ABSTRACT
The Institute of Medicine's 2006 report titled "Hospital-Based Emergency Care: At the Breaking Point" called national attention to the lack of specialty-trained emergency care practitioners, particularly in rural America. One suggested strategy for narrowing the gap between the prevalence of residency-trained, board-certified emergency physicians practicing in rural and urban emergency departments is the development of rural clinical experiences for emergency medicine residents during the course of their training. This article addresses promotion of a rural emergency medicine rotation to hospital leadership and resident recruits, examines funding sources, discusses medical liability and disability insurance options, provides suggestions for meeting faculty and planned educational activity residency review committee requirements, and offers guidance about site selection to direct emergency medicine academic leaders considering or planning a new rural emergency medicine rotation.
Subject(s)
Emergency Medicine/education , Hospitals, Rural , Internship and Residency/organization & administration , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Faculty, Medical , Humans , Internship and Residency/methods , Rural Population , United StatesABSTRACT
Altered level of consciousness describes the reason for 3% of critical emergency department (ED) visits. Approximately 85% will be found to have a metabolic or systemic cause. Early laboratory studies such as a bedside glucose test, serum electrolytes, or a urine dipstick test often direct the ED provider toward endocrine or metabolic causes. This article examines common endocrine and metabolic causes of altered mentation in the ED via sections dedicated to endocrine-, electrolyte-, metabolic acidosis-, and metabolism-related causes.
Subject(s)
Consciousness Disorders/etiology , Acidosis/complications , Acidosis/diagnosis , Acidosis/psychology , Aged , Child , Consciousness Disorders/diagnosis , Consciousness Disorders/metabolism , Consciousness Disorders/physiopathology , Cushing Syndrome/complications , Cushing Syndrome/diagnosis , Cushing Syndrome/psychology , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/psychology , Ethylene Glycol/poisoning , Female , Glucose Metabolism Disorders/complications , Glucose Metabolism Disorders/diagnosis , Glucose Metabolism Disorders/psychology , Humans , Hyperammonemia/complications , Hyperammonemia/diagnosis , Hyperammonemia/psychology , Inappropriate ADH Syndrome/complications , Inappropriate ADH Syndrome/diagnosis , Inappropriate ADH Syndrome/psychology , Metabolic Diseases/complications , Metabolic Diseases/diagnosis , Metabolic Diseases/psychology , Methanol/poisoning , Pregnancy , Salicylates/poisoning , Thyroid Diseases/complications , Thyroid Diseases/diagnosis , Thyroid Diseases/psychology , Water-Electrolyte Imbalance/complications , Water-Electrolyte Imbalance/diagnosis , Water-Electrolyte Imbalance/psychologyABSTRACT
Metabolic acidosis is defined as an acidemia created by one of three mechanisms: increased production of acids, decreased excretion of acids, or loss of alkali. This article addresses the identification and correct diagnosis of metabolic acidosis by reviewing important historical factors, pathophysiological principles, clinical presentation,and laboratory findings accompanying common high and normal anion gap metabolic acidoses in emergency department patients.
