Annals of emergency medicine
-
Although we commonly assume that because residents spend a given number of months in the emergency department they achieve adequate exposure to all necessary clinical entities, this has never been shown. We suspect, rather, that great variability exists among residents in the number and variety of patients they see; and that with respect to the ED, there are important diagnoses that are rare or absent in the clinical pathology of a training program. To confirm these hypotheses, we implemented a computerized system of recording patients and diagnoses managed in the ED by the 33 residents of the University of Illinois Affiliated Hospitals Emergency Medicine Residency. ⋯ In this study, residents fell short of these guidelines with 50.5% of diagnoses. While absolute quantity of exposure does not assure competence in management, we recommend that each residency monitor the experience of its residents. This allows a residency to change its curriculum to make optimum use of available pathology, as well as to supplement deficiencies in clinical experience with case simulations.
-
Anaphylactic reactions to Crotalidae envenomation are extremely rare. The presentation of anaphylaxis after envenomation can be a confusing variable in the timely diagnosis of both problems. ⋯ His symptoms resolved after administration of 0.8 mg SQ epinephrine, 100 mg IV diphenhydramine, 2,000 mL normal saline IV, and 250 mg IV methylprednisolone. Only one previous case report of anaphylactic shock from a rattlesnake bite could be found in the medical literature.