Articles: emergency-medicine.
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We describe and evaluate a pilot course designed to teach rapid sequence intubation (RSI) to pediatric emergency physicians. A questionnaire was utilized to assess participants' self-assessment of knowledge and skills in defined areas related to rapid sequence intubation, before and after the course. Thirteen pediatric emergency physicians (nine attendings and four fellows) participated in the pilot course. ⋯ These areas included: knowledge of indications and contraindications for RSI, knowledge of specific sedating and paralyzing agents, knowledge of complications of RSI and their management, and level of comfort performing RSI when indicated (P < 0.05). We conclude that a formal course can significantly enhance self-assessment concerning ability to perform rapid sequence intubation. Further study is required to determine if such a course improves performance of this procedure.
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Pediatric emergency care · Dec 1994
Management of moderate head injury in childhood: degree of consensus among Canadian pediatric emergency physicians.
The purpose of this study was to assess the degree of consensus among Canadian pediatric emergency physicians regarding the management of moderate head injury in children. A questionnaire regarding the management of moderate head injury in a child was developed, and it concentrated on indications for admission and policies regarding skull radiograph. The questionnaire was given to all pediatricians who are members of the Emergency Section of the Canadian Pediatric Society (n = 33) and who represent 15 Canadian pediatric emergency departments. ⋯ Agreement of more than 70% regarding indications for ordering a skull radiograph was achieved only for clinical suspicion of a depressed skull fracture. In conclusion, for the average child who is well after a loss of consciousness after a head injury lasting three minutes or less, the majority of respondents do not routinely admit the child or order a routine skull radiograph. A reasonable degree of consensus (70-80%) regarding ordering of skull radiographs and admission is based on clinical criteria.
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The aim of this study was to assess the competence of senior medical students in recognizing and managing life-threatening ward emergencies and to compare the competence of a group that had received emergency medicine teaching with one that had not. This was achieved by asking 60 final year medical students to complete a structured written clinical examination designed to test these skills. Comparisons were made between the group that had received emergency medicine teaching (the 'taught' group) and that which had not (the 'untaught' group) with respect to numerical scores on the examination and the number of fatal management errors committed. ⋯ The 'untaught' group committed 0.25 fatal errors per student per case compared with the 'taught' group that committed 0.06 fatal errors per student per case (P < 0.001). There is considerable scope to improve the competence of senior medical students for dealing with life-threatening ward emergencies. Students who had received emergency medicine teaching scored significantly better than those who had not suggesting that emergency medicine teaching is a suitable tool to help equip medical students to deal with life threatening ward emergencies.
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Since emergency physicians (EPs) frequently initiate referrals and consultations, accept patients in referral, and may provide consultation services, it is imperative that EPs fully understand these processes. Such an understanding improves communication and facilitates professional interactions and patient care. ⋯ Specific recommendations are made for consultation initiation and execution. The dynamics and ethical/legal issues associated with initiating and accepting referrals and consultations are discussed.
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Review
Emergency pain management: a Canadian Association of Emergency Physicians (CAEP) consensus document.
Pain is the most common presenting complaint heard in Emergency Medicine, yet it is poorly controlled. Evaluation of this pain should be with use of objective pain scales completed by the patient, not relying on physician impression. Treatment modalities available in the Emergency Department, a review of medications and their dosing as well as specifics to pediatric pain management are presented. ⋯ At the writing of the consensus paper, however, no specific ideas were borrowed from any one article. The appended bibliography is suggested reading, selected from the larger literature review. There are to date few controlled multi centre trials in overall pain management that would allow guidelines to be produced.