Report of the Task Force on Residency Training Information (2000-2001), American Board of Emergency Medicine.

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the fourth annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (1999-2000), American Board of Emergency Medicine.

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the third annual report on the status of US emergency medicine residency programs. [American Board of Emergency Medicine. Report of the Task Force on Residency Training Information (1999-2000), American Board of Emergency Medicine. Ann Emerg Med. May 2000;35:481-498.]

Report of the Task Force on Residency Training Information (1998-1999), American Board of Emergency Medicine.

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the second annual report on the status of US emergency medicine residency programs. [American Board of Emergency Medicine: Report of the Task Force on Residency Training Information (1998-1999), American Board of Emergency Medicine. Ann Emerg Med May 1999;33:529-545.]

Report of the Task Force on Residency Training Information, American Board of Emergency Medicine.

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. Before the compilation of this report, this information has not been widely available.

Effects of modified positioning and mobilization of back pain and delayed bleeding in patients who had received heparin and undergone angiography: a pilot study.

OBJECTIVE: To examine the effects that a modified positioning and mobilization routine had no back pain and delayed bleeding in patients who had received heparin and undergone cardiac angiography. DESIGN: An experimental research design was used. Each patient was assigned randomly to either the control group, which required 6 hours of bed rest after cardiac angiography, or the experimental group. The experimental group had modified positioning, in which the head of the bed was elevated to a maximum of 45 degrees, and modified mobilization, in which they were ambulated briefly at the bedside 4 hours after angiography. SETTING: Two cardiology units of a 700-bed urban teaching hospital in western Canada. SAMPLE: All patients admitted for nonemergent cardiac angiography were approached for consent, to attain a sample of 29 patients, and were randomly assigned to the experimental or the control group. METHOD: Each patient was randomly assigned before cardiac angiography. The assignment was confidential until the patient was admitted to the cardiac unit after angiography. A demographic tool and the McGill Present Pain Intensity Scale were used to collect data. Perception of pain was evaluated over four observation periods. A research assistant monitored sanguineous drainage on the dressing and hematoma to evaluate the presence of delayed bleeding. DATA ANALYSIS: Demographic information was analyzed primarily through descriptive statistics. Results were analyzed to compare back pain and delayed bleeding between the two groups. Wilcoxon scores and t tests both were used for analysis and correlated well with each other. RESULTS: The group with the modified positioning and mobilization routine experienced significantly less pain overall (p = 0.02), less pain at each interval, and significantly less pain intensity (p < 0.05). There was no difference in bleeding. One person in each group had an estimated blood loss of more than 100 ml through the pressure dressing. CONCLUSION: This pilot study supports our hypothesis that modifying the immobilization of patients after cardiac angiography is associated with a reduction in back pain and with no increase of delayed bleeding at the femoral access site. The results support the need for further investigation of ambulation interventions after cardiac angiography.

Acute suppurative salpingitis with concomitant intrauterine pregnancy.

A 20-year-old woman presented to the emergency department with a history of lower abdominal pain and recent loss of consciousness. She was admitted with a primary diagnosis of abdominal pain; ectopic pregnancy was ruled out. The culture of the endocervix was positive for Neisseria gonorrhoeae. Surgical exploration of the pelvis was performed, and histological analysis of the specimen showed an acute suppurative salpingitis and an intrauterine pregnancy. The patient was placed on intravenous antibiotics. Postoperative course was unremarkable, and the patient was discharged on oral antibiotics. Although a rare entity acute suppurative salpingitis with concomitant intrauterine pregnancy are not mutually exclusive. Ectopic pregnancy should be the presumptive diagnosis when clinical presentation is consistent with pelvic inflammatory disease and pregnancy especially in the first trimester. Patients who are pregnant and exhibit clinical signs and symptoms that are consistent with salpingitis should be admitted for aggressive management of their high-risk pregnancy. Fetal wastage seems to be significant in spite of aggressive management. Endocervical culture for N gonorrhoeae should be obtained from all pregnant patients with follow-up treatment pending culture results. The following is a case presentation along with a review of the existing cases in the English literature and discussion of the possible pathogenesis and clinical outcome of this entity.

Prospective analysis of mental status progression in ethanol-intoxicated patients.

Distinguishing patients with uncomplicated ethanol intoxication from intoxicated patients with other causes of mental status depression is a common clinical dilemma. The authors serially tested mental status in a group of ethanol-intoxicated patients to determine the interval over which mental status changes could be attributed to uncomplicated intoxication. Study patients were identified by (1) admission breath ethanol greater than or equal to 100 mg/dL; (2) ethanol-related impairment necessitating further observation or treatment; and (3) not critically ill or exhibiting focal neurologic signs. Mental status scores (sums of specific indices of alertness, orientation, and agitation) were determined initially, 1 hour after arrival, then every 2 hours. Causes of mental status depression other than acute intoxication were diagnosed in 16 patients, while another 18 failed to completely normalize mental status by the time of emergency department discharge or hospital admission. The remaining 71 with uncomplicated ethanol intoxication required (mean +/- SD) 3.2 +/- 3.6 hours to normalize mental status scores. A large proportion, however, took considerably longer to normalize mental status: 15 (21%) took 7 or more hours, and three (4%) took as long as 11 hours. Although patients with ethanol-associated depression of mental status lasting 3 hours after emergency department admission should be carefully evaluated for other causes of mental status abnormalities, the authors' observations indicate considerable individual variation in the duration of mental status depression caused by uncomplicated ethanol intoxication.

Controversial issues in clinical management of the simple wound.

The primary goals of the practitioner managing a simple wound are to encourage primary healing and avoid infection. We conclude from this analysis that the four basic aspects of wound management we have reviewed, the timing of wound repair, the preparation of the wound, local anesthetic management, and antimicrobial therapy, will continue to be fertile topics for investigation and debate.

Phenytoin loading in chronic alcoholic patients.

Controversy exists concerning the appropriate loading dose of phenytoin in chronic alcoholic patients. Chronic alcoholics are frequently assumed to have low albumin levels secondary to malnutrition and liver disease. Phenytoin is bound to albumin, and therefore the usual loading dose of phenytoin might result in a higher percentage of unbound drug and increased toxicity in these patients. Thirty-six chronic alcoholic patients were given a 15-mg/kg loading dose of phenytoin by constant intravenous infusion. After the infusion, patients were evaluated for clinical signs of phenytoin toxicity. At 1 hour after infusion, blood was sent for determination of total phenytoin, free phenytoin, and albumin levels. Fifteen patients were hypoalbuminemic (mean, 3.4 g/dL); 21 patients had albumin levels within the normal range (mean, 4.3 g/dL). In the hypoalbuminemic group, the mean free phenytoin level was 1.1 micrograms/mL, and the mean total phenytoin level was 13.6 micrograms/mL. In patients with normal albumin levels, the mean free phenytoin level was 1.3 micrograms/mL, and the mean total phenytoin level was 15.7 micrograms/mL. There were no statistically significant differences in total phenytoin or free phenytoin levels between either groups. No patient had a postinfusion phenytoin level (either free or total) within the toxic range. Although our sample size was small, our results suggest that a 15-mg/kg loading dose of phenytoin does not produce toxic levels in chronic alcoholics.