Annals of emergency medicine
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A program of physician training in the specialty of emergency medicine was developed in Costa Rica, Central America, during the years 1993 and 1994. The program involved 2 phases: a faculty preparation course, and the residency itself. The preparation of faculty members for the residency was undertaken in Costa Rica, with a US emergency faculty physician residing in the host country to assist in the development of the program. ⋯ The first emergency medicine specialists graduated from the 3-year training program in 1997. The residency program continues to function at the time of this publication. This description is offered as one model for the initiation of emergency medicine specialty training in a developing country.
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Emergency department patients who require intravenous access but lack peripheral intravenous sites frequently require central line placement. Blind percutaneous brachial vein cannulation has been proposed as an alternative in these patients but is associated with high failure and complication rates. We evaluated an ultrasound-guided approach to percutaneous deep brachial vein or basilic vein cannulation in ED patients with difficult intravenous access. ⋯ Ultrasound-guided brachial and basilic vein cannulation is safe, rapid, and has a high success rate in ED patients with difficult peripheral intravenous access.
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To determine the predictive value of the rate of change of serial beta-human chorionic gonadotropin (hCG) values in patients with symptoms suggestive of ectopic pregnancy but who have indeterminate transvaginal ultrasound findings, and to determine whether the predictive value was enhanced depending on whether the endometrial cavity was empty at ultrasound examination. ⋯ The rate of change of serial beta-hCG values, in patients with an indeterminate pelvic ultrasound examination, is predictive of ectopic pregnancy. Addition of whether the endometrial cavity is empty at ultrasound leads to a further improvement in predictive accuracy.