J Emerg Med
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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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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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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.
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A 28-year-old woman presented to the emergency department for treatment of a corneal abrasion. Shortly after inserting two drops of proparacaine hydrochloride eye drops into her conjunctival sac, she experienced a tonic-clonic seizure. The absorption, systemic effects, and side effects of topical ophthalmological preparations are discussed.
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Intravenous fluid therapy is a mainstay in the treatment of trauma and hypovolemia. However, controversy exists as to its effective use by prehospital personnel. We reasoned that 12-gauge catheters, shown to have significantly greater fluid flow than 14- or 16-gauge catheters, might allow prehospital care providers to have a more significant role in patient resuscitation. ⋯ The catheters were placed under normal field conditions. Per preexisting protocols, departure from the scene and transport to the hospital were not delayed for any paramedic interventions, including starting intravenous lines. The 12-gauge catheters can be successfully used by paramedics, both to establish large bore intravenous access prior to arrival at the emergency department and to institute effective fluid therapy where time and circumstances allow.