Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Despite an increasing number of elderly emergency department (ED) patients, emergency medicine (EM) residency training lacks geriatric-specific curricula. The objective was to determine if a 1-year geriatric curriculum, designed for residents, would affect residents' attitudes, knowledge, and decision-making for older patients seen in the ED. ⋯ Geriatric educational curricula for EM residents may positively affect knowledge base and appropriate decision-making when working with older adults in the ED. These educational enhancements may place elderly patients at less risk of adverse outcomes.
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A left lateral tilt of 15° has been advocated during trauma resuscitation of near-term pregnant patients to avoid the potential for hemodynamic compromise caused by aortocaval compression in the supine position. This recommendation is supported by limited objective evidence, and an experimental determination of the optimal tilt required would be very difficult to accomplish logistically. A derivation of the Guyton/Coleman/Summers computer model of cardiovascular physiology was used to analyze the theoretically expected hemodynamic responses to varying degrees of lateral tilt for a normal pregnancy and during a simulated hemorrhagic shock. ⋯ Current trauma guidelines suggest that the pregnant trauma patient be placed in a 15° left lateral tilt position to prevent aortocaval compression. A computer simulation study suggests that this tilt may be inadequate to offload the vena cava and normalize the circulation.
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The future of academic emergency medicine (EM) is based on the continued successful recruitment and cultivation of new faculty from EM residents. Little data exist as to the current rate of residents initially choosing an academic career path or which residency programs are best situated to result in new faculty. ⋯ Our data indicate that program region, size, and research productivity were best associated with academic career selection. Program length was not found to be significantly associated with academic career selection by residents, in contrast to previous studies. While many of these factors are not changeable, academic productivity can be cultivated by decision-makers wishing to increase their residents' academic career selection as opposed to changing program length to extend training for an additional year. It is our belief that our model provides a good description of programmatic factors affecting career choice. Additional research is necessary to further validate these findings, as well to provide important context to their general applicability for policy-makers and program directors.
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An abnormal field Glasgow Coma Scale (GCS) score of ≤13 has been used in our emergency medical services (EMS) system to prompt transport to a trauma center. For elders, Ohio has recently adopted a GCS of ≤14 to prompt EMS transport to a trauma center, as older patients respond differently to trauma and may benefit from a different GCS threshold. This study sought to determine if a field GCS of 14 is an appropriate cutoff to initiate transport to a trauma center among injured elders. ⋯ Changing the EMS trauma triage cutoff for elders from GCS 13 to GCS 14 results in improved sensitivity for clinically relevant outcomes. In injured elders, the decline in GCS from 15 to 14 is associated with increased mortality, a finding not observed in younger adults. Elders with GCS 14 have greater odds of mortality and TBI than adults with GCS 13. These results support recent changes in EMS trauma triage guidelines for elders adopted in Ohio.
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The purpose of this study was to determine the effect of an automated procedure logging (APL) system on the number of procedures logged by emergency medicine (EM) residents. Secondary objectives were to assess the APL's effect on completeness and accuracy of procedure logging and to measure resident compliance with the system. ⋯ There was a significant increase in the daily mean number of procedures logged after the implementation of APL. Recorded data were more complete and more accurate during this time frame. This innovative system improved resident logging of required procedures and helped our assessment of Accreditation Council for Graduate Medical Education (ACGME) Patient Care and Practice-Based Learning Competencies for individual residents.