Emergency Medicine Newsletter
Summer 2026
From the Chair
Hi, everyone! My name is Dr. Jacy O'Keefe and I am the new Chair of Emergency Medicine. I attended the UND School of Medicine & Health Sciences for medical school and completed my emergency medicine residency and medical education fellowship at Regions Hospital in St Paul, Minn. I currently work in Bismarck, N.D., at Sanford Health and I am also the medical director for the Standing Rock Ambulance Service. I am one year into my role as the Chair of Emergency Medicine and I am excited to continue representing our department. Chelsay Tsyver is the administrative assistant for the department and is definitely the backbone and master organizer of all things going. I want to thank everyone for their patience and hard work this past year. Please do not hesitate to reach out with any suggestions or concerns! Cheers to a great second year!
Medical Student Match Results 2026
- Mikale Kuntz - Vanderbilt University Medical Center, Nashville, Tenn.
- Connor Griffin - University of Alabama Hospital, Birmingham, Ala.
- Paxten Wahlund - University of South Dakota Sanford School of Medicine, Sioux Falls, S.D.
- Elizabeth Driscoll - Wake Forest Baptist Medical Center, Winston-Salem, N.C.
- Marie Tate - University Hospitals- Columbia, Columbia, Mo.
- Jack Gibbons - Hennepin County Medical Center, Minneapolis, Minn.
- Lincoln Kranz - Baylor S&W- Baylor College of Medicine, Temple, Texas
Mike Schlosser Scholarship Recipients
Dr. Michael "Mike" Schlosser was born in Mandan, N.D. He received his undergraduate degree from UND and at age 29 returned to the UND School of Medicine & Health Sciences. His family practice residency in Bismarck led him to practice family medicine in Linton, N.D., in 1990-93 before joining Fargo Sanford Emergency Medicine in 1993. In 2012, Mike and his wife, Cynthia, a nurse, moved to Aberdeen, S.D., to practice emergency medicine at Avera Health System until his death in 2015. At age 59, Mike was killed in a motor vehicle head-on collision by an impaired driver. Mike and his wife have five children and four grandchildren.
In 1985, as a medical student, Mike joined the North Dakota National Guard as battalion surgeon of the 164th Engineer Battalion in Minot, N.D. He also functioned as Assistant State Surgeon. In 1990 Mike left the military, returning in 2007 to the U.S. Army Reserves as a medical officer. Mike served in various positions with four deployments to Iraq, Afghanistan, and Tripler Army Medical Center. He served a total of 15 years in the U.S. Army. Military service was a family affair with his wife Cynthia, and three of his sons (Andrew, Joseph, and Benjamin) also serving. The family has 89 collective military years dedicated.
Mike enjoyed the outdoors. In 1991 his family purchased 20 registered Hereford cows. Both Mike and Cynthia were involved with the management of the breeding, vaccination, and feeding program. At the time of his death, Mike was operating a 150-head female herd. His favorite comment was “the cow may kick me, but she won’t threaten to sue me!” Mike was also an avid hunter with his sons, partners, and wife. He and his family enjoyed water skiing, downhill skiing, diving in the Caribbean and trips to Europe.
Dr. Schlosser was a constant source of mentorship and encouragement for those considering careers in healthcare and the military. He displayed never-ending compassion for those struggling with mental health, substance abuse, and homelessness, and his laid back demeanor was a calming presence in the sometimes chaotic environment of the emergency department. Dr. Schlosser’s dry and sometimes edgy sense of humor was sure to crack a smile from even the most stoic patient or staff member, and his presence will be missed by all who were blessed to work with him. He was exceptionally proud of his North Dakota heritage and education.
This scholarship was established by Dr. Schlosser’s friends and family to honor his legacy and benefit medical students who intend to serve their country by practicing emergency medicine in North Dakota or the military.
The Dr. Mike Schlosser Scholarship Award recipients this year were Mikale Kuntz and Connor Griffin.
Notable Research Clinical Pearls
Pearl 1
Preston RA, Caizapanta E V, Afshartous D, et al. J Hypertens. Published online March 31, 2026. doi:10.1097/HJH.0000000000004304
Summary:
- New guidelines suggest replacing the term “hypertensive urgency” with “markedly elevated asymptomatic hypertension”; they also suggest that this entity does not require emergency treatment, and certainly not with parenteral agents, because no evidence suggests that such treatment is necessary. Elevated blood pressure (BP) readings are often transient and self-resolving, and treatment can cause dramatic BP changes that might place patients at greater risk of complications than living with elevated BP for a few hours or days. The authors of this study, focusing on the last point, sought to document how often treatment in the ED with antihypertensive agents for patients with so-called hypertensive urgency overshoots recommended safe BP lowering.
- Generally, recommendations state that systolic BP (SBP) should never be lowered by >80 mm Hg acutely, and the target decrease in mean arterial pressure should not exceed 25%, because further lowering might exceed cerebral autoregulation parameters and decrease cerebral perfusion pressure.
- This retrospective cohort evaluation included consecutive patients presenting to the University of Miami ED for hypertensive urgency between 2015 and 2018. Potential cases were identified from SBP data in the electronic health record, and only those with SBP >220 mm Hg and diastolic BP >120 mm Hg (i.e., very high values) were included. Subsequently, a manual chart review (whose methods are not described) excluded patients with evidence of worsening end-organ failure (e.g., hypertensive emergencies). Finally, patients with acute, potentially transient conditions that might have accounted for the elevated BP (e.g., painful conditions or intoxication) were excluded. Therefore, the analytic group consisted of patients with markedly elevated BP and minimal or no symptoms, at least theoretically, and certainly no evidence of end-organ disease.
- Next, the authors documented which antihypertensive medications the participants received and the proportion of patients with excessive BP lowering in the subsequent 5 hours.
- A total of 3,823 patients were identified, and 1,553 were included. Most exclusions were due to an acute medical condition contributing to the elevated BP. Half the patients were between 40 and 60 years of age, and 60% were determined not to have adhered to their hypertension medication regimen.
- The most commonly used agents were oral clonidine, extended-release nifedipine, IV hydralazine, IV labetalol, oral lisinopril, or no medications.
- In the clonidine group, 18% had an SBP decrease >80 mm Hg, and 46% had a mean MAP decrease >25%; the corresponding percentages were 20% and 38% for IV labetalol; 18% and 44% for IV hydralazine; and 1% and 21% for oral nifedipine.
Practice update: Hypertensive urgency is not a true medical diagnosis anymore and it has been recommended to replace the term “hypertensive urgency” with “markedly elevated asymptomatic hypertension” to prevent overtreatment. This study examines how often antihypertensive treatment in the ED leads to excessive drops in BP for patients with markedly elevated BP. The substantial proportion of patients who experienced BP drops beyond recommended safety thresholds highlights the risk of overtreatment, even with oral antihypertensives. Despite methodologic limitations, the findings support a more conservative approach in asymptomatic patients without end-organ damage.
Pearl 2
Leonard J, Harding M, Cook L et al. The Lancet Child & Adolescent Health, 2024; 8, 482-490. DOI: 10.1016/S2352-4642(24)00104-4.
- Introduction: Each year, more than 8 million children in the U.S. are evaluated in emergency departments (EDs) following blunt trauma, but less than 1% are diagnosed with cervical spine injuries (CSI). Computed tomography (CT) scans are often used to evaluate for CSIs. This exposes children to ionizing radiation increasing their lifetime risk of cancer. A newly published Lancet study, “A Cervical Spine Injury Prediction Rule for Children After Blunt Trauma,” led by Dr. Julie Leonard, was conducted to develop and validate a clinical prediction rule to identify children at risk of CSI after blunt trauma that could minimize unnecessary radiation from CT use.
- Study Question: Can a reliable clinical prediction rule be developed to identify CSIs in pediatric patients after blunt trauma, minimizing unnecessary imaging?
- Study Design: The study enrolled children <18 years who experienced blunt trauma and were evaluated at 18 EDs affiliated with the Pediatric Emergency Care Applied Research Network. Data regarding physical signs and symptoms were collected from the treating ED clinicians. Factors associated with risk for CSI were identified in a multistep process that included logistic and Poisson regression, and classification and regression tree analysis for the final design of the decision rule. The sensitivity, specificity, positive predictive value, and negative predictive value of the rule were assessed with an independent validation cohort.
- Results:
- Out of 22,430 children included in the study, 433 (1.9%) were found to have CSI.
- The study identified 4 high risk factors for CSI to be used to triage children to
CT (12% risk for a cervical spine injury):
- Glasgow Coma Scale scores of 3-8
- Unresponsiveness on the AVPU scale
- Abnormal airway/breathing/circulation
- Focal neurologic deficits
- In children without high-risk findings, 5 additional findings identified children
with intermediate, non-negligible risk of CSI (3.6% risk of a cervical spine injury):
- Altered mental status
- Substantial head
- Substantial torso injury
- Midline neck pain
- Midline neck tenderness
- Notably this risk stratification approach towards identifying high and intermediate risk traumatic injuries mirrors the PECARN clinical decision tool for blunt head trauma. High risk findings generally warrant CT imaging and intermediate risk findings in the absence of high risk findings can start with x-ray imaging. Without any of these risk factors, the patient’s cervical spine can be clinically cleared with any imaging because the risk for a cervical injury is extremely low (0.2%).
Practice update: Using the risk factors in an imaging algorithm could significantly reduce the use of CT without increasing the use of x-rays. The PECARN CSI prediction rule is clinically sensible and easy to implement in emergency settings.
Upcoming Educational Sessions (CME)
| Date | Topic | Speaker | Location |
|---|---|---|---|
|
Aug. 15-16, 2026 |
Wilderness Medicine Weekend |
Dr. Jon Solberg |
Turtle River State Park in ND |
|
Nov. 12, 2026 |
Frostbite |
Dr. Johnson |
Zoom |
|
Oct. 15, 2026 |
Hyperbaric Medicine |
Dr. Ajayi |
Zoom |
|
TBD |
Toxicology |
Dr. Strand |
Zoom |
|
TBD |
Aviation Medicine |
Dr. Lyng |
Zoom |
Faculty Spotlight
Eric Johnson, M.D., Emergency Medicine
Dr. Eric Johnson, MD, FAAFM, FAWM. Clinical Faculty, University of Nevada Reno School of Medicine and Advisory Board. Member of Wongchhu Sherpa Memorial Hospital, Kamding, Nepal. Teton Valley (ID) Fire/EMS/SAR Medical Director and Medical Advisor for Global Rescue, LLC.
Dr. Johnson’s medical career includes family medicine and emergency medicine for 20+ years, along with wound and hyperbaric medicine. He is a past President of the Wilderness Medical Society with interests in altitude, cold, diving, and lightning injuries. Dr. Johnson has worked with the Himalayan Rescue Association at the Pheriche Nepal clinic for two seasons and an “Everest ER” physician for three seasons. He has been instrumental in building the Wongchhu Sherpa Memorial Hospital in the SoluKhumbu Valley, Nepal. Dr. Johnson has Iloprost experience from Pheriche Clinic and has seen digits being saved after Iloprost treatment.
Annika Strand, M.D., Emergency Medicine, Toxicology
I am proud and excited to serve as the new Clerkship Director for Emergency Medicine at Altru Health System. Born and raised in Grand Forks, it is especially meaningful to guide the next generation of physicians in the community that shaped me. I completed my undergraduate degree in biology at Concordia College in Moorhead, Minn., and attended medical school at the University of North Dakota. I completed my emergency medicine residency and medical toxicology fellowship at Regions Hospital in St. Paul, Minn.
I chose Emergency Medicine because I love the fast-paced, problem-solving nature of caring for patients of all ages with any complaint. During medical school, I found myself enjoying all of my rotations, and emergency medicine allowed me to maintain a broad knowledge base and practical skill set in medicine. My additional training in medical toxicology adds a unique perspective to my practice, particularly in the evaluation and management of medication overdoses, toxic exposures, and other complex, undifferentiated high-acuity presentations.
In my role as Clerkship Director, I am dedicated to exposing learners to the dynamic environment of the emergency department and preparing them for success in any field they choose. I will strive to create a supportive learning environment where students feel comfortable asking questions, thinking critically, and engaging with diverse patient populations. Outside of the hospital, I enjoy spending time with my friends and family, my two young sons, and our two golden retrievers. I also enjoy traveling to the lake, playing volleyball, snowboarding, reading, and going to concerts.
David Ajayi, M.D.
Dr. David Ajayi completed his medical degree at the University of Ibadan, in Ibadan, Nigeria. He went on to receive his Master of Public Health degree, with Health Policy and Management concentration, at Emory University in Atlanta, Ga., where he also completed his preventive medicine residency. Following residency, Dr. Ajayi completed his fellowship in undersea and hyperbaric medicine at Hennepin Healthcare in Minneapolis, Minn. Dr. Ajayi is board certified in both undersea and hyperbaric medicine, and preventive medicine. He is also DMAC level 1 (medical examiner of divers) and DMAC level 2d (diving medical physician) certified.
Dr. Ajayi currently practices hyperbaric and dive medicine at Essentia Health in Fargo, where he serves as the Medical Director of the Hyperbaric and Dive Department, as well as serves as the Medical Director of the Supply Chain Management of Essentia Health systemwide. Dr. Ajayi is a Clinical Assistant Professor at the University of North Dakota School of Medicine & Health Sciences.
Dr. Ajayi’ s work has been published in journals such as Mayo Clinic Proceedings and the Undersea and Hyperbaric Medical Society’s UHM Journal. In collaboration with researchers at University of North Dakota, he co-authored a randomized controlled clinical trial (hyperbaric and persistent concussive symptoms following mild traumatic brain injury) recently published with the MDPI’s Trauma Care Journal. He continues to do research in partnership with the University of North Dakota.
Resident & Faculty Recognition
Emergency & EMS physician Dr. John Lyng, graduate of Mayville State University (BS 2001) and the UND School of Medicine & Health Sciences (MD 2005), delivered the 71st Louis H. Bauer Lecture on May 18, 2026, at the Aerospace Medical Association (ASMA) and Undersea and Hyperbaric Medical Society (UHMS) Annual Scientific Meeting in Denver, Colo.
Dr. Lyng’s lecture, “Redefining Readiness in the Sky: Development of Evidence-Based Recommendations to Update On-Board Medical Kits in the United States,” focused on advancing emergency medical preparedness and volunteer medical responder capabilities during in-flight medical events occurring on board US-based commercial passenger aircraft. This lecture pulled back the curtain and provided insight into how a panel of medical and aviation experts used epidemiologic data and expert consensus to develop evidence-supported recommendations to update federal requirements governing the contents of on-board medical kits found on US-based commercial passenger aircraft.
Current Clerkship Site Directors
- Minot Campus: Dr. Virginia Keaveny
- Bismarck Campus: Dr. Steven Schmidt and Dr. Kyle O’Boyle
- Fargo Campus: Dr. Colin Johnson and Dr. Elizabeth Roeber
- Grand Forks Campus: Dr. Annika Strand