Review

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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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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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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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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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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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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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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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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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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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

3800 W Chapman Ave Ste 3200
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

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WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.