Review Archives - Page 3 of 4 - The Western Journal of Emergency Medicine

Evaluation of Emergency Medicine Community Educational Program

Out-of-hospital emergencies occur frequently, and laypersons are often the first to respond to these events. As an outreach to our local communities, we developed “Basic Emergency Interventions Everyone Should Know,” a three-hour program addressing cardiopulmonary resuscitation and automated external defibrillator use, heart attack and stroke recognition and intervention, choking and bleeding interventions and infant and child safety.

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Paget-Schroetter Syndrome: Review of Pathogenesis and Treatment of Effort Thrombosis

Effort thrombosis, or Paget-Schroetter Syndrome, refers to axillary-subclavian vein thrombosis associated with strenuous and repetitive activity of the upper extremities. Anatomical abnormalities at the thoracic outlet and repetitive trauma to the endothelium of the subclavian vein are key factors in its initiation and progression.

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Critical Care

Etomidate as an Induction Agent in Septic Patients: Red Flags or False Alarms?

Despite its widespread use in North America and many other parts of the world, the safety of etomidate as an induction agent for rapid sequence intubation in septic patients is still debated. In this article, we evaluate the current literature on etomidate, review its clinical history, and discuss the controversy regarding its use, especially in sepsis. We address eight questions

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Need for Injury-Prevention Education in Medical School Curriculum

Injury is the leading cause of death and disability among the U.S. population aged 1 to 44 years. In 2006 more than 179,000 fatalities were attributed to injury. Despite increasing awareness of the global epidemic of injury and violence, a considerable gap remains between advances in injury-prevention research and prevention knowledge that is taught to medical students. This article discusses the growing need for U.S medical schools to train future physicians in the fundamentals of injury prevention and control. Teaching medical students to implement injury prevention in their future practice should help reduce injury morbidity and mortality. Deliberate efforts should be made to integrate injury-prevention education into existing curriculum. Key resources are available to do this. Emergency physicians can be essential advocates in establishing injury prevention training because of their clinical expertise in treating injury. Increasing the number of physicians with injury- and violence- prevention knowledge and skills is ultimately an important strategy to reduce the national and global burden of injury.

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Non-Traumatic Urologic Emergencies in Men: A Clinical Review

Although true urologic emergencies are extremely rare, they are a vital part of any emergency physician’s (EP) knowledge base, as delays in treatment lead to permanent damage. The four urologic emergencies discussed are priapism, paraphimosis, testicular torsion, and Fournier’s gangrene. An overview is given for each, including causes, pathophysiology, diagnosis, treatment, and new developments.

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Crowding and Delivery of Healthcare in Emergency Departments: The European Perspective

Emergency department (ED) crowding is a multifactorial problem, resulting in increased ED waiting times, decreased patient satisfaction and deleterious domino effects on the entire hospital. Although difficult to define and once limited to anecdotal evidence, crowding is receiving more attention as attempts are made to quantify the problem objectively.

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Paramedics’ Ability to Perform Drug Calculations

The ability to perform drug calculations accurately is imperative to patient safety. Research into paramedics’ drug calculation abilities was first published in 2000 and for nurses’ abilities the research dates back to the late 1930s. Yet, there have been no studies investigating an undergraduate paramedic student’s ability to perform drug or basic mathematical calculations. The objective of this study was to review the literature and determine the ability of undergraduate and qualified paramedics to perform drug calculations.

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The Clinical Differentiation of Cerebellar Infarction from Common Vertigo Syndromes

This article summarizes the emergency department approach to diagnosing cerebellar infarction in the patient presenting with vertigo. Vertigo is defined and identification of a vertigo syndrome is discussed. The differentiation of common vertigo syndromes such as benign paroxysmal positional vertigo, Meniere’s disease, migrainous vertigo, and vestibular neuritis is summarized. Confirmation of a peripheral vertigo syndrome substantially lowers the likelihood of cerebellar infarction, as do indicators of a peripheral disorder such as an abnormal head impulse test. Approximately 10% of patients with cerebellar infarction present with vertigo and no localizing neurologic deficits. The majority of these may have other signs of central vertigo, specifically direction-changing nystagmus and severe ataxia.

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Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department

To examine barriers to the use of OMT in the ED and provide suggestions to ameliorate these barriers.

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Balancing Potency of Platelet Inhibition with Bleeding Risk in the Early Treatment of Acute Coronary Syndrome

To review available evidence and examine issues surrounding the use of advanced antiplatelet therapy in an effort to provide a practical guide for emergency physicians caring for patients with acute coronary syndromes (ACS).

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Challenging the Cost Effectiveness of Medi-Cal Managed Care

Researchers and consultants have promoted expansion of Medi-Cal managed-care (MCMC) to additional Medi-Cal beneficiaries currently covered under the Medi-Cal Fee-for-Service (FFS) program to achieve greater cost efficiency and quality of care.

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Turning Your Abstract into a Paper:Academic Writing Made Simpler

Academic writing is a critical skill distinct from creative writing. While brevity is vital, clarity in writing reflects clarity of thought. This paper is a primer for novice academic writers.

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Critical Care

Supraclavicular Subclavian Vein Catheterization: The Forgotten Central Line

While the supraclavicular approach to the subclavian vein has been described since 1965, it is generally employed much less often than the “traditional” infraclavicular approach. Although randomized trials are lacking, the best evidence suggests that the supraclavicular approach has a number of important advantages to the infraclavicular approach. The landmarks and relative merits of the procedure are described in this paper.

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Ed Administration

Analysis of the Literature on Emergency Department Throughput

The purpose of this paper was to review and analyze all the literature concerning ED patient throughput. The secondary goal was to determine if certain factors would significantly alter patients’ ED throughput.

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The Colorado Compendium: An Article-Based Literature Review Program

The immense body of knowledge that emergency medicine (EM) encompasses is constantly growing and ever changing. Textbooks build a strong foundation for the EM resident, but journal articles critical for modifying and improving EM practices are equally important for a well-rounded education. Determining which journal articles are vital to an EM residency education is a challenge. Lacking a formalized list of key articles available to EM residents and realizing that a list of articles without a guide may be difficult and confusing for novice readers, we created the “Colorado Compendium”: a recommended reading list, limited to 100 articles with accompanying summaries, tailored to emergency medicine residents.

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Devastating Brain Injuries: Assessment and Management Part I: Overview of Brain Death

Perhaps one of the greatest achievements in medicine to date, organ transplantation has transformed the lives of thousands – bringing life to those who would surely have died without it.

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Second Impact Syndrome

A controversial term first described by Saunders and Harbaugh1 in 1984, Second Impact Syndrome (SIS) consists of two events. Typically, it involves an athlete suffering post-concussive symptoms following a head injury.

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Open Access: The Alternative to Subscription-Based Medical Publishing

Since the inception in 1655 of The Philosophical Transactions of the Royal Society,1 one of the world’s first scientific journals,2 the subscription-based journal has been the traditional model for disseminating scientific and medical knowledge.

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Malpractice Cases in Wound Care and a Legal Concept: Special Defense

There is no doubt that in today’s practice of emergency medicine it is imperative to be familiar with how the law relates to administrative and clinical practice. It is my pleasure to announce, as section editor, the new Legal Medicine section of the Western Journal of Emergency Medicine. It is anticipated that the articles will cover a variety of areas and cases in the law. Some articles may focus on a particular disease or entity, with representative malpractice cases, and clinical caveats. Other articles may focus on legal concepts that enter the arena of emergency medicine. I have provided brief examples of each of these in this initial manuscript. Other articles could also cover original research related to law such as the standard of care in a given clinical situation or legal concepts such as consent, do-not-resuscitate, and AMA among others. I am hopeful that it will be of great interest to the readers. We welcome submissions and contributions for consideration.

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Prehospital Care

Issues and Solutions in Introducing Western Systems to the Pre-hospital Care System in Japan

This report aims to illustrate the history and current status of Japanese emergency medical services (EMS), including development of the specialty and characteristics adapted from the U.S. and European models. In addition, recommendations are made for improvement of the current systems.

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Wide Complex Tachycardias: Understanding this Complex Condition Part 2 – Management, Miscellaneous Causes, and Pitfalls

Author Affiliation Gus M. Garmel, MD Stanford University School of Medicine/Kaiser Permanente, Santa Clara INTRODUCTION Patients who present with electrocardiograms (ECGs) demonstrating wide complex tachycardias (WCTs) are often challenging to clinicians. Not only may the patient present with (or be at risk for) hemodynamic compromise, but their treatment may result in hemodynamic collapse if […]

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The Imminent Healthcare and Emergency Care Crisis in Japan

Japan has a universal healthcare system, and this paper describes the reality of the healthcare services provided, as well as current issues with the system.

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Clinical Emergency Medicine Algorithms: Vaginal Bleeding in Early Pregnancy (Less than 20 weeks)

Author Affiliation Chris Feier, MD Department of Emergency Medicine, Keck School of Medicine University of Southern California INTRODUCTION “Clinical Emergency Medicine (EM) Algorithms” was born out of my frustration with the educational process in medicine. Throughout medical school, professors teach us by a disease-based system. We read textbooks and learn about Takayasu’s Arteritis andDiphyllobrohtium […]

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Wide Complex Tachycardias: Understanding this Complex Condition: Part 1 – Epidemiology and Electrophysiology

Author Affiliation Gus M. Garmel, MD Stanford University School of Medicine/Kaiser Permanente, Santa Clara INTRODUCTION Patients presenting to the emergency department (ED) with electrocardiograms (ECGs) indicating wide complex tachycardias (WCTs) are difficult to manage. Furthermore, these ECGs are often challenging to interpret.1,2 Patients typically have ongoing chest discomfort, with or without symptoms of dyspnea, lightheadedness, […]

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Ten Solutions for Emergency Department Crowding

Author Affiliation Robert W. Derlet, MD University of California, Davis School of Medicine, Department of Emergency Medicine John R. Richards, MD University of California, Davis School of Medicine, Department of Emergency Medicine INTRODUCTION Over the past decade, emergency department (ED) crowding has occurred and progressed. It has become a major topic of discussion at […]

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Combining Ketamine and Propofol (“Ketofol”) for Emergency Department Procedural Sedation and Analgesia: A Review

Author Affiliation Sanjay Arora, MD Department of Emergency Medicine, Keck/USC School of Medicine, Los Angeles, CA INTRODUCTION Emergency physicians must be comfortable and confident in providing safe and effective procedural sedation and analgesia (PSA). Goals of PSA include providing an adequate level of sedation while minimizing pain and anxiety, maximizing amnesia, minimizing the potential […]

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