JACEP
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Emergency department patients treated by first and second year emergency medicine residents were compared with those treated by surgical interns and residents and medical interns and residents to see if emergency medicine residents are exposed to patients with problems that aid in teaching and whether there is a suitable correspondence between patient severity and clinical training level. The Emergency Department Surveillance System at The Johns Hopkins Health Services Research and Development Center was used to gather data. Results indicated emergency medicine residents were exposed to fewer severe medical causes than medical housestaff but saw a significantly greater number of severe surgical cases than surgical interns and residents. ⋯ Regarding outcome, there was no significant difference among the clinician groups. For all the patients, pain and anxiety levels improved significantly. Although the findings may be specific to The Johns Hopkins Adult Emergency Department, they demonstrate the methods and motivation for examining the training experience offered emergency medicine residents.
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The intracardiac administration of medications in cardiac arrest is advocated when an intravenous route cannot be established. Although warnings of complications of this mode of therapy are reiterated throughout the literature, their careful documentation is lacking. Paramedics were trained to administer intracardiac medications, under strict criteria, in patients with prehospital sudden cardiac death. ⋯ Potential complications of the intracardiac route were identified and sought. However, complications were no more common in this group of patients than in the control group. Paramedics can successfully administer intracardiac medications when indicated.
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In a retrospective study of 106 patients with complete follow-up of dog bites treated in the emergency department the following factors greatly increased the risk of infection: age greater than 50 years, delay in seeking treatment, location on an upper extremity, and puncture wounds. Debridement and irrigation decreased the incidence of infection, and sutured wounds were not more likely to become infected than those left open. ⋯ Up to 50% of infections from dog bites are caused by pasturella multocida, and the remainder by a wide range of organisms, including streptococcus. Ninety-five percent of these organisms will be sensitive to penicillin.
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A 52-hour course in emergency medicine for first-year medical students was developed from the Department of Transportation's (DOT) training program for emergency medical technicians (EMT). The objective of the course was to train students to provide life support and emergency care in the field at the level of competence of the EMT. ⋯ The program is well received by students and allows for introduction of clinical material into the first-year curriculum. The DOT training program for the EMT provides a useful model that, with slight adaptation, is appropriate for the first-year medical student.