J Emerg Med
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Although Emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) residency curricula. ⋯ EM residents report caring for mechanically ventilated patients frequently, but receive little education on mechanical ventilation. Furthermore, as residents' performance on the assessment tool is only correlated with their self-reported comfort with caring for ventilated patients, these results demonstrate an opportunity for increased educational focus on mechanical ventilation management in EM residency training.
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For medical students, the emergency department (ED) often presents ethical problems not encountered in other settings. In many medical schools there is little ethics training during the clinical years. The benefits of reflective essay writing in ethics and professionalism education are well established. ⋯ Medical students encounter patients with numerous ethically based issues. Frequently, they note conflicts between ethical principles. Such essays constitute an important resource for faculty, resident, and student ethics training.
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Ultrasound (US) measurement of the optic nerve sheath diameter (ONSD) has been utilized as an indirect assessment of intracranial pressure. It is usually performed by trained ultrasonographers. ⋯ Emergency physicians were capable of accurately measuring the ONSD using bedside US. Prospective studies with a larger sample size are recommended to validate these findings.
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Observational Study
Bacteriology of Urinary Tract Infections in Emergency Patients Aged 0-36 Months.
Because urinary tract infection (UTI) is the most frequent source of serious bacterial infections in young children, we studied the bacteriology of such infections in our institution. ⋯ Age- and sex-based assumptions guiding evaluation for and treatment of UTIs in young children should be reevaluated. We may not be culturing enough young boys, risking missed UTIs with potential for renal injury in this vulnerable group. Based on their significant rate of Gram-positive infections, those boys we treat empirically might benefit more from trimethoprim/sulfamethoxazole or amoxicillin/clavulanic acid than from third-generation cephalosporins. The persistence of positive cultures in 2-year-olds suggests we should be culturing beyond 24 months in both sexes. Urine Gram stains should be more frequently considered.
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Emergency medicine (EM) residency programs have significant scheduling flexibility. As a result, there is potentially significant variation in scheduling practices. Few studies have previously sought to describe this variation. It is unknown how this affects training time in the emergency department. ⋯ There are different scheduling modalities used to create resident schedules. This flexibility results in a large amount of diversity in scheduling practices, with certain patterns allowing for significantly more clinical time. This may result in a vastly different training experience for EM residents.