J Emerg Med
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Radial head subluxation (RHS) is a common pediatric orthopedic injury, frequently diagnosed through the classic history of axial traction to the upper extremity of a child. However, not all children with RHS will present with this classic history. This may result in misdiagnosis and delay of appropriate treatment. ⋯ The classic and nonclassic history groups were equivalent in patient age, spontaneous reductions, and physician reductions. A trend towards more radiographs was noted in the nonclassic group. This study suggests that even in the absence of the classic history of upper extremity traction, radial head subluxation should be suspected in any pediatric patient with an upper extremity complaint who presents with the affected arm in the nursemaid's position.
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In this third article in a continuing series on objectives for emergency medicine training, orthopedic objectives are presented. Orthopedic complaints are common in emergency medicine. Direction in mastering evaluative, cognitive, and procedural skills are provided utilizing behaviorally based objectives and references. These objectives provide a structure for systematically learning the content of orthopedics through enlightened patient care, questioning of attending physicians and supervisors, and directed reading.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ventilation performance: standard resuscitation bag and the resuscitation bag controller.
Clinical evaluation of ventilation performance during resuscitation is largely subjective. A mechanical device, the resuscitation bag controller (RC), which encircles the bag and allows controlled compression may improve the precision and accuracy of ventilation with manual resuscitation bags (MRB). We hypothesize that more precise, controlled pressure ventilation can be delivered with the RC, compared to the MRB. ⋯ PAPS were less than or equal to 30 cm H2O for 93% of all breaths. Hospital personnel delivered a significantly greater percent of inadequate (less than 0.8 L) breaths, 19 versus 7.4%, and excessive pressure breaths, 9.2 versus 4.2%, when compared to prehospital personnel. We conclude that the resuscitation bag controller offers little advantage over standard bag resuscitation for adult resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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A mandatory lecture course in emergency medicine, consisting of 13 lectures, was given to junior medical students over 3 years at Texas Tech University Regional Academic Health Center--El Paso. The performance of the students on a 25-question pretest and posttest was compared to a statistically similar group of their classmates on geographically separate campuses of Texas Tech University School of Medicine undergoing an otherwise comparable junior year clinical curriculum. Both groups exhibited improvement in posttest scores from pretest score values; additionally, students exposed to the lecture series at Texas Tech--El Paso performed significantly higher on the posttest, compared to the other campuses. We conclude that some emergency medicine material is successfully learned by junior medical students during their required third year clerkships; however, important learning objectives within the domain of emergency medicine can be most successfully taught if a mandatory junior year lecture course in emergency medicine is also incorporated into the third year curriculum.
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Controversy exists over the need for cervical spine radiographs in alert, nonintoxicated victims of blunt trauma. We identified 286 patients admitted to a Level II trauma center over a 14-month period who were alert (Glasgow Coma Scale [GCS] greater than 13) and considered at high risk for cervical spine injury by published criteria. ⋯ Mandatory cervical spine radiography in this group would have resulted in an additional cost of $33,699. Routine cervical spine radiography in alert, nonintoxicated asymptomatic victims of blunt trauma is a costly practice that warrants further examination.