J Emerg Med
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There is growing concern in academic emergency medicine as to the appropriateness of 24-hour faculty coverage in the teaching emergency department. We surveyed 170 teaching emergency departments, 49 of which had approved emergency medicine residencies, asking for information regarding 24-hour faculty coverage. We were able to separate each department into one of 15 profiles based on the two variables of average ED yearly census and hospital type. Seventy-three percent of university teaching hospital EDs and 65% of those with emergency medicine residencies have 24-hour faculty coverage; 83% of private teaching hospital EDs and 100% of those with emergency medicine residencies have 24-hour faculty coverage; and 79% of city/county teaching hospital EDs and 80% of those with emergency medicine residencies have 24-hour faculty coverage.
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Clinical Trial Controlled Clinical Trial
Lidocaine reduces intravenous diazepam pain.
We studied 41 consecutive patients receiving intravenous (IV) diazepam in the preoperative holding area to evaluate whether low-dose IV lidocaine could ameliorate pain of the diazepam injection. In a double-blind trial we found 1 cc of 1% lidocaine effective versus placebo at lowering the incidence of pain from 80% to 5% (P less than .001) and recommend its routine use as an antecedent to IV diazepam.
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The effective teaching of clinical emergency medicine to medical students requires efficiency in the management of both student and faculty time. Presented is a course outline that makes use of the following elements to structure and augment clinical time in the emergency department (ED): Videotape to present a 19.7-hour series of faculty-produced lectures covering a "core" emergency medicine curriculum. A microcomputer to facilitate staggered scheduling of clinical time. ⋯ Once established, this program can be administered with fewer than five faculty hours per month assisted by a part-time (25% full-time equivalent) clerical coordinator. The total cost for the instructional program is $86.37 per student using the new technologies, and $144.15 per student when presenting the same program using traditional teaching techniques. The use of new technologies in student teaching will therefore result in significant savings.
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The physical properties of lightning are given, including a description of the different observed lightning forms. The wide variety of effects of lightning on humans is reviewed. ⋯ Recommendations for emergency department evaluation, treatment, and disposition are given. Guidelines to prevent humans from being struck by lightning are discussed.
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Near-drowning is defined as survival for at least some period of time after suffocation from submersion in a liquid. This article is a comprehensive review of the demography, pathophysiology, treatment, and prevention of near-drowning, an accident that affects approximately 6,000 to 7,000 Americans per year. Forty percent of these victims are children younger than 5 years. ⋯ The hypothermic patient requires special considerations. The role of aggressive cerebral resuscitation has not been elucidated. Prevention of the circumstances that lead to near-drowning must be stressed as a public service.