J Emerg Med
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Our goal was to determine the level of burnout, depression, life and job satisfaction of Canadian emergency physicians. Six instruments were administered: the emotional exhaustion, depersonalization, and personal accomplishment intensity subscales of the Maslach Burnout Inventory (MBI); the Centre for Epidemiologic Research Self-Report Depression Scale (CES-D); the Satisfaction With Life Scale (SWLS); and the Emergency Physician Job Satisfaction Measurement Instrument (EPJS). Forty-six percent of the sample fell within the medium to high level of emotional exhaustion, 93% within the medium to high range for depersonalization, and 79% within the medium to low range for personal accomplishment. ⋯ Involvement in medical education, increased clinical hours worked per year, and region of residence-Quebec were negative contributors to EPJS scores (P < 0.05). Involvement in medical education is a significant factor among physicians experiencing depressive symptomatology. Time away from clinical practice is important to job satisfaction and emotional well-being.
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This article is the first of a two-part series outlining the objectives for emergency medicine residents on a cardiology rotation. Cardiology is offered as an off service rotation or an elective at some emergency medicine residency training programs. ⋯ We have developed a written core curriculum containing a subject content list, learning objectives, and references for emergency medicine residents on cardiology services. This is the 28th in a series of objectives for off-service rotations for emergency medicine residents.
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Randomized Controlled Trial Comparative Study Clinical Trial
Interpleural block for patients with multiple rib fractures: comparison with epidural block.
Interpleural block (IPB) was compared with epidural block (EB) in 17 adults with unilateral multiple rib fractures and hemopneumothorax. The study was a randomized, crossover, before-after trial on the first and second hospital days. An IPB catheter was inserted along with a chest tube, and an upper thoracic EB was also established in the same patient. ⋯ Serum levels of lidocaine were similar and in the safe range. The technique of IPB seemed to be easier than EB. In conclusion, IPB with lidocaine is as effective for pain relief as EB.
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Trauma patients frequently have blood drawn for type and crossmatch. The majority of these units are held for 48 hours and never used for that patient. We conducted a retrospective review and followed with a prospective protocol, attempting to identify a variable that would predict the need for blood transfusion, thus decreasing cost and blood waste. ⋯ No patient received uncrossmatched blood, and there were no complications. Implementation of this protocol decreased our units crossmatched for each unit transfused from 3.8 to 2.8. Prehospital blood pressure is a useful adjunct to clinical judgement in identifying major trauma patients who can be initially managed safely without crossmatching.