effect of emergency department overcrowding on efficiency of emergency medicine residents' education

Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding [EDO] on the training of emergency medicine residents [EMR] is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR's education. In this cross-sectional study, the effects of overcrowding on EMR's education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs. The crowding level was calculated based on the national emergency department overcrowding scale [NEDOCS]. The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. 130 questionnaires were filled out during 61 shifts. 47 [77.05%] shifts were overcrowded. The attend's ability to teach was not affected by overcrowding in the resuscitation room [p=0.008]. The similar results were seen regarding the attend's training ability in the acute care unit. It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs

Knowledge of emergency medicine residents in relation to prevention of tetanus

Knowledge of emergency medicine residents about the management of patients suspected of having tetanus-favoring wounds is very important due to their responsibility for the treatment of such patients. The aim of the present study was to evaluate this knowledge and making sure of the adequacy of instructions they have received in relation to prevention of tetanus. A reliable and reproducible questionnaire was used to evaluate knowledge of all the emergency medicine residents in Imam Hussein Hospital in Tehran, Iran, about conditions favoring tetanus [9 questions] and proper interventions in such conditions [12 questions]. The questionnaires were completed and scored as poor and good. The Mann-Whitney U test was used to analyze data. Statistical significance was set at P<0.05. In the present study, 73 emergency medicine residents were evaluated [45.2% male]. Knowledge of 31 [42.5%] residents in relation to conditions favoring tetanus and 41 [56.2%] residents in correct therapeutic interventions was in good level. The most frequent incorrect answer was related to diabetic ulcers and wounds in patients with sepsis. There was an increase in scores of conditions favoring tetanus [P<0.001] and correct therapeutic interventions [P=0.001] with an increase in educational years. However, age [P=0.64], gender [P=0.31], job experience [P=0.38] and participation in educational courses [P=0.67] had no effect on the knowledge level of emergency medicine residents. According to the findings of the pre-sent study, the knowledge of emergency medicine residents about correct management of patients suspected of tetanus was low, which emphasizes the necessity of providing further instructions on prevention of tetanus in wound management

Confusing hypoxia in a 21-year-old intubated multiple trauma patient

A 21-year-old man was brought to the emergency department due to multiple trauma [MT] caused by a motor-car accident [MCA]. On arrival, the patient was intubated by prehospital emergency medical services [EMS] and had a Glasgow coma scale [GCS] score of 6 on 10 [Due to intubation, verbal score was omitted]. Physical examination revealed blood pressure of 150/70 mmHg, oxygen saturation [O2sat] of 60%, and pulse rate of 110/min. Examination of the tracheal tube site revealed incorrect esophageal placement. The patient was intubated again and his O2sat improved and reached approximately 96%. His pupils were reactive and of the same size. The Doll's eye was normal, and plantar reflex was neuter in both sides. Neither expanding hematoma nor emphysema was observed in his neck. Laceration was noted on his left ear, but otorrhagia and tympanic perforation were not found. The lung sounds were normal in both sides. Extended focused abdominal sonography for trauma [e-FAST] examination revealed the absence of free fluid in the abdomen and pericardial space. No deformity of limbs was noted and the distal pulses were palpable. The patient's O2sat decreased during his admission to the emergency department, and further examination indicated obvious de-creased sound in his right lung that could not be reversed by needle thoracostomy. On reviewing his previous chest computed tomography, an obvious questionable pathology was detected in his right side