Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Emergency physicians accurately interpret video capsule endoscopy findings in suspected upper gastrointestinal hemorrhage: a video survey.
Acute upper gastrointestinal (GI) hemorrhage is a common emergency department (ED) presentation whose severity ranges from benign to life-threatening and the best tool to risk stratify the disease is an upper endoscopy, either by scope or by capsule, a procedure performed almost exclusively by gastroenterologists. Unfortunately, on-call gastroenterology specialists are often unavailable, and emergency physicians (EPs) currently lack an alternative method to endoscopically visualize a suspected acute upper GI hemorrhage. Recent reports have shown that video capsule endoscopy is well tolerated by ED patients and has similar sensitivity and specificity to endoscopy for upper GI hemorrhage. ⋯ After brief training, EPs can accurately interpret video capsule endoscopy findings of presence of gross blood or no blood with high sensitivity and specificity.
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Comparative Study
How competent are emergency medicine interns for level 1 milestones: who is responsible?
The Next Accreditation System (NAS) of the Accreditation Council for Graduate Medical Education (ACGME) includes the implementation of developmental milestones for each specialty. The milestones include five progressively advancing skill levels, with Level 1 defining the skill level of a medical student graduate, and Level 5, that of an attending physician. The goal of this study was to query interns on how well they thought their medical school had prepared them to meet the proposed emergency medicine (EM) Level 1 milestones. ⋯ Many entering EM interns may not have had either teaching or assessment on the knowledge, skills, and behaviors making up the Level 1 milestones expected for graduating medical students. Thus, there is a potential gap in the teaching and assessment of EM interns. Based on these findings, it is unclear who will be responsible (medical schools, EM clerkships, or residency programs) for ensuring that medical students entering residency have achieved Level 1 milestones.
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The objective was to evaluate the accuracy of pediatric emergency physician (EP) sonography for infants with suspected hypertrophic pyloric stenosis (HPS). ⋯ Trained pediatric EPs can accurately assess the pylorus with US in the evaluation of HPS with good specificity.
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Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department (ED). Little is known about the aggregate costs of ED evaluations for these patients. The authors sought to estimate the annual national costs associated with ED visits for dizziness. ⋯ Total U.S. national costs for patients presenting with dizziness to the ED are substantial and are estimated to now exceed $4 billion per year (about 4% of total ED costs). Rising costs over time appear to reflect the rising prevalence of ED visits for dizziness and increased rates of imaging use. Future economic studies should focus on the specific breakdown of total costs, emphasizing areas of high cost and use that might be safely reduced.
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Comparative Study
The diagnostic value of serum ischemia-modified albumin levels in experimentally induced carbon monoxide poisoning and their correlation with poisoning severity.
The objectives were to determine the diagnostic value of blood ischemia-modified albumin (IMA) levels in experimentally induced carbon monoxide (CO) poisoning and to analyze their correlation with poisoning severity. ⋯ Ischemia-modified albumin levels are higher in rats exposed to CO. This indicates that IMA levels can potentially be important in the diagnosis of exposure to CO or of CO poisoning. However, IMA levels are not a good biochemical marker in terms of determining the severity of poisoning.