Biomedical subjects
Publications and source records attributed to C O Davis.
Electrical injuries may cause tetanic contractions capable of producing fractures, even at very low voltages. Patients with localized pain and swelling require radiographs to assess for fracture, even in the absence of other associated trauma.
STUDY OBJECTIVES: To compare the performance of an evidence-based medicine (EBM) approach and a traditional approach to teaching critical appraisal skills to emergency medicine residents. METHODS: This was a prospective, case-controlled trial of 32 emergency medicine residents (16 control and 16 intervention). Intervention residents were exposed to a monthly, 1-hour journal club using an EBM approach to critical appraisal over the course of 1 year. Control residents were exposed to a traditional, unstructured journal club, also monthly. Both groups were given a factitious article to evaluate in an essay format before and after the 12-month study period. The Wilcoxon rank sum test was used to compare mean improvement in test scores for each group. RESULTS: The mean improvement in test scores was 1.80 for the control group and 1.53 for the intervention group; these values were not significantly different (P =.90). The difference in mean change in test score between the 2 groups was.27 points. CONCLUSION: Compared with a traditional approach, an EBM approach to teaching critical appraisal did not appear to improve the critical appraisal skills of emergency medicine residents. However, because of the small number of subjects studied, small differences in critical appraisal skill improvement cannot be ruled out.
A 16-item survey was mailed to the directors of 618 paramedic training programs in the United States to determine (1) the number of lecture hours devoted to toxicology topics and (2) how often paramedic training includes a rotation in a poison control center. The response rate was 82%. Toxicology accounts for approximately 2% of paramedic students' total training. Cardiovascular drug toxicity and hazardous materials are discussed for over 60 minutes by more than 50% of paramedic training programs. Four paramedic programs have no lecture time on cyclic antidepressant overdoses and one program has no lecture time on carbon monoxide poisoning. Eighty-one percent (377 of 467) have access to a regional poison control center; 11% (42 of 377) use the poison control center as a paramedic training site. Some US paramedic training programs spend insufficient time covering topics that have significant out-of-hospital morbidity. Although poison control centers are often available, they are underutilized for paramedic training.
INTRODUCTION: Epinephrine overdoses in children have been associated with supraventricular tachycardia. Myocardial ischemia subsequent to epinephrine overdose has not been reported in pediatric patients. CASE REPORT: We report a case of ventricular dysrhythmias and myocardial ischemia in a 5-year-old boy who received 10 times the recommended dose of subcutaneous epinephrine. Prehospital providers administered the epinephrine, believing it was part of a "high-dose" epinephrine protocol. DISCUSSION: There is no role for high-dose epinephrine in the treatment of allergic reactions or asthma. Careful epinephrine dosing, using mg/kg and verifying the volume, dilution, and route of administration is essential to prevent epinephrine toxicity.
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We present the unusual case of a 12-year-old child with bilateral localized tension pneumothoraces that were initially both difficult to diagnose and refractory to needle decompression. This case illustrates several important variations in the diagnosis and treatment of tension pneumothorax. To the best of our knowledge, it also represents the only reported case of bilateral localized tension pneumothoraces presenting in the pediatric age group.
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Seizures are the most common serious complication of flumazenil usage in adults. We report a prolonged seizure in an 11-month-old child that occurred immediately after the administration of 0.3 mg of flumazenil. Precautions recommended for the administration of flumazenil in adults should also be used in pediatric patients.