A Molecular Method to Detect Wound Cells in Bloodstains Resultant of Sharp Force Injuries for Crime Scene Reconstruction.

Previous research by the authors on an animal model showed that bloodstains can contain additional information about their somatic origin in the form of wound cells. Bloodstains produced by a gunshot wound to the head were distinguished from bloodstains produced by a gunshot wound to the chest by testing the stains for a brain microRNA marker. In this study, the effectiveness of the technique was examined on blood drops shed externally from a stab wound to the liver of rat carcasses. Specifically, investigations were conducted on the liver microRNA marker, rno-mir-122-3p, with the QIAGEN miScript System, and PCR analysis. Between the two stabbing methods used, 67% of the scalpel blades and 57% of the blood drops tested positive for rno-mir-122-3p; however, other samples tested negative giving inconclusive results as to the wound-of-origin. The amount of the liver cells in the bloodstains appeared to be related to the extent of trauma.

Core curricular elements for fellowship training in international emergency medicine.

OBJECTIVES: The objective was to describe the common educational goals, curricular elements, and methods of evaluation used in international emergency medicine (IEM) fellowship training programs currently. IEM fellowship programs have been developed to provide formal training for emergency physicians (EPs) interested in pursuing careers in IEM. Those fellowships are variable in scope, objectives, and duration. Previously published articles have suggested a general curriculum structure for IEM fellowships. METHODS: A search of MEDLINE, EMBASE, and CINAHL databases from 1950 to June 2008 was performed, combining the terms international, emergency medicine, and fellowship. Online curricula and descriptive materials from IEM fellowships listed by the Society for Academic Emergency Medicine (SAEM) were reviewed. Knowledge and skill areas common to multiple programs were organized in discrete categories. IEM fellowship directors were contacted for input and feedback. RESULTS: Eight articles on IEM fellowships were identified. Two articles described a general structure for fellowship curriculum. Sixteen of 20 IEM fellowship programs had descriptive materials posted online. These information sources, plus input from seven fellowship program directors, yielded the following seven discrete knowledge and skill areas: 1) emergency medicine systems development, 2) humanitarian relief, 3) disaster management, 4) public health, 5) travel and field medicine, 6) program administration, and 7) academic skills. CONCLUSIONS: While IEM fellowships vary with regard to objectives and structure, this article presents an overview of the current focus of IEM fellowship training curricula that could serve as a resource for IEM curriculum development at individual institutions.

International emergency medicine fellowships.

The active interchange of intellectual ideas in the quest to improve healthcare globally will likely be best served by active interchange among physicians around the world. Subspecialty fellowship training programs for United States and foreign graduates will provide a focused path to development of a global network of physicians dedicated to the delivery of high-quality emergency health services.

Intravenous epinephrine in life-threatening asthma.

STUDY OBJECTIVE: Intravenous epinephrine is a potentially vital therapy for patients with life-threatening asthma but is often avoided because of concerns about its safety. We evaluated the safety of intravenous epinephrine in a series of adults with life-threatening asthma. METHODS: We performed an explicit retrospective chart review on a case series of 27 emergency department patients aged 19 to 58 years (mean 25 years) who were treated with intravenous epinephrine for a life-threatening exacerbation of asthma between 1989 and 1997. Explicit criteria for adverse effects, including cardiac arrhythmia or ischemia, hypotension or hypertension, neurologic injury, and death, were defined before chart review. RESULTS: No patient had an arrhythmia other than sinus tachycardia, and there were no cases of cardiac ischemia, hypotension, neurologic deficit, or death. CONCLUSION: Intravenous epinephrine was safe in this small series of younger adults with acute life-threatening asthma. A prospective trial of its use to better define an efficacy and risk-benefit relationship is justified.