Annals of emergency medicine
-
The retention of knowledge and skill proficiency was evaluated for emergency care attendants (ECAs), emergency medical technicians (EMT-As) and paramedics (EMT-Ps). The sample represented 4.1% of the total number of individuals trained and certified in these positions in Texas. The average loss of didactic knowledge did not exceed 10% over a two-year period. ⋯ Participants in continuing education programs experienced an 11% better retention average for skill than did nonparticipants. The employees of privately operated ambulance services retained their basic skills better than did members of other types of services. The rate of knowledge deterioration for the sample evaluated was not correlated (R = 0.08) to the original written score.
-
We present the case of a patient with traumatic ventricular septal defects following blunt chest trauma. The pathophysiology and clinical presentation of the lesion are discussed. Definitive diagnostic procedures should be performed immediately in patients with suggestive findings to establish the diagnosis and to determine the magnitude of the shunt and the presence of pulmonary hypertension.
-
Adherence to physician-developed process criteria is critical to the medical and legal acceptance of algorithm-directed nonphysician care of acute non-life-threatening illnesses seen in the emergency department. It is generally assumed that adherence to prescribed medical process criteria results in acceptable patient outcomes. ⋯ Our evaluation indicated that, under ideal circumstances of daily audit and supervisory feedback, a conformance rate of 80% was achieved. This is a 100% improvement over a group in which neither element was operative.
-
A case of severe methemoglobinemia and hemolytic anemia following ingestion of 5.6 gm of phenazopyridine with suicidal intent by a 16-year-old woman was successfully treated with intravenous methylene blue. Methemoglobinemia was suspected in this patient because of her intense central cyanosis, chocolate-colored blood, and minimal dyspnea. The patient's peripheral blood smear exhibited "bite cells." To the best of our knowledge, this is only the third such case reported in the literature. The pathophysiology, diagnosis, and therapy are reviewed.