The American journal of emergency medicine
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A novel strategy using videotape recordings of initial trauma resuscitations was incorporated into the quality assurance program at a level 1 trauma center. Described are the process of taping the resuscitations, the multidisciplinary nature of the resuscitation team, the security measures taken to assure patient confidentiality, and the review process involved. The videotape review process was incorporated into a multidisciplinary educational trauma conference. ⋯ The videotape process allowed an unblased, indisputable accurate documentation of the sequential application of the protocols of evaluation and resuscitation espoused in the ATLS course. We found 23% overall deviation from ATLS resuscitation principles, with at least one aspect of the resuscitation deviating from expected ATLS performance in 64% of the patients. In addition to documenting adherence to ATLS principles, this study illustrated the impact of the videotape review process on the education of eight senior residents in surgery.
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A case is presented of simultaneous uvulitis and epiglottitis in an afebrile patient without elevation in the white blood cell count. This case is reported to illustrate the need for a high index of suspicion for the rare association of uvulitis and epiglottitis.
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A study was undertaken to determine if use of a structured review instrument (SRI) increased the perceived overall satisfaction with a journal club in a group of emergency medicine residents. Before and 6 months after the introduction of a structured checklist format for article review, a 5-point Likert scale (1 = worst, 5 = best) was used to assess residents' satisfaction with the journal club, as well as the following subsidiary outcome parameters resident and leader workload, educational value in interpreting the medical literature, and application of the information to clinical practice. Additional measured outcome variables included resident attendance and number of articles read per attendee. ⋯ Following introduction of the SRI, residents were more satisfied with the journal club (3.8 v 3.2, P < .05). There was no change in resident attendance (92% v 71%, P = .65), total articles read (75% v 70%, P = .33), or perceived workload (3.3 v 3.1; P = .3). The use of a SRI was found to increase resident satisfaction and improve the perceived educational value of a journal club without increasing residents' workload or decreasing attendance.
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Case Reports
Vomiting, ataxia, and altered mental status in an adolescent: late-onset ornithine transcarbamylase deficiency.
A case of a 13-year-old boy with protracted vomiting, ataxia, and altered mental status, ultimately diagnosed with late-onset ornithine transcarbamylase (OTC) deficiency, is presented. OTC deficiency is the most common urea cycle defect and typically is diagnosed in male infants with irritability, poor feeding, vomiting, lethargy, and often death caused by the effects of hyperammonemia. Late-onset OTC deficiency has been described in patients of all ages. ⋯ The pathophysiology, clinical features, differential diagnosis, and treatment of this disorder are discussed. Because of the risks of serious consequences, early detection and treatment of OTC deficiency and hyperammonemic episodes are mandatory. Emergency physicians caring for children and adults need to be aware of the spectrum of clinical presentations of OTC deficiency, including late-onset disease.
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Thromboembolic events such as deep vein thrombosis (DVT) and pulmonary embolism (PE) are very uncommon in the pediatric age group; even more rare is the white clot syndrome. We present the case of a 13-year-old girl who presented with no known risk factors for thromboembolic disease or cardiopulmonary complaints, yet was found to have extensive lower extremity DVT and PE. This patient also suffered the rare but potentially devastating complication of heparin therapy referred to as the white clot syndrome, resulting in amputation of the lower extremity. Greater awareness of both thromboembolic disease in children and the white clot syndrome may lessen the morbidity and mortality associated with these entities.