Annals of emergency medicine
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Endorsed emergency medicine (EM) residency programs were surveyed as to the nature and extent of training they provided in pediatric emergency care (PEC). In the surveys returned (82%) there were several important findings. The amount of time in PEC training was generally two months per year of training. ⋯ The training program directors were equally divided in their satisfaction with this aspect of their programs. Changes were recommended by 80% of the directors. Changes most often suggested were increasing pediatric patient exposure and obtaining PEC specialists as trainers.
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Reported is a case of ethanol-induced hypoglycemic coma in a 33-month-old boy after accidental ingestion of ethanol. Blood glucose was 10 mg% and blood ethanol was 71 mg%. ⋯ The pathophysiology and clinical presentation of this not uncommon metabolic disorder are discussed. A plan for early recognition and management is presented.
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Medical experiences encountered in the activities of an emergency department are important for the development of a well-trained internist. Therefore, a rotation in the emergency department must remain an integral part of any program in internal medicine. ⋯ The faculty attendings provide supervision, immediately available consultation, and an on-going curriculum, including daily lectures and chart review. The results of their programmatic change have been the following: 1) enthusiasm and satisfaction on the part of the housestaff; 2) a 20+ increase in admissions to the hospital from the emergency department; 3) decreased utilization of the observation unit; and 4) fewer patients leaving without being examined.
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Methemoglobinemia must be considered in the differential diagnosis of the cyanotic patient. Methemoglobin cannot carry oxygen or carbon dioxide. ⋯ Severe cases may result in hypoxia and require treatment with methylene blue. Not all cases respond to methylene blue, and methylene blue itself may produce serious side effects.