered in the US

– Interaction Member Profiles 2000-01

– JAM A 1999: Physician Service Opportunities Abroad

Results:Experience Required:

• Board Cert . 22 (56%)

• Minimum Clin. Exp 14 (36%)

• Prior International Exp 11 (28%)

PicturePictureFACIAL NERVE NEURITIS SECONDARY TO ULTRAVIOLET RADIATION Sean M. Bryant MD1,2, Kirk L. Cumpston DO1,2, Mark B. Mycyk MD1,2, Jerrold B. Leikin MD4, Michael Rezak MD, PhD5, Erin Pallasch Pharm.D3

Toxikon Consortium-Cook County Hospital1, University of Illinois at Chicago Department of Emergency Medicine2, Illinois Poison Center3, ENH-OMEGA4, ENH-Glenbrook Hospital Movement Disorders Center5

BACKGROUND

• Ultraviolet Radiation (UV) is composed of 3 different spectra:– UVA (320nm to 400nm)

– UVB (290nm to 320nm)

– UVC (200nm to 290nm)

BACKGROUND

• Dermal toxicity has been primarily associated with UVA and UVB.

• Toxicity to deeper (i.e. nervous) tissue has not been described.

CASE

CASE

• Several weeks later, weakness to left side of face with discomfort in neck.

• Diagnosed with seventh nerve palsy.

• Diagnostic Workup– Normal CT of head

– Normal MRI of brain

– Urine Arsenic, Lead, Mercury, Cadmium in nontoxic range.

CASE

• Physical Findings– Marked synkinetic movements involving eyelid

closure.

– Spasmodic and prolonged eyelid closure.

– Dystonic contractions of all muscles of facial expression on left.

• Treatment– Neurontin, Celebrex

DISCUSSION

• Approximated energy production by a 400 watt metal halide bulb (µW/cm2)

Envelope Intact Not Intact

UVA 4.53 10.05

UVB 0.07 14.01

UVC 0.00 15.11

CONCLUSION

• Rarely has UV radiation been implicated in damage to subcutaneous nerves.

• This case demonstrates that significant neurologic morbidity may follow high exposure to UV radiation.

REFERENCES• Danno K, Sayeed QK, Horiguchi Y, et al: Ultraviolet Radiation Abolishes Cutaneous

Nerve Stainings With Two Axon-Specific Antibodies In Guinea -Pig Skin. Archives of Dermatologic Research 1993;248:460 -465.

• Hof D, Fox JM: Modification of Ultraviolet Radiation Effects On The Membrane Of Myelinated Nerve Fibers By Sulfhydryl Compounds. Journal of Membrane Biology 1984;79:1-6.

• Lieberman EM: Ultraviolet Radiation Effects On Isolated Nerve Fi bers. Advances in Biological & Medical Physics 1970;13:329 -350.

• Marconi A, Vaschieri C, Zanoli S, et al: Nerve Growth Factor Protects Human Keratinocytes From Ultraviolet-B-Induced Apoptosis. Journal of Investigative Dermatology 1999;113:920-927.

• Misery L: The Neuro-Immuno-Cutaneous System And Ultraviolet Radiation. Photodermatology, Photoimmunology & Photomedicine 2000;16:78-81.

• Saade NE, Nasr IW, Massaad CA, et al: Modulation Of Ultraviolet -Induced Hyperalgesia And Cytokine Upregulation By Interleukins 10 And 13. British Journal of Pharmacology 2000;131:1317-1324.

• Schwarz W, Fox JM: Ultraviolet –Induced Alterations Of The Sodium Inactivation In Myelinated Nerve Fibers. Journal of Membrane Biology;36:297 -310.

ABSTRACTBackground: Dermatitis has frequently been described as a consequence to ultraviolet (UV) exposure. We describe a patient who developed facial nerve injury following significant exposure to UV radiation. Case Report: A 49-year-old construction worker developed erythema and edema on the left side of his face (exposed side) 12 hours after working within 18 inches of a metal halide incandescent light bulb for a total of 2 hours. The outer envelope of this 400 watt bulb had been broken and the filaments were reattached by an electrician. A mid-left facial burn resolved over the next 2 days. One month later, the patient noted a painful burning sensation over the left side of his face associated with marked left facial weakness and inability to close his eye (peripheral VIIth nerve palsy). A CT scan of the brain and a comprehensive urinalysis for heavy metals were normal. Pain was controlled with gabapentin. 2 months later, synkinetic left facial movements were noted (suggesting aberrant regeneration). Over the next several months, forceful episodic spasmodic activity developed in the muscles of facial expression on the left, identical to that seen in hemifacialspasm. Conclusion: Rarely has UV radiation been implicated in damage to subcutaneous nerves. This case demonstrates that significant neurologicmorbidity may follow high exposure to UV radiation.

BACKGROUND

• UVA– Penetrates deeper dermal tissues

• UVB– Penetrates to the upper dermal level

• UVC– Effectively absorbed by the stratum corneum

CASE

• Facial nerve stimulation test– Neurophysiologic evidence of asymmetry of

facial nerves.

– Needle EMG revealed no denervation.

– Noted to have abberrant regeneration with abnormal movements on the left during evaluation.

DISCUSSION

• The amount of energy increases by several orders of magnitude if the integrity of the outer envelope is compromised.

• These values should be compared with the Threshold Limit Values (TLV).

• The amount of energy received over 2 hours significantly exceeds the TLV.

UV Exposure Limits

PicturePictureBAKING SODA POISONING FOLLOWING PROPHYLACTIC

“NIPPLE DIPPING” TO PREVENT COLIC Sean M. Bryant MD1,2, Stuart Feldman MD1, Michelle M. Miner MD3, Davina Sparks BSN4, Daniel O. Hryhorczuk MD 1

Toxikon Consortium-Cook County Hospital1, University of Illinois at Chicago Department of Emergency Medicine2, Southern Illinois University Department of Pediatrics3, Illinois Poison Center, Chicago, Illinois4

BAKING SODA

BACKGROUND

• Baking soda is made from soda ash also known as sodium carbonate.

• Soda ash is manufactured or mined in the form of an ore called trona.

• It is dissolved into a solution through which carbon dioxide is bubbled, and sodium bicarbonate precipitates out forming 99% baking soda.

CASE

• Significant laboratory results:– WBC 23,000/mm3

– Sodium 187 mmol/L, Bicarbonate 44 mmol/L

– pH 7.95

• Grandmother reveals history of dipping milk bottle nipples and pacifiers in baking soda, in addition to adding baking soda to formula,with the intention to prevent colic.

CASE

Time (Hospital Day)T=1 Patient with episodes of apnea, hypoxia, and tonic posturing.

Transferred to NICU for ventilatory management.CT of brain reveals edema. Given Phenobarbital 20 mg/kg and hydrated with 0.9% saline.

T=2 Sodium 173-165 mmol/L, bicarbonate 41-36 mmol/L,pH 7.73-7.54. Given one dose of acetozolamide. No seizures.

T=3 Sodium 149 mmol/L, bicarbonate 25 mmol/L, pH 7.35.Several early AM episodes of seizure activity responding to lorazepam. Treated with phenytoin. Extubated and on room air.

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CLINICAL COURSE

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PicturePictureFAILURE OF HYPERINSULINEMIA/EUGLYCEMIA THERAPY IN SEVERE DILTIAZEM OVERDOSE Kirk L Cumpston DO1,2,3,4, Mark B Mycyk MD1,2,3,4, Erin Pallasch PharmD4, Mariah Manzanares MD 2, Joseph Knight DO2, Steven Aks DO1,2,3,4, Daniel O Hryhorczuk MD1,2,3,4

Toxikon Consortium1, Cook County Hospital2, University of Illinois at Chicago3, Illinois Poison Center4 Chicago, Illinois

I N S U L I N

Y E W ( T A X U S S P P . )

ABSTRACT• Background: We report failure of Hyperinsulinemia/Euglycemia (HIE) therapy in 3

cases of diltiazem overdose, initiated after standard antidotal therapy (SAT) withintravenous fluids, glucagon, calcium and vasopressors. Case Reports: (1) A 55-year-old male developed hypotension and bradycardia after ingesting 32 g of Diltiazem SR, 4 hours prior to arrival (PTA). After 30 minutes of aggressive SAT without improvement, a bolus of 90 u regular(R) insulin and an infusion of 90 u R insulin/hr were started, but the patient expired 45 minutes later. (2) A 58-year-old male ingested 7.2 g of Diltiazem XR, 3 hours PTA. Because aggressive SAT and transcutaneous pacing failed, HIE therapy with a 10 u bolus and 0.5 units/kg/hr of R insulin was started 10 hours after arrival, but the patient expired 3 hours later. (3) A 36-year-old female ingested 3.4 g of Diltiazem CD, 2.5 hours PTA. The patient had an acetyldiltiazem level of 5,700ng/dl. After 7 hours of aggressive SAT and transvenous pacing, HIE was started with 0.2 units/kg/hr R insulin; this patient survived, but remains in a permanent vegetative state. Conclusion: A number of successes with HIE therapy, at our own institution and in the published literature, used insulin doses of 0.1-1.0 units/kg. Since early experimental canine studies used insulin doses of up to 12units/kg, failures in these cases suggest the optimal dose of insulin in HIE therapy for severe diltiazem overdose is yet to be determined.

BACKGROUND

• In the past insulin and glucose have been used in combination to treat myocardial infarction and left ventricular failure after coronary bypass surgery

BACKGROUND

• The effects of insulin on the cardiac myocyte has been studied in animal models showing increased inotropic action and utilization of glucose as a substrate.

• One proposed mechanism is a change in the configuration of the cellular membrane, which changes the permeability of electrolytes

BACKGROUND

• Kline etal. has perfomed a number of elegant studies on verapamil poisoned canines. The 1996 study compared standard antidotes with HIE.

CASE #1

• A 55-year-old male developed hypotension and bradycardia after ingesting 32 g of Diltiazem XR, 4 hours prior to arrival (PTA). After 30 minutes of aggressive standard antidotal therapy(SAT) without improvement, a bolus of 90 u regular(R) insulin and an infusion of 90 u R insulin/hr were started, but the patient expired 45 minutes later.

CASE #2

• A 58-year-old male ingested 7.2 g of Diltiazem XR, 3 hours PTA. Because aggressive SAT and transcutaneouspacing failed, HIE therapy with a 10 u bolus and 0.5 units/kg/hr of R insulin was started 10 hours after arrival, but the patient expired 3 hours later.

CASE #3

• A 36-year-old female ingested 3.4 g of Diltiazem XR, 2.5 hours PTA. The patient had an acetyldiltiazem level of 5,700ng/dl. After 7 hours of aggressive SAT and transvenous pacing, HIE was started with 0.2 units/kg/hr R insulin (1u/kg/hr was recommended); this patient survived, but remains in a permanent vegetative state.

CASE #1 TREATMENT TIMELINE

• 4.5 hours post ingestion(PI), SBP 80, HR 30,

• 10 minutes post arrival no response to glucagon5mg, CaCl3 6 amps, NE drip

• 15 minutes post arrival 1.0u/kg bolus then 1.0u/kg/hr insulin started

• 1hour post initiation of HIE, 5.5 hours post ingestion the patient expired

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SBP


• Printing a 36” X 72” Poster • Ensure the correct printer is attached to

the computer • Use Computer B in the “Cave”

• From the “File” menu in MS Publisher, select “Print”

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• Printing a 36” X 72” Poster • Select the Design Jet 755CM(C3198B)

printer from the drop-down menu

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• Printing a 36” X 72” Poster (continued)• Select “Properties” • Select Landscape Orientation • Select Paper source as 36” roll • Select Application page size 36” X 18” • Select “Fit to this page…” and input

72” X 36”

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• Printing a 36” X 72” Poster (continued)• In the Advanced tab, select “…in

computer” and “Autorotate”

• Click “OK”

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• Printing a 36” X 72” Poster (continued)

• In the print menu, click “OK”

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General Suggestions for Preparing General Suggestions for Preparing PostersPosters

• Easily read from a distance of 4 feet• Organize to correspond with abstract

• Title• Study Objectives• Design• Type of Participants

• Edit material down to essential words• Use tables and lists whenever possible

•Interventions•Measurements•Results•Conclusion

Questions?Questions?

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