Biomedical subjects
Publications and source records attributed to G C Hamilton.
Three coagulation tests available in the emergency department are described in this article. Methods, results, and implications in the bleeding patient are reviewed.
The understanding of human anatomy is a critical component of the practice of medicine. A specialty with the breadth of emergency medicine is best approached with a sound basis in anatomy and pathophysiology which leads to a better understanding and differential diagnosis of the disease process. It was the authors' opinion that a specialty with the surgical emphasis found in emergency medicine should have a correlating emphasis in the anatomical sciences. Subsequent testing of PGY-II residents demonstrated a fair to poor understanding of anatomy when gauged by a standard freshman anatomy examination tailored to clinical circumstances. This paper reports on a 3-year experience in giving a 1-week 40-hour anatomy course which included didactic presentations by the anatomy and surgery departments. The impact of this course on clinical practice, problems in its preparation, and outcome of a shared experience with residents from general surgery are discussed. The course is felt to be a successful addition to the training of emergency medicine specialists.
Twenty-three passengers died on June 2, 1983, when a McDonnell Douglas DC-9 experienced an inflight rear lavatory fire near Cincinnati, OH. Evidence of toxic fume inhalation was developed by investigators, demonstrating lethal levels of carbon monoxide and cyanide in the victims' blood. An analysis of the inflight progression of fire and smoke, and the subsequent extension of this following the emergency landing at Greater Cincinnati Airport has been accomplished. This data is augmented by other data from previous accidents of this type. Data from interviews with survivors was collected, including inflight experiences, emergency escape processes and airport disaster management during the emergency. Several practical means of respiratory protection both inflight and during emergency evacuation are documented. Onboard preventive measures in regard to this type of emergency have been identified. Emergency evacuation and modern airport disaster management techniques are codified and described. This recent accident provides information for future adoption by the responsible authorities so that inflight and postflight fires do not continue to cause significant numbers of fatalities. Modified lightweight passenger breathing apparatus, upgraded flight attendant and aircrew portable breathing apparatus, floor level guidance to exits, less flammable and toxic interior materials, improved passenger evacuation information, tailored airport emergency response procedures, and upgraded toilet smoke detector equipment are examples.
Accurate diagnosis of urinary tract infection (UTI) is possible in the emergency department. Clinical differentiation of upper tract infection (pyelonephritis) from lower tract infection (cystitis) is difficult. The consequences of untreated UTI justify treatment by the emergency physician. Many treatment schemes are available. Single-dose antibiotic therapy is the preferred treatment method for uncomplicated UTI. It reduces compliance problems, effectively cures lower UTI, and provides for early identification of patients with more complex infection. The complications of this therapy are minimal.
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A case of acute nontraumatic suppurative mediastinitis in a 56-year-old man is presented. The patient was admitted with signs and symptoms of a left lower lobe pneumonia and acutely developed mediastinal widening on chest radiograph. A mediastinal abscess was drained by posterior mediastinotomy after a complicated hospital course. Mediastinitis is a rare complication of pneumonia. It is a serious condition, requiring prompt diagnosis and aggressive therapy, and should be considered in the differential diagnosis of acute mediastinal widening.
The publication of textbooks that are relevant to emergency medicine has increased rapidly during the past decade. This increase has created confusion in the selection of appropriate texts for both emergency medicine residency and hospital emergency department libraries. A critical review of 703 pre-selected texts was performed. From this review, a recommended list of 165 books for the resident library and 27 books for the emergency department library is suggested. The cost of these libraries is $6,433.05 and $1,230.05, respectively. The libraries are designed to assist emergency physicians and librarians in attaining maximum value in the expensive process of textbook selection.
The general concepts of defibrillation are reviewed. Research continues in the area of implanted defibrillators, new circuiting, and more effective current transfer.
The techniques of cardiac pacing, the types of pacing electrodes, technologic advances and new devices, and the future of pacing in CPR are discussed.
Although there are complications associated with cardioversion, they are relatively infrequent and usually of small magnitude compared with the primary disease. Cardioversion is an invaluable part of the emergency physician's armamentarium.
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An outline of a didactic curriculum from the Core Content in Emergency Medicine is presented. The 430 hours of lecture are distributed over three years. Three new categories have been added to the Core Content as previously defined by the Graduate/Undergraduate Education Committee of the American College of Emergency Physicians: drugs of emergency medicine, laboratory/radiology use in emergency medicine, and resident evaluation series. The benefits of this core curriculum are improved organization in educational format, better defined curricular guidelines for developing residencies, and standardized guidelines for individual topic assessment and review.
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Faculty development is a training process that strives continually to improve the creativity, productivity, and longevity of individuals committed to the practice of academic medicine. Information pertinent to faculty development is contained in textbooks scattered throughout the medical literature. From a more than 80-volume personal library, a list of 15 recommended texts in 11 major topics is given. The cost of this library is +333.50. This library was designed to assist emergency physicians in obtaining useful sources of information as part of their continuing education as academic faculty.
Up to 50% of the 36 months of resident training in emergency medicine may be on off-service rotations. The experience on these rotations can lack educational content and opportunity pertinent to emergency medicine. The resident rarely has readily available and structured guidance to optimize training in terms of the anticipated needs of the specialty. In response to this problem, the authors have written curricula containing subject content listings, objectives, and supplied references for 16 off-service rotations. A plan for implementing the materials and an example from the obstetrics-gynecology rotation is given. After 12 months' experience, the authors have subjective responses from residents and off-service program directors that support the value of this information. Positive reports include: Residents having a better understanding of faculty expectations, improved "consistency of experience," residents appreciating the added attention, improved performance, and expanded reading efforts. One expressed concern is "too much to read." The project continues to evolve.
This is the fourth article in a continuing series on objectives for emergency medicine training; plastic surgery objectives will be presented. Plastic surgery topics overlap many in emergency medicine. Specific behaviorally based objectives for mastery of skills in plastic surgery are outlined. Specific references are provided for additional information and reinforcement in skill mastery. The basic concepts of plastic surgery are probably best learned by observation and supervised performance. Specific objectives provide guidance and direction for the didactic as well as the supervised experiences in skill mastery. These objectives provide a structure for systematically learning and mastering the content presented on a plastic surgical rotation or experience in emergency medicine training.
This is the fifth in a continuing series of objectives to direct resident training in emergency medicine. Approximately 50% of resident experience and training in emergency medicine takes place outside of the direct control and influence of full-time emergency medicine faculty. To gain some direction and control over these off-service rotations, objectives and references are offered here. Objectives for a dermatology rotation as well as contents and references are presented.
In this third article in a continuing series on objectives for emergency medicine training, orthopedic objectives are presented. Orthopedic complaints are common in emergency medicine. Direction in mastering evaluative, cognitive, and procedural skills are provided utilizing behaviorally based objectives and references. These objectives provide a structure for systematically learning the content of orthopedics through enlightened patient care, questioning of attending physicians and supervisors, and directed reading.