J Emerg Med
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Editorial Comment
Emergency medicine administrative managers for the 21st century.
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Review Case Reports
Mediastinal teratoma presenting as massive hemoptysis in an adult.
Massive hemoptysis is a rare but potentially life-threatening presentation in the emergency department (ED). We describe a case of massive hemoptysis caused by a mediastinal teratoma in an otherwise healthy young man. ⋯ A differential diagnosis for massive hemoptysis is presented. The initial management of these patients in the ED and the diagnostic options are discussed.
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In this article, we propose a methodology to be used by emergency medicine faculty members who are interested in career planning and faculty development on an individual basis. The basic competencies needed by faculty and methods of setting goals are described. Educational courses, workshops, seminars, and self-study strategies that can be used to provide the basic competencies and meet defined goals are described, including the advantages and disadvantages of each method, the time commitment, and needed resources. The advantage of this methodology is the ability to customize a program to meet individual needs and fit into the constraints of available time and monetary resources.
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Spurred by concerns over increasing costs and variable quality, public and private third-party payors are moving their subscribers into managed care plans. A central feature of many of these plans is coordination of patient care through a primary care provider (PCP). In exchange for easy access to the PCP, patients are expected to limit their use of emergency services for episodic, primary, and urgent care problems. ⋯ The first 3 mo following plan implementation were chaotic and frustrating for all parties, with many difficulties due to an unprepared infrastructure. Changes in ED operations and maturation of the payor and health care provider network eventually resulted in a reasonably smooth system accompanied by reductions in ED visit volumes of at least 15%. Continual evolution of role and goals will be necessary if EDs are to maintain an active presence in a health care system dominated by managed care plans.
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Hemoptysis due to pulmonary arteriovenous malformation (PAVM) is rare in pediatric patients, but it must be included in the differential diagnosis of hemoptysis after other etiologies are excluded. We present a case of an 11-yr-old girl who presented with massive hemoptysis due to a PAVM.