Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Factors associated with failure of noninvasive positive pressure ventilation in the emergency department.
To determine the factors associated with failure of noninvasive positive pressure ventilation (NPPV) in patients presenting with acute respiratory failure to the emergency department (ED). ⋯ Patients with pH < or = 7.35 and an RR > or =20 min(-1) after one hour of NPPV had an increased risk of subsequent endotracheal intubation.
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Comparative Study
Resident efficiency in a pediatric emergency department.
To measure the hourly rate of patients evaluated and treated by resident physicians in an academic pediatric emergency department (PED) and examine differences in the rate by subspecialty and year of training. ⋯ Significant differences in the rate of patients evaluated and treated in the PED exist by resident subspecialty and year of training. Knowing these rates is helpful in evaluation of resident performance, because it allows comparison with peers. Additionally, such information may be useful for residency program evaluators to gauge the amount of patient exposure for residents.
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Comparative Study
Changing opioid use for right lower quadrant abdominal pain in the emergency department.
To compare the use of opioid analgesia in the treatment of emergency department patients with acute right lower quadrant (RLQ) abdominal pain between 1998 and 2003 and to explore the relationship between opioid use and abdominal computed tomography (CT) scanning. ⋯ Opioid administration to patients with RLQ pain has dramatically increased between 1998 and 2003. During these five years, the number of patients receiving opioids more than doubled and the time to first administration of opioids decreased by one hour. The authors show that this cannot be attributed to an increased use of CT scanning.
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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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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.