Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To examine how emergency department (ED) overcrowding has been defined in the medical literature. ⋯ Although ED overcrowding has been a topic of frequent investigation, current definitions of the problem are often implicit or focus on factors outside of the ED itself. A more consistent approach to defining ED overcrowding would help to clarify the distinctions between causes, characteristics, and outcomes of overcrowding.
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Overwhelming gram-negative bacterial infection and life-threatening systemic inflammation are widespread problems in critically ill emergency department patients. Currently, the treatment of these patients is largely supportive, focusing on antibiotics, fluids, hemodynamic and ventilatory support, and intensive monitoring. The only Food and Drug Administration-approved pharmaceutical agent for the treatment of sepsis is activated protein C, with its use largely relegated to the intensive care unit. ⋯ High mobility group box 1 (HMGB1), a protein previously known only as a nuclear transcription factor, is now implicated as a late mediator of sepsis. Targeting late mediators of lethal systemic inflammation represents a novel approach that may widen the therapeutic window and lead to new strategies for inhibiting the deleterious effects of the inflammatory cascade. Here the authors review the studies that led to the discovery of HMGB1 as a late mediator of systemic inflammation and discuss the possibility of HMGB1 as a therapeutic target for septic patients in the emergency department.
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To assure a smooth transition to their new work environment, rotating students and housestaff require detailed orientations to the physical layout and operations of the emergency department. Although such orientations are useful for new staff members, they represent a significant time commitment for the faculty members charged with this task. ⋯ The videos are viewed through Web-based streaming technology that allows learners to complete the orientation process from any computer with Internet access before their first shift. This report describes the stepwise process used to produce these videos and discusses the potential benefits of converting to an Internet-based orientation system.
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A substantial number of emergency medicine providers are publishing stories and other creative expressions related to their medical experiences. This is a systematic review of such publications, introduces the term "emergency medicine narratives" to describe such pieces, and proposes a framework to classify the various forms of expression. Specifically, six genres of emergency medicine narratives are discussed: medical autobiography, clinical narratives, creative narratives, out-of-hospital narratives, lay exposition, and photojournalism. This review explores the utility of these narratives and the role they play within the field of emergency medicine, provides a bibliography of emergency narratives, and suggests future questions that might be addressed regarding this growing phenomenon in the field of emergency medicine.
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A substantial number of emergency medicine providers are publishing stories and other creative expressions related to their medical experiences. This is a systematic review of such publications, introduces the term "emergency medicine narratives" to describe such pieces, and proposes a framework to classify the various forms of expression. Specifically, six genres of emergency medicine narratives are discussed: medical autobiography, clinical narratives, creative narratives, out-of-hospital narratives, lay exposition, and photojournalism. This review explores the utility of these narratives and the role they play within the field of emergency medicine, provides a bibliography of emergency narratives, and suggests future questions that might be addressed regarding this growing phenomenon in the field of emergency medicine.