Annals of emergency medicine
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Garter snake bites are generally innocuous to human beings. We report a case of human envenomation from the Wandering Garter snake (Thamnophis elegans vagrans). The patient, who was bitten on his right third fingertip, rapidly developed local edema, ecchymosis, and hemorrhagic vesicles. ⋯ The clinical picture was similar to that in three previous patients with Thamnophis envenomation in that clinical signs followed a prolonged bite. Thamnophis species have Duvernoy's glands, which may be analogous to venom glands in Crotalidae (pit viper) species. The progressive local effects produced by secretions of these glands may be confused with early Crotalidae envenomation.
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Comparative Study
Work-related stress and depression among practicing emergency physicians: an international study.
To compare the levels of work-related stress and depression reported by practicing emergency physicians in three survey sites and to determine the effects of gender and marital status on the stress and depression experienced by these physicians. ⋯ Statistical differences among practicing emergency physicians from the United States, Australasia, and the United Kingdom were observed, but the actual levels of work-related stress and depression were similar and did not appear severe. Marriage was associated with lower levels of depressive symptomatology.
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To characterize the role of emergency medicine residency programs in determining emergency medicine career choice among medical students. ⋯ An emergency medicine residency program that is closely affiliated with a medical school is strongly and independently associated with a quantitatively and statistically significant increase in the proportion of students from that school who choose a career in emergency medicine. These data support the proposition that, if emergency medicine is to meet national manpower shortage needs by attracting students to the specialty, it must establish residency programs within the primary teaching hospital(s) of medical schools. Such a configuration does not currently exist in the majority of schools.
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Comparative Study
Chemical dependency in emergency medicine residency programs: perspective of the program directors.
To evaluate the educational background, knowledge, and experiences regarding chemical dependency among emergency medicine program directors. The program directors' awareness of substance use and alcohol abuse among emergency medicine residents was examined by comparing their estimates with the actual rates reported by the residents. ⋯ Emergency medicine program directors must be more attentive to potential alcohol abuse among emergency medicine residents and should receive additional education regarding chemical dependency.
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Presented is the case report of a toddler who suffered delayed-onset paraplegia after a motor vehicle accident. An improperly used adult lap belt is postulated as the etiology causing a probable vascular event with ischemic injury to the distal cord; however, recurrent cord injury from presumed occult spinal instability was a possible explanation. This case highlights that the syndrome of spinal cord injury without radiographic abnormality can present subtly (in this case, foot "pain"), that full neurologic manifestations can be delayed, and that good neurologic recovery is possible.