Overcoming barriers to promotion for women and underrepresented in medicine faculty in academic emergency medicine.

Equity in the promotion of women and underrepresented minorities (URiM) is essential for the advancement of academic emergency medicine and the specialty as a whole. Forward-thinking healthcare organizations can best position themselves to optimally care for an increasingly diverse patient population and mentor trainees by championing increased diversity in senior faculty ranks, leadership, and governance roles. This article explores several potential solutions to addressing inequities that hinder the advancement of women and URiM faculty. It is intended to complement the recently approved American College of Emergency Physicians (ACEP) policy statement aimed at overcoming barriers to promotion of women and URiM faculty in academic emergency medicine. This policy statement was jointly released and supported by the Society for Academic Emergency Medicine (SAEM), American Academy of Emergency Medicine (AAEM), and the Association of Academic Chairs of Emergency Medicine (AACEM).

Urethral Calculi.

Urolithiasis is a condition with calculi commonly found within the kidney, ureter, or bladder. The urethra is an uncommon location of urolithiasis, with limited case reports and literature reviews of its presentation and management. Here we discuss a 24-year-old female who presented with urinary urgency, flank pain, and urinary retention for 12 hours. Physical exam showed a calculus at the urethral meatus. This case discusses the manual removal of a urethral calculus in a female patient with use of forceps, resulting in complete resolution of symptoms and urinary retention.

Rare External Jugular Vein Pseudoaneurysm.

External jugular vein pseudoaneurysm is a very rare cause of a neck mass due to the low pressure venous system. This case demonstrates a 27-year-old female who presented to the emergency department with a non-tender, compressible, left-sided neck mass that enlarged with valsalva and talking, and intermittent paresthesias. Upon workup, she was diagnosed with an external jugular vein pseudoaneurysm. Complications of this diagnosis are mentioned in the literature; however, most patients with an external jugular vein pseudoaneurysm or aneurysm can be safely discharged with close follow-up with a vascular surgeon.

Top 10 evidence-based countermeasures for night shift workers.

Emergency edicine providers are responsible for ensuring the emergency department is staffed 24 hours a day. As such, providers must efficiently transition between day, swing and night shift on an almost weekly basis. There is no formal education in medical school or residency on how to approach the transition to and from night shift, remain alert and productive and maximise sleep during the day. There are a multitude of blogs and online sources discussing night shift, but few, if any, provide an evidence-based approach. This article will provide the top 10 evidence-based recommendations to increase sleep, maximise performance, decrease fatigue on shift and improve quality of life outside the workplace.

Low Fidelity Trainer for Fiberoptic Scope Use in the Emergency Department.

Audience: The low fidelity trainer for fiberoptic scope is designed to train emergency medicine (EM) residents PGY I-IV, and medical students interested in EM. Introduction: Fiberoptic intubation is a skill that Emergency Medicine (EM) providers should be familiar with, though it is a rarely encountered procedure in the clinical setting. Approximately 1% of endotracheal intubations are performed using fiberoptic intubation.1,2 The success rate of first attempt fiberoptic intubation is about 50%. When fiberoptic intubation is used as a rescue device it has been shown to be about 70 % successful.1 Despite being an important skill for emergency physicians to have, fiberoptic intubation competency is not required during emergency medicine residency1 and resident physicians have limited exposure to learning this life-saving skill.Given that fiberoptic intubation is a rarely performed procedure in the clinical setting, the most practical way for EM learners to gain proficiency would be through simulation. The use of fiberoptic trainers in anesthesiologist resident training has shown improvement in first pass success and overall skills with using the fiberoptic scope.3-6 Simulation has also been shown to improve resident procedural knowledge and skills in many other fields.7-11 Simulation offers training with seldom performed procedures, and there is evidence that simulation does improve patient outcomes and reduce errors.2,12-14 In order to help EM learners gain confidence and increase their comfort in using the fiberoptic scope, we developed a low fidelity training model that allows the learner to practice fiberoptic intubation. Educational Objectives: By the end of this training session, learners will be able to 1) list indications, contraindication, and complications in performing fiberoptic intubations, 2) know how to use and maneuver a fiberoptic scope, and 3) be able to successfully intubate the trainer model. Educational Methods: The training model consists of a large 55-gallon tote with polyvinyl chloride (PVC) pipes enclosed in the tote. The pipes were arranged in various manners: several pipes simulated the oropharynx and trachea, and others were arranged into a series of mazes, to require the learner to manipulate the scope through the maze to reach the end. The multiple stations within the model provided ample opportunity for the learner to acquire confidence with the fiberoptic scope and the movements required to maneuver the scope into position. Research Methods: The model was used in our weekly Emergency Medicine conference during a low fidelity simulation day. The residents were split into groups consisting of 5-6 learners. The residents and medical students were given a brief 5-minute lecture on fiberoptic intubation, which reviewed indications for fiberoptic intubation, and a demonstration on how to operate the fiberoptic scope. Following the briefing, each group had approximately 25-30 minutes to practice using the simulated fiberoptic scope model. Each learner in the group was then encouraged to practice navigating the other mazes at their own discretion. Residents and medical students were given a survey before and after using the fiberoptic training model to assess their knowledge and confidence in performing the procedure. Results: The use of the fiberoptic trainer was successful in helping learners to become more familiar with the fiberoptic scope and learn the skills to maneuver the scope successfully through the trainer. Each resident performed a survey prior to and after the fiberoptic instruction and training. They were asked to rate their confidence in identifying airway landmarks, perform the procedure without supervision, and identify correct supplies needed for procedure. All areas increased in confidence except in identifying correct supplies for PGY-II (-0.1), and PGY-III (-0.4). The greatest increase was amongst PGY-I residents in confidence identifying airway landmarks, with an increase of 4.2. Discussion: As with any simulation model, this model does not perfectly recreate human anatomy. For example, in our model there were no simulated secretions or blood. The actual appearance of the anatomy will be very different from that which was used in our model, which may lead to an unsuccessful intubation attempt. The scenarios in which we were using the trainer was a low stress environment, unlike the usual emergency setting. Despite this, there was an increase in learner confidence in using a fiberoptic scope to manage emergency airways. It also offered a unique experience and gave the learners an opportunity to learn how to manipulate the fiberoptic scope that a traditional high fidelity model may not offer. Future comparisons could be made between a low fidelity simulation and high fidelity simulation device, and the addition of simulated secretions could help increase learning and confidence in fiberoptic intubations. Topics: Difficult airway management, Fiberoptic intubation, fiberoptic use in emergency department.

Promoting an obesity education program among minority patients in a single urban pediatric Emergency Department (ED).

BACKGROUND: The purpose of this study was to assess the feasibility of the Emergency Department (ED) as a place for obesity education and to evaluate its impact on patient's lifestyle modification. METHODS: In this study, children between 8 and 18 years of age, who presented to the ED for non-urgent reasons in a single urban hospital, were enrolled. Parents' perception of their child's diet and exercise were assessed prior to the intervention. Both parents and children attended a brief audio-visual presentation that provided educational information on age-appropriate diet and exercise. Following the intervention, the participants were asked about their impressions regarding the ED as a place to receive obesity education and whether they plan to make any changes in diet and exercise. RESULTS: One hundred children and their parents participated in this study. Of these, 76 were Latino and 21 were African-Americans. The mean age was 14 years, and the mean body mass index (BMI) was 25.6. Following the intervention, 21 (100 %) of the African-American parents and 73 (98.6 %) of the Latino parents felt that the ED should provide obesity education. Eighteen (85.7 %) of the African-American parents and 72 (97.3 %) of the Latino parents planned to make changes in their child's diet and exercise. Among the children, 21 (100 %) of African-American participants and 76 (100 %) of Latino participants reported that they found the audio-visual useful. Seventeen (81.0 %) of the African-American children and 73 (96.1 %) of Latino children stated learning new information from the intervention program. CONCLUSIONS: This study suggests the ED may have a role in primary health promotion and obesity prevention. An ED-based intervention may be used to provide education about obesity prevention and has the potential to impact life style modifications, including diet and exercise.

An evidence-based approach to emergency department management of acute urinary retention.

Approximately 10% of men in their 70s and 33% of men in their 80s report at least 1 episode of acute urinary retention, and this urological emergency presents unique assessment and treatment challenges in the emergency department setting. Patients presenting with acute urinary retention are often in severe pain and require urgent diagnosis and prompt treatment. The differential diagnosis of acute urinary retention is vast, with some causes leading to permanent impairment if not dealt with in a timely manner. Quick recognition of the cause and timely bladder decompression are of utmost importance in preventing morbidity and relieving pain. This review analyzes the etiology, key historical and physical findings, differential diagnosis, and diagnostic studies for acute urinary retention in both men and women. Treatment algorithms for men and women, current controversies regarding urinary catheter usage, and recommendations on criteria for disposition are also presented.

A retrospective analysis of the utility of an artificial neural network to predict ED volume.

OBJECTIVE: The objectives of this study are to design an artificial neural network (ANN) and to test it retrospectively to determine if it may be used to predict emergency department (ED) volume. METHODS: We conducted a retrospective review of patient registry data from February 4, 2007, to December 31, 2009, from an inner city, tertiary care hospital. We harvested data regarding weather, days of week, air quality, and special events to train the ANN. The ANN belongs to a class of neural networks called multilayer perceptrons. We designed an ANN composed of 37 input neurons, 22 hidden neurons, and 1 output neuron designed to predict the daily number of ED visits. The training method is a supervised backpropagation algorithm that uses mean squared error to minimize the average squared error between the ANN's output and the number of ED visits over all the example pairs. RESULTS: A linear regression between the predicted and actual ED visits demonstrated an R2 of 0.957 with a slope of 0.997. Ninety-five percent of the time, the ANN was within 20 visits. CONCLUSION: The results of this study show that a properly designed ANN is an effective tool that may be used to predict ED volume. The scatterplot demonstrates that the ANN is least predictive at the extreme ends of the spectrum suggesting that the ANN may be missing important variables. A properly calibrated ANN may have the potential to allow ED administrators to staff their units more appropriately in an effort to reduce patient wait times, decrease ED physician burnout rates, and increase the ability of caregivers to provide quality patient care. A prospective is needed to validate the utility of the ANN.

Recurrent intussusception.

Recurrent intussusception is defined as an occurrence of intussusception of a bowel loop in a patient with a prior resolution of intussusception, either spontaneously or with an intervention. It is not rare to develop a subsequent episode after a successful reduction of intussusception. We report the cases of 2 children who presented to the emergency department with recurrent intussusception and review the pertinent literature.

Long-term ophthalmological follow-up of children with Parinaud syndrome.

BACKGROUND AND OBJECTIVE: To assess the long-term ophthalmological outcome of Parinaud syndrome. PATIENTS AND METHODS: The files of 6 children with tumor-related Parinaud syndrome diagnosed and observed from 2000 to 2007 were reviewed. All had papilledema indicating increased intracranial pressure. RESULTS: Mean presentation-to-diagnosis delay was 3.6 weeks. Treatment consisted of surgical shunting and complete or partial resection with adjuvant chemotherapy (n = 4) and radiation (n = 3). Visual acuity remained stable or improved in 8 of 9 eyes with 20/30 visual acuity at diagnosis; improved bilaterally in 1 patient from 20/100 to 20/25; and deteriorated bilaterally in 1 patient from 20/30 and 20/200 to counting fingers and hand motions, respectively. The most improvement was achieved within 4 months. Findings at follow-up (mean: 4.2 years) included up gaze limitation (minimal in 2 patients), abnormal convergence, convergence retraction nystagmus, and light-near dissociation. One child had bilateral optic atrophy. CONCLUSION: Children with tumor-related Parinaud syndrome tend to have subtle but measurable residual ophthalmological findings years after diagnosis and treatment.