Annals of emergency medicine
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Despite an excellent military experience with the use of the "universal donor" as an immediately available blood component, considerable reluctance to use uncrossmatched Group O packed cells (TOB) remains. In addition, problems continue with rapid blood acquisition in the emergency department. To study the safety of TOB used as an immediate resuscitation component, a 30-month prospective study of all patients arriving at a single trauma unit was undertaken. ⋯ All patients were followed clinically and by the blood bank for any signs of transfusion reactions or incompatibility throughout their hospital courses; none developed. There were no deaths related to transfusion incompatibility. We conclude that TOB used as an immediate resuscitative blood component is safe.(ABSTRACT TRUNCATED AT 250 WORDS)
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The growing number of elderly in the United States will continue to increase the demand for emergency services. Although the emergency medicine core curriculum, as defined by the American College of Emergency Physicians, requires mandatory training in pediatrics, there is no mention of geriatric care. A special body of knowledge regarding normal aging as well as the special presentation of disease in the elderly is required to provide optimum care for the aged patient. ⋯ This curriculum identifies specific educational objectives for training in geriatric emergencies that can be summarized as follows: identify those impairments and functional disorders that often complicate diagnosis and therapy; acquire an understanding of how physiologic changes in aging affect normal laboratory and radiologic values; develop knowledge of drug side effects and interactions in this population; understand and treat the group of disease peculiar to the elderly; recognize diseases and injuries that present a different clinical picture in old age; and differentiate and treat common psychosocial emergencies in the elderly. These educational objectives are further defined using a specific interlinked framework of didactic presentations, journal clubs, case conferences, therapeutic audits, formal rotations, and consultants. This format will provide valuable educational experiences for the emergency medicine resident and may strengthen positive attitudes toward geriatric medicine.