J Emerg Med
-
This is a continuing series of objectives to direct resident training in emergency medicine. Electrocardiography may not receive individual attention in many training programs. However, the importance, omnipresence, and medicolegal potential of electrocardiography in the practice of emergency medicine suggests its individual attention. Contents and specific learning objectives are presented to provide guidelines for resident mastery, following the format presented by preceding subjects.
-
On December 1, 1991, a new federal law designed to increase public use of advance directives takes effect. After that date, health care facilities must provide written information about advance directives to all adult patients. This information must describe (1) the patient's rights to make medical care decisions under state statutes and case law, and (2) how patients can secure these rights within the scope of the provider's policies. ⋯ However, emergency physicians should anticipate that the law will provide not only benefits, but also some burdens. Many institutions will expect emergency department personnel to disseminate and explain the required information, and annotate the medical record. It is the specialty's responsibility to gather empirical data that can guide the use of advance directives in emergency departments.
-
Case Reports
Emergency department echocardiography in the diagnosis and therapy of cardiac tamponade.
A 44-year-old male presented to the emergency department in shock with jugular venous distension and upper chest cyanosis. Superior vena cava syndrome was ruled out by computed tomography (CT scan). However, a large pericardial effusion was found on CT scan and confirmed by sonography. Pericardial tamponade was diagnosed by emergency physicians and sonography-guided pericardiocentesis was performed with marked improvement in symptomatology.
-
Anticonvulsant management of status epilepticus (SE) may result in respiratory depression, often requiring endotracheal intubation (ETI). By examining rates of ETI in childhood SE after intravenous diazepam or lorazepam, when administered alone or in combination with phenytoin, the influence of anticonvulsants on the frequency of ETI during SE was determined. The medical records of 142 consecutive children younger than 16 years of age admitted from a university hospital ED with seizures during a 28-month period were retrospectively reviewed. ⋯ Patients receiving lorazepam had ETI rate of 27% (4/15), compared to 73% (8/11) in the diazepam group (P = 0.026, Fisher's exact). The groups were not significantly different in age, weight, sex, seizure type, seizure duration, and appropriate anticonvulsant dosage. A prospective, randomized trial comparing lorazepam and diazepam is warranted to confirm the apparent advantage of lorazepam in reducing respiratory depression.