Can J Emerg Med
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ABSTRACTBackground: There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework. Objective:The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER). Method:ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. ⋯ The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from α = 0.90 to 0.95 for each subscale and α = 0.97 overall. The combined, 24-item ITER used to assess residents' competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles. Conclusion:Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively.
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To determine whether novices can distinguish between properly and improperly placed guidewires in a vascular access model after only minimal training. ⋯ Sonographic guidewire visualization, a step recommended for ensuring proper vessel cannulation during central venous access, can be accomplished by novices with a high degree of accuracy.
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ABSTRACTHypokalemic periodic paralysis is the most common form of periodic paralysis and is characterized by attacks of muscle paralysis associated with a low serum potassium (K+) level due to an acute intracellular shifting. Thyrotoxic periodic paralysis (TPP), characterized by the triad of muscle paralysis, acute hypokalemia, and hyperthyroidism, is one cause of hypokalemic periodic paralysis. The triggering of an attack of undiagnosed TPP by β2-adrenergic bronchodilators has, to our knowledge, not been reported previously. ⋯ One patient developed hyperkalemia after a total potassium chloride supplementation of 110 mmol. Thyroid function testing was diagnostic of primary hyperthyroidism due to Graves disease in both cases. These cases illustrate that β2-adrenergic bronchodilators should be considered a potential precipitant of TPP.
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ABSTRACTOphthalmologic complaints represent approximately 2% of emergency department (ED) visits. Acute vision loss is the most serious of such presentations and requires prompt assessment for a treatable cause. ⋯ We report the case of a previously healthy 33-year-old man who presented to the ED with acute bilateral vision loss that was ultimately diagnosed as central serous retinopathy (CSR), an idiopathic, self-limited condition that typically affects males age 20 to 50 years. This condition is not mentioned in standard emergency medicine textbooks or the emergency medicine literature, and our hope is that our report will serve to illustrate a typical case of CSR and help prompt emergency physicians to consider this diagnosis in the appropriate circumstances.
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ABSTRACTTrimethoprim/sulfamethoxazole (TMP/SMX), also known as Septra, is a commonly encountered and prescribed antibiotic in emergency department patients. The side effects associated with TMP/SMX are generally mild and self-limited, but serious side effects, including Stevens-Johnson syndrome and drug-induced aseptic meningitis, have been reported. We discuss the case of a 33-year-old woman who presented to our emergency department with the signs and symptoms of meningeal inflammation after being prescribed TMP/SMX 3 days earlier for an abscess with cellulitis.