User:Tyfon9/Francis Fesmire

Francis Miller Fesmire (born 16 November 1959) is an American emergency physician and a nationally-recognized expert in myocardial infarction. He has authored numerous academic articles and has assisted in the development of clinical guidelines on the standard of care in treating patients with suspected myocardial infarction by the American College of Emergency Physicians, the American Heart Association, and the American College of Cardiology. He has performed numerous research investigations in chest pain patients, reporting the usefulness of continuous 12-lead ECG monitoring, two-hour delta cardiac marker testing, and nuclear cardiac stress testing in the emergency room. The culmination of his studies was The Erlanger Chest Pain Evaluation Protocol [1] published in the Annals of Emergency Medicine in 2002.

Background
Born in 1959 in Atlanta, Georgia, Dr. Fesmire grew up in Chattanooga, Tennessee and graduated high school Valedictorian from the Baylor School in 1978 [2]. Dr. Fesmire is listed on Wikipedia as a Notable Baylor Alumni along with classmate Bill Dedman who won the 1989 Pulitzer Prize in Journalism. He graduated Magna Cum Laude from Harvard College in 1981. At Harvard, his Leverett House roommate was sound editor Kenton Jakub [3] and his dorm advisor was cellist Yo-Yo Ma. Dr. Fesmire graduated from Vanderbilt University School of Medicine in 1985 and completed a residency in Emergency Medicine at University Hospital [4] in Jacksonville, Florida in 1988 where he received the Outstanding Resident Award. Dr. Fesmire practiced as an emergency physician at Memorial Hospital [5] from 1988 until 1991 and has been practicing at Erlanger Baroness Hospital since 1991 employed by EmCare.

Awards
Dr. Fesmire was honored with the Emergency Medicine Foundation's [6] Young Investigator Award in 1996 for his work in developing a rapid protocol for the evaluation of chest pain patients. He gained international notoriety when he won the 2006 Ig Noble Prize in Medicine for a 1988 case report detailing the use of digital rectal massage as a cure for persistent hiccups [7-12]. In 2008, Dr Fesmire was named a Hero of Emergency Medicine [13] by the American College of Emergency Physicians.

Current Work
Dr. Fesmire currently resides in Chattanooga with his wife Connie and two sons, Forrest and Hunter. He is Medical Director of Chest Pain Center of Erlanger Medical Center. He also is Professor and Clinical Research Director of the Emergency Medicine Residency Program of the University of Tennessee College of Medicine [15]. He is Chairman of the Clinical Policy Committee [16] of the American College of Emergency Physicians and serves on the Board of Trustees of the Society of Chest Pain Centers [17]. He recently finished his first Novel, Nashville Skyline, and is seeking a publisher.

Cardiac Papers
Fesmire FM, MacMath TL: The ECG in acute myocardial infarction. J Emerg Med 1988; 6:405-410. PMID: 3225450]

Fesmire FM, Wears RL: The utility of the presence or absence of chest pain in patients with suspected acute myocardial infarction. Am J Emerg Med 1989; 7:372-377. PMID: 2500132

Fesmire FM, Percy RF, Wears RL, MacMath TL: Risk statification according to the initial ECG in patients with suspected acute myocardial infarction. Arch Int Med 1989; 149: 1294-1297. PMID: 2730248

Fesmire FM, Percy RF, Wears RL, MacMath TL: The initial ECG in Q wave and non-Q wave myocardial infarction. Ann Em Med 1989; 18:741-746. PMID: 2735591

Fesmire FM, Wears RL, Percy RF: In-hospital outcome in patients with coronary artery disease who rule-out for myocardial infarction (letter). N Engl J Med 1989; 320:1423-24. PMID: 2716794

Fesmire FM, Percy RF, Wears RL: Diagnostic and prognostic importance of the previous ECG in comparison to the initial ECG in patients admitted for suspected acute myocardial infarction. South Med J 1991; 84:841-846. PMID: 2068623

Fesmire FM, Percy RF, Wears RL, Baxt WG: Decision making in patients with suspected acute myocardial infarction (letter). Ann Emerg Med 1992; 22:1167-1168. PMID: 1514736

Fesmire FM, Smith EE: Continuous 12-lead electrocardiograph monitoring in the emergency department. Am J Emerg Med 1993; 11:54-60. PMID: 8447874

Fesmire FM, Bardonner JB: ST-segment instability preceding simultaneous cardiac arrest and acute myocardial infarction in a patient undergoing continuous 12-lead electrocardiographic monitoring. Am J Emerg Med 1994; 12:69-76. PMID: 8285979

Fesmire FM, Wharton DR, Calhoun FB: Instability of ST-segments in the early stages of acute myocardial infarction in patients undergoing continuous 12-lead ECG monitoring. Am J Emerg Med  1995; 13: 158-163. PMID: 7893299

Fesmire FM: Chest pain treatment center (letter). Ann Emerg Med; 1995;26:104-105. PMID: 7646699

Fesmire FM: Modified limb lead placement for rapid ECG (editorial). Am J Emerg Med 1995;13:603-604. PMID: 7662065

Fesmire FM: ECG diagnosis of acute myocardial infarction in the presence of LBBB in patients undergoing continuous ECG monitoring. Ann Emerg Med; 1995; 26:69-82. PMID: 7793725

Fesmire FM, Percy RF, Bardonner JB, Wharton DR, Calhoun FB: Usefulness of Automated Serial ECG Monitoring During the ED Evaluation of Chest Pain Patients. Ann Emerg Med 1998; 31:3-11. PMID: 9437335

Fesmire FM: Unnecessary Thrombolysis (letter). Ann Emerg Med 1997;29:553-554. PMID: 9095023

Fesmire FM, Percy RF, Bardonner JB, Wharton DR, Calhoun FB: Serial CK-MB Testing During the Emergency Department Evaluation of Chest Pain: Utility of a 2 hour Delta CK-MB of +1.6 ng/ml. Am Heart J 1998:136:237-244. PMID: 9704684

Fesmire FM: Delta CK-MB outperforms delta Troponin I at 2 hours during the initial ED evaluation of chest pain. Am J Emerg Med 2000;18:1-8. PMID: 10674522

Fesmire FM: A rapid rule out protocol for identification and exclusion of acute myocardial infarction: Continuous 12-lead ECG monitoring in conjunction with the 2-hour ΔCK-MB. Am J Emerg Med 2000;18:698-702. PMID: 11043626

Fesmire FM: Which chest pain patients potentially benefit from continuous 12-lead ST-segment monitoring with automated serial ECG. Am J Emerg Med 2000;18:773-778. PMID: 11103727

Fesmire FM, Hughes AD, Stout PK, et al: Selective dual nuclear scanning in low risk patients with chest pain to reliably identify and exclude acute coronary syndromes. Ann Emerg Med 2001;38:207-215. PMID: 11524638

Fesmire FM: Improved identification of acute coronary syndromes with delta cardiac serum marker measurements during the emergency department evaluation of chest pain patients. Cardiovasc Toxicol 2001; 1:117-123. PMID: 12213983

Fesmire FM, Fesmire CE: Improved identification of acute coronary syndromes with second generation cardiac troponin I assay: Utility of 2-hour delta cTnI > + 0.02 ng/ml. J Emerg Med 2002; 22:147-152. PMID: 11858918

Fesmire FM, Eriksson SV, Stout PK, et al: Use of Baseline ST-Vector Magnitude to Identify Electrocardiographic Injury in Patients with Suspected Acute Myocardial Infarction. Am J Emerg Med 2002; 20:535-540. PMID: 12369028

Fesmire FM, Hughes AD, Fody EP, Stout PK, et al: The Erlanger chest pain evaluation protocol: A one year experience with serial 12-lead ECG monitoring, 2-hour delta serum marker measurements, and selective nuclear stress test to identify and exclude acute coronary syndromes. Ann Emerg Med 2002; 40: 584-594. PMID: 12447334

Fesmire FM, Peterson ED Roe MT, Wojcik JF: Early utilization of IIb/IIIa inhibitors in the the emergency department treatment of acute coronary syndromes: A local quality improvement initiative. Am J Emerg Med 2003;21:302-308. PMID: 12898487

Fesmire FM: Electrocardiographic ST-elevation: a source of error or source of burden to emergency physicians (editorial). Am J Emerg Med 2004;22:120-122. PMID: 15011229

Fesmire FM, Eriksson SV: Vectorcardiography risk stratifies chest pain patients with left ventricular hypertrophy on the initial ECG. Annals Noninvasive Electrocardiology 2004; 9:149-155. PMID: 15084212

Fesmire FM, Christenson, Fody EP, Feintuch. Delta CK-MB outperforms myoglobin at 2 hours during the ED identification and exclusion of troponin positive non-ST segment elevation acute coronary syndromes. Ann Emerg Med 2004; 44:12-19. PMID: 15226704

Fesmire FM. Improving Care in Patients with Acute Coronary Syndromes: The Erlanger Quality Improvement Initiative. Crit Pathways in Cardiol 2004;3:158-164. PMID: 18340159

Fesmire FM, Jagoda A. Are we putting the cart ahead of the horse: who determines the standard of care for management of patients in the emergency department? Ann Emerg Med 2005: 46:198-200. PMID:16046953

Fesmire FM. Utility of ST segment deviation sum score and change score in identification of acute myocardial infarction. Am J Emerg Med 2010; in press.

Clinical Guidelines
American College of Emergency Physicians: Clinical policy for the initial approach to adults presenting with a chief complain of chest pain, with no history of trauma. Ann Emerg Med 1995; 25:274-299. PMID: 7832368

American College of Emergency Physicians: Clinical policy: Critical issues in the evaluation and management of patients with acute myocardial infarction or unstable angina. Ann Emerg Med 2000; 35:521-544. PMID: 10783419

American College of Emergency Physicians: Clinical policy: Critical issues in the evaluation and management of patients presenting with suspected pulmonary embolism. Ann Emerg Med 2003;41:123-133. PMID: 12548278. acep.org, 2003.

American College of Emergency Physicians: Clinical policy: Critical issues in the evaluation and management of patients presenting with suspected lower-extremity deep venous thrombosis. Ann Emerg Med 2003;42:124-135. PMID: 12827132. acep.org, 2003.

Fesmire FM, Brady WJ, Hahn S, et al. Clinical Policy: Indications for Reperfusion Therapy in Emergency Department Patients with Suspected Acute Myocardial Infarction. Ann Emerg Med 2006; 48:358-383. PMID: 16997672. acep.org, 2006.

Fesmire FM, Decker WW, Diercks DB, et al. Clinical Policy: Critical issues in the evaluation and management of adult patients with non-ST-segment elevation acute coronary syndromes. Ann Emerg Med 2006; 48:270-301. PMID: 16934648. acep.org,2006.

ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American 	College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing 	Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction). Circulation 2007;116:e148-304. PMID: [ http://www.ncbi.nlm.nih.gov/pubmed/17679616 17679616]. circ.ahajournals.org, 2008.

American College of Cardiology/American Heart Association Task Force on Perfomrance Measures. ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.Circulation 2008;118:2596-2648. PMID: 19001027. circ.ahajournals.org, 2008.

Humanities in Medicine
Fesmire FM: An intern's kiss. Am J Emerg Med 1989; 7:663. PMID: 2625527

Fesmire FM: Ode to a tired physician. J Emer Med 1996;14:517-518.