Articles: emergency-medicine.
-
Comparative Study
A comparison of Jefferson Medical College graduates who chose emergency medicine with those who chose other specialties.
Fifty-three graduates of Jefferson Medical College who chose emergency medicine (EM) over the decade from 1981 through 1990 were compared with the other graduates of that school during that decade who chose other specialties, using the database of the school's longitudinal study of its students. As seniors, those who chose EM had the highest debt of seniors going into any specialty. ⋯ The students who chose EM also indicated their great willingness to see patients from low-income households, and were willing to spend more of their practice time serving these groups than were the students who chose the other specialties. The authors discuss these findings as related to the nature of EM and medical school graduates' choices of specialties.
-
The Pediatric Critical Care Unit (PCCU) at the Children's Hospital of Western Ontario provides a transport service and team (critical care physician, critical care nurse, respiratory therapist) which transports critically ill newborns, infants, and children. The purpose of this study was to identify the medications used during transport and to determine age-related differences. Results of a prospective study of all drugs administered by the transport team to 174 patients during their stabilization and transport from November 1, 1987 through October 31, 1988 are presented. ⋯ The use of different classes of drugs varied with age; anticonvulsants were most frequently administered to children, sedatives and respiratory medications to infants, and antibiotics and miscellaneous medications to newborns. The wide range of medications used may reflect the diversity of diseases causing critical illness which reinforces that transport teams must have access to and knowledge of a variety of medications. The formulary of medications taken by the critical care transport team is included.
-
Clinical Trial Controlled Clinical Trial
Missed myocardial ischaemia in the accident & emergency department: E.C.G. a need for audit?
Accident & Emergency Department Senior House Officers rely heavily on their ECG interpretation skills in the diagnosis and management of patients with chest pain. This prospective double-blind study was designed to test the accuracy with which Accident & Emergency Senior House Officers interpret ECGs, by comparing their interpretation with that of a Consultant Cardiologist. ECGs from 279 of 314 consecutive patients with chest pain were analysed. ⋯ Despite the inaccurate interpretation of 43% of abnormal ECGs, 96.5% of the patients in the study were considered to have been managed correctly. Audit of all ECGs recorded in the Accident & Emergency Department should be undertaken by someone with experience of ECG interpretation. New A&E staff should receive training in the interpretation of ECGs.
-
In summary, the emergency department or office-based physician should distinguish first between inflammation and injury. A clinical diagnosis of fracture should be made before obtaining and reading films. ⋯ A neurologic examination should be documented before undertaking reduction. Finally, if in doubt, a splint for 24 to 48 hours until an orthopedic opinion is available causes no harm.