Air and knee bolster restraint system: laboratory sled tests with human cadavers and the Hybrid III dummy.

UNLABELLED: Growing evidence from data base and laboratory studies demonstrates effective occupant protection with the airbag supplemental restraint and seatbelt restraint system. Concern that drivers of vehicles equipped with airbags may assume adequate protection without concomitant seatbelt use prompted the study of unbelted occupant behavior in frontal crashes. OBJECTIVE: To evaluate the crash protection afforded unbelted drivers in airbag-equipped vehicles. DESIGN: Six laboratory sled tests were conducted with a production driver's side airbag and knee bolster restraint system but without a seatbelt restraint system. MATERIALS AND METHODS: Four human cadavers and the Hybrid III dummy were used as occupants in 32 km/h and 48 km/h tests with a simulated mid-size vehicle. MEASUREMENTS AND MAIN RESULTS: Head contact with the windshield/header region of the simulated vehicle and abdominal impingement on the lower rim of the steering wheel were noted in all tests. Autopsy examinations and radiographic images identified extensive spinal and thoracic trauma in addition to lower extremity and facial injuries. Injury Severity Scores were considered severe to critical for all occupants. CONCLUSIONS: The evidence suggests the need to emphasize the use of seatbelts in conjunction with airbags and to develop a redesigned airbag and knee bolster system to control occupant kinematics and loading more effectively.

Impact of emergency medicine residency program on rotators' emergency medicine education.

STUDY OBJECTIVE: To assess the perceived impact of emergency medicine residency programs on other program directors' perceptions of emergency medicine as a distinct service and educational entity. DESIGN: Self-administered questionnaire. TYPE OF PARTICIPANTS: Residency directors in medicine, surgery, pediatrics, and obstetrics and gynecology at sites containing emergency medicine residency programs. RESULTS: Two hundred twenty-four of 372 questionnaires (60.1%) were returned completed, with equal distributions among all specialties. Respondents stated that the presence of the emergency medicine training program has positively influenced their attitude toward emergency medicine as a specialty (61% agree, 26% neutral), improved their residents' training in emergency medicine (47% agree, 31% neutral), and improved emergency care at their institution (65% agree, 26% neutral). Fifty-seven percent think emergency physicians should teach emergency medicine (27% were neutral). There were statistically significant associations between age of the emergency medicine program and perceived improvement in rotating residents' education and institutional delivery of emergency care. CONCLUSION: Residency directors in other specialties have a generally positive view of emergency medicine as a specialty and as an important component of their residents' education. The presence of an emergency medicine training program appears to have positively influenced their attitudes, improved their residents' education, and improved emergency care. Older programs have positively influenced attitudes to a greater degree than have newer programs.

Light reflection rheography as a noninvasive screening test for deep venous thrombosis.

STUDY OBJECTIVE: To determine if light reflection rheography is a useful screening tool for the diagnosis of proximal leg deep venous thrombosis. DESIGN: Light reflection rheography was compared with duplex ultrasonography and/or contrast venography on emergency patients being evaluated for proximal leg deep venous thrombosis. SETTING: University hospital emergency department. TYPE OF PARTICIPANTS: Seventy-five ED patients being evaluated for acute leg deep venous thrombosis. INTERVENTIONS: Seventy-five patients being evaluated for clinically suspected deep venous thrombosis had light reflection rheography performed on the involved extremity immediately before duplex ultrasonography and/or contrast venography. Duplex ultrasonography and/or contrast venography was the definitive diagnostic test. MEASUREMENTS AND RESULTS: Seventy-five patients had light reflection rheography performed, 72 had duplex ultrasonography, 19 had contrast venography, three had contrast venography alone, and 16 had both duplex ultrasonography and contrast venography. A comparison of light reflection rheography with duplex ultrasonography and/or contrast venography reveals that 39 light reflection rheography examinations were true-negative, 17 were true-positive, one was false-negative, and 18 were false-positive. The sensitivity of light reflection rheography for the detection of proximal leg deep venous thrombosis is 94.4% (95% confidence interval [CI], 72.7-99.9%), the negative-predictive value is 97.5% (95% CI, 86.8-99.9%), the specificity is 68.4% (95% CI, 54.8-80.1%), and the positive-predictive value is 48.6% (95% CI, 31.4-66%). CONCLUSION: Light reflection rheography proved to be an excellent screening tool for emergency patients with the clinical suspicion for an acute proximal leg deep venous thrombosis. A normal light reflection rheography examination was 97.5% accurate as a negative predictor. That is, a normal light reflection rheography excluded the diagnosis of proximal leg deep venous thrombosis when compared with duplex ultrasonography and/or contrast venography when the duplex ultrasonography and/or contrast venography showed no evidence of proximal leg deep venous thrombosis. An abnormal light reflection rheography does not equate to an acute leg deep venous thrombosis as the specificity was only 68.4%. An abnormal light reflection rheography mandates further diagnostic studies such as duplex ultrasonography and/or contrast venography to confirm a diagnosis of proximal leg deep venous thrombosis.

Physicians' views on how specialty-specific the first year of residency should be.

The nature of the first year of postgraduate medical education has gone through many changes over the years. Relatively recent changes have made this first year into a specialty-specific experience. Medical students are increasingly experiencing a narrowed and less broad-based clinical education. Many students, residents, and attending physicians complain that they wish they had had a "rotating" or "flexible" internship. Graduate medical education authorities have recently recommended that the internship year return to a broad-based general medical education experience. In 1989, the authors surveyed the entire physician faculty and housestaff at a large academic health sciences center, asking them what type of first postgraduate year (PGY-1) the physicians had experienced themselves and what type of PGY-1 they recommended for future graduating medical students. Over one-third strongly recommended that the PGY-1 should be broad-based and not specialty-specific.

Motor vehicle crash injury patterns and the Virginia seat belt law.

Injuries to front seat occupants in tow-away crashes in the Charlottesville, Va, area were compared for 1 year before and 1 year after Virginia's seat belt use law took effect. Vehicle and occupant data were combined to examine crash and injury patterns. Reported seat belt use in crashes increased after the law, and there were substantial decreases in injuries. Front seat occupants were less likely to receive medical treatment following a crash in the postlaw period. The reduction in the number of injuries was greater for passengers in the right front seat than for drivers and for frontal crashes than for other types of crashes. The injury reduction effects occurred primarily through reductions in the number of head and face injuries, particularly those that occur from contact with windshields and instrument panels.

Computed tomography diagnosis of acute facial swelling in an adult hemophiliac.

Acute facial swelling can be life-threatening due to airway obstruction. Hemophiliac patients presenting with acute facial swelling must have accurate and expedient diagnosis. We report the case of acute nontraumatic swelling in a hemophiliac patient that was easily and accurately diagnosed by the use of computed tomography scan.

Excision of multiple epidermal facial cysts in Gardner's syndrome.

A rhytidectomy incision is recommended to excise multiple facial epidermal cysts in patients with Gardner's syndrome. The advantage of this approach is that it permits excision of excess skin over the cyst with esthetically pleasing hidden scars. The alternative to this procedure, a separate incision over each cyst, results in disfiguring and conspicuous scars.

Incidence of 24-hour faculty coverage in teaching EDs.

There is growing concern in academic emergency medicine as to the appropriateness of 24-hour faculty coverage in the teaching emergency department. We surveyed 170 teaching emergency departments, 49 of which had approved emergency medicine residencies, asking for information regarding 24-hour faculty coverage. We were able to separate each department into one of 15 profiles based on the two variables of average ED yearly census and hospital type. Seventy-three percent of university teaching hospital EDs and 65% of those with emergency medicine residencies have 24-hour faculty coverage; 83% of private teaching hospital EDs and 100% of those with emergency medicine residencies have 24-hour faculty coverage; and 79% of city/county teaching hospital EDs and 80% of those with emergency medicine residencies have 24-hour faculty coverage.

Painless aortic dissection: an unusual cause of syncope.

Presented is a case of syncope as the initial sign of a painless aortic dissection. The patient was stabilized by percutaneous drainage of a hemopericardium, and then underwent angiography and successful operative repair. Although uncommon, painless aortic dissection should be included in the differential diagnosis of a syncopal episode.