Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Assessment of a new method to distinguish esophageal from tracheal intubation by measuring the endotracheal cuff pressure in a porcine model.
With the knowledge of differences in anatomic structures between the trachea and the esophagus, the authors conducted an animal study to evaluate the usefulness of endotracheal cuff pressure in distinguishing endotracheal and esophageal intubations. ⋯ The cuff pressure in the esophageal intubation was significantly higher than that in the endotracheal intubation under the same inflated volume from 1 to 10 mL. This may provide the basis for an adjunctive, simple, rapid, and reliable method to verify endotracheal intubation.
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On September 18, 2003, Hurricane Isabel made landfall as a category 2 hurricane over the mid-Atlantic region, generating record conditions for the region's 27 years of monitoring. The purpose of this study was to investigate the impact of the hurricane on the number and type of emergency department (ED) patient visits and its impact on hospital admission rate from the day of landfall to day 5 postlandfall. Comparisons were made with a control group, which comprised average daily ED census during the six-month period preceding landfall and the average daily admission rates for the preceding six months. ⋯ A significant overall reduction in ED visits by almost half the typical average volume was noted on the day of landfall (-46%). During the four days immediately following landfall, however, there was a marked increase in the overall ED census, with a particularly high increase on day 1 postlandfall. The largest complaint category increase was minor trauma (+57%). Hospital admission rates were highest on the day of landfall and seemed to return to baseline on day 1 postlandfall. These data may be useful for structuring ED personnel and hospital resource allocation to better serve its community during hurricane preparedness planning.
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Systems-based practice is one of the six core competencies implemented by the Accreditation Council for Graduate Medical Education to direct residency educational outcome assessment and accreditation. Emergency medicine-specific systems-based practice criteria have been described to define the expected knowledge and skill sets pertinent to emergency medicine practitioners. High-fidelity patient simulation is increasingly used in graduate medical education to augment case-based learning. The authors describe a simulation-based curriculum to address the emergency medicine-specific systems-based practice core competency.
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The survival of patients who present to the emergency department with severe injury or illness is dismal. Resuscitation researchers are interested in advancing the science of resuscitation, and clinical studies must be conducted to determine the best treatment protocols. These studies must reflect good science and must balance individual patient autonomy and safety with scientific progress that benefits society as a whole. ⋯ There is concern and some evidence that the federal guidelines have impeded the advancement of resuscitation science. Several strategies have been suggested to improve the situation. These include 1) better education of resuscitation researchers regarding the federal guidelines, 2) a toolbox for resuscitation researchers clarifying the guidelines, 3) advocacy for the advancement of resuscitation science as a public good, and 4) a national research advisory board that provides unbiased reviews of clinical studies and guidelines for local institutional review boards regarding risks, benefits, and communication strategies for waiver of and exception from consent proposals.