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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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.
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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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A simple 10-point scale was devised for the purpose of determining which trauma patients should go to a trauma center. The acronym "CRAMS" represents the five components measured: Circulation, Respiration, Abdomen, Motor, and Speech. The results of field triage were compared to final emergency department (ED) disposition. ⋯ This was compared to 8 defined as major trauma by Champion's Trauma Score. Of 313 defined as minor trauma by ED disposition (discharged home), 307 were defined as minor trauma (CRAMS greater than or equal to 9) in the field (specificity, 98%). The CRAMS scale provides an effective net for major trauma while ensuring that minor trauma is not unnecessarily diverted to a trauma center.