Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To examine presentations and prevalence of head injury among elder victims of blunt trauma and to estimate the prevalence of occult injuries associated with a normal level of consciousness, absence of neurologic deficit, and no evidence of significant skull fracture. ⋯ Elder patients with head trauma are at higher risk of developing a significant intracranial injury, including subdural and epidural hematoma. An occult presentation is also more common in elders.
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Medical knowledge is one of six core competencies identified by the Accreditation Council for Graduate Medical Education. The authors present a tool for assessment of medical knowledge developed by the Council of Emergency Medicine Residency Directors. ⋯ The result is a collaborative specialty-wide approach to the common problem of formatting tests to assess medical knowledge. The tool has been widely accepted by both residents and residencies.
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Delta opioids have been shown to confer ischemic preconditioning and pharmacologic ischemic preconditioning to the myocardium. However, their role in providing extended pharmacologic ischemic preconditioning in hemorrhagic shock has not been explored. The authors examined the effects of 24-hour preinfusions of a selective delta opioid receptor agonist, Deltorphin-Dvariant (Delt-Dvar), on hemodynamic stability and duration of survival in a rat model of severe hemorrhagic shock. ⋯ Twenty-four-hour pretreatment with Delt-Dvar decreases plasma lactate levels and improves hemodynamic stability and survival during hemorrhagic shock. The use of delta-specific opioids may improve survival from hemorrhagic shock and have clinical utility in providing ischemic protection in scenarios of planned ischemia.
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Verapamil is a lipid-soluble calcium channel blocker with significant mortality in overdose. Previous investigators have demonstrated the benefit of lipid emulsion therapy in ameliorating toxicity from lipid-soluble agents. The authors investigated the effect of Intralipid treatment in a rat model of verapamil toxicity. ⋯ Intralipid treatment prolongs survival and doubles median lethal dose in a rat model of verapamil toxicity. The mechanism of action remains to be elucidated.