Articles: emergency-medicine.
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Pediatric emergency care · Oct 1996
Comparative StudyViews of pediatric emergency fellows and fellowship directors concerning training experiences in child abuse and neglect.
Emergency physicians are an important part of the teams responsible for the management of victims of child abuse and neglect. As the number of fellowship-trained pediatric emergency physicians working in these emergency departments increases, their influence on the field of child abuse will increase. An evaluation of the experiences and possible weakness in the child abuse training of pediatric emergency fellows will assist in improving their fellowship experience. ⋯ Child abuse training is an important part of the fellowship experience of pediatric emergency fellows. Because a majority of pediatric emergency medicine fellows report that their respective programs are providing less than adequate training in child abuse management, further evaluation of fellowship curriculums and training experiences is required. The establishment and utilization of regional or national child abuse training centers is one option for improving this situation.
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To determine emergency physicians' (EPs') attitudes toward physician-assisted suicide (PAS), factors associated with those attitudes, current experiences with attempted suicides in terminally ill persons, and concerns about the impact of legalizing PAS on emergency medicine practice. ⋯ Although the majority of Oregon EPs favor the concept of legalization of PAS, most have concerns that safeguards in the Oregon initiative are inadequate to protect vulnerable patients. These physicians would consider not resuscitating terminally ill patients who have attempted suicide under the law's provisions, only in the setting of documentation of the patient's intent.
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A study was undertaken to determine if use of a structured review instrument (SRI) increased the perceived overall satisfaction with a journal club in a group of emergency medicine residents. Before and 6 months after the introduction of a structured checklist format for article review, a 5-point Likert scale (1 = worst, 5 = best) was used to assess residents' satisfaction with the journal club, as well as the following subsidiary outcome parameters resident and leader workload, educational value in interpreting the medical literature, and application of the information to clinical practice. Additional measured outcome variables included resident attendance and number of articles read per attendee. ⋯ Following introduction of the SRI, residents were more satisfied with the journal club (3.8 v 3.2, P < .05). There was no change in resident attendance (92% v 71%, P = .65), total articles read (75% v 70%, P = .33), or perceived workload (3.3 v 3.1; P = .3). The use of a SRI was found to increase resident satisfaction and improve the perceived educational value of a journal club without increasing residents' workload or decreasing attendance.
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At a time in which the integrity of the medical profession is perceptibly challenged, emergency physicians (EPs) have an opportunity to reaffirm their commitment to both their patients and their practice through acceptance of a virtue-based ethic. The virtue-based ethic transcends legalistic rule following and the blind application of principles. Instead, virtue honors the humanity of patients and the high standards of the profession. ⋯ In addition to the long-recognized virtues of prudence, courage, temperance, and justice, 6 additional virtues are offered: unconditional positive regard, charity, compassion, trustworthiness, vigilance, and agility. These virtues might serve as ideals to which all EPs can strive. Through these, the honor of the profession will be maintained, the trust of patients will be preserved, and the integrity of the specialty will be promoted.
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Comparative Study
[Accuracy of measurement and overestimation of CO2 of two capnometers intended for potential use in emergency medicine].
Capnometry, the noninvasive measurement of end-expiratory CO2 concentration (cCO2, vol%) or calculation of its respective partial pressure (pCO2; mmHg) is an established method. However, for prehospital settings, capnometry is still used very restrictively, mainly owing to the respective devices used. The prerequisite for their use is sufficient accuracy (+/-2 mmHg) and easy handling. Two special capnometers (STAT CAP. Nellcor: mainstream, semiquantitative estimation; Capnocheck 8200, BCI: sidestream, quantitative measurement, numeric display), developed recently for potential use in emergency medicine, are said to fit these criteria. Therefore, the objective of the present investigation was to assess the accuracy and precision of both devices, comparing methods under standardized in vitro (reference gases) and in vivo (intubated and ventilated patients) conditions. ⋯ Evaluation of the accuracy of capnometers must focus on the necessary pH2O correction and the possible effects exercised by O2 (and N2O) as well as the possible dependence on barometric pressure (if pCO2, mmHg, is the desired value). The "Capnocheck" showed an accuracy of more than 2 mmHg in dry gas mixtures as well as in humidified air. Concerning the practical use during constant artificial ventilation, the digital display and accuracy of the sidestream capnometer allow for reliable conclusions on patients' ventilation and circulation (CO2 elimination). The 90% accuracy of the segment bar display of Nellcor's "STAT CAP", per se covering only a rather broad range of 20 mmHg, obviously does not provide more than a rough overview. Therefore, the STAT CAP cannot be recommended for prehospital capnometry in the field. However, both the accuracy of the BCI capnometer (Capnocheck) and its numeric display and easy handling strongly recommend this device also for clinical use.