The American journal of emergency medicine
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The objective was to investigate the use characteristics of home nebulizers and to measure the benefit gained from dispensing home nebulizers (compared with their cost) to patients from the hospital. During the study period, August 28,1996 to May 17,1997, a sample of 232 of the 291 entries from a log of home nebulizers dispensed by the hospital respiratory care department were surveyed over the telephone. Of the 232 study subjects under the age of 21, a telephone interview of a guardian or supervising adult was completed in 106 subjects (46%) a mean of 43 weeks after the home nebulizer was prescribed (47% of the cohort received their home nebulizers from the inpatient service and another 47% were discharged with home nebulizers from the emergency department (ED)). ⋯ Hospital inpatient units and EDs which have the ability to dispense a home nebulizer, have an additional therapeutic option available for selected patients who may benefit from it. Medical insurance companies should fully support (ie, pay for) home nebulizers because it is cost effective. If there is any concern about the reliability of the patient to follow-up with their primary physician, the patient's primary physician should be contacted to discuss the feasibility of discharging the patient with a home nebulizer.
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We conducted an anonymous moonlighting and academic practice survey of all emergency medicine residents enrolled in accredited programs during 1997. Expanding on previous work, this survey included specific details and practice trends of moonlighting emergency medicine residents and for comparison also included academic work requirements. The typical emergency residency program requires residents to work 204 hours monthly. ⋯ Half of all residents surveyed, whether involved in moonlighting practice or not, would violate a ban on the practice. Residents universally felt that moonlighting enhanced residency performance and was a positive educational experience. Use of these data may aid in the development of formal guidelines regarding emergency medicine moonlighting practice.
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Posterior shoulder dislocation is a relatively uncommon event, with an incidence of 1% to 4% of all shoulder dislocations. Because of the infrequency of this condition, the diagnosis is often missed, with significant consequences to the patient Injury in the athlete is usually from a direct blow or fall onto an outstretched arm. ⋯ A careful history and physical examination, complete radiographic evaluation, and a high level of suspicion are required to identify posterior shoulder dislocation. Treatment consists of prompt closed reduction, or operative repair if this is unsuccessful.
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Seven cases of hydrogen cyanide gas poisoning which occurred in an industrial building in Hong Kong are presented here. Two of them were more severely injured and required specific antidotal treatment. The other five were mild and responded to supportive treatment alone. ⋯ Cyanide poisoning is relatively uncommon in urbanized area, so high index of suspicion is important for early diagnosis and treatment. We believe that prevention of cyanide poisoning can be achieved by proper storage of chemicals, and by enforcing rescuers to wear special chemical protective clothing to avoid systemic poisoning because of dermal absorption of hydrogen cyanide gas. As there are newer and safer cyanide antidotes available, each emergency department should have a stock of updated products such as hydroxocobalamin.
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Nineteen emergency medicine (EM) physicians (14 residents and 3 attendings) from an EM residency program which teaches ultrasound as part of the curriculum, were asked to rate 40 ultrasound scans showing different degrees of kidney hydronephrosis, first solely on the basis of their prior knowledge and experience. One week later, after a brief 15 minute lecture on a new objective method to read degrees of hydronephrosis, the same EM physicians were again asked to rate the 40 ultrasounds. One month later, to assess retention of the method, the same physicians were asked to read the same scans using the objective method presented 1 month prior. ⋯ Agreement of the group regarding scan interpretation improved and was maintained after the educational intervention (multirater kappa + .19, .32, and .32 for the three tests administered). When the differences between each week's readings and the gold standard were assessed, differences decreased with each successive test, and were statistically significant with the third test (P = .029). We conclude that our brief educational intervention improves agreement among physicians in readings of ultrasound scans and also significantly increases accuracy in readings when compared with a gold standard.