ABSTRACT
STUDY OBJECTIVE: To evaluate the educational background, knowledge, and experiences regarding chemical dependency among emergency medicine program directors. The program directors' awareness of substance use and alcohol abuse among emergency medicine residents was examined by comparing their estimates with the actual rates reported by the residents. DESIGN: An anonymous survey mailed in March 1992. TYPE OF PARTICIPANTS: The program directors of all 86 Accreditation Council for Graduate Medical Education-approved emergency medicine residencies. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The 67 responding program directors represented 1,637 (77%) of the 2,130 emergency medicine residents on duty at the time of the survey. Thirty-three (49%) had suspected chemical dependency in a resident at least once, 22 (33%) had identified a chemically dependent resident, and nine (13%) hired a resident known to be in recovery. Substantial percentages reported no or slight knowledge regarding physician impairment issues. Twenty program directors (30%) received no education or only informal education regarding physician impairment. Compared to a February 1992 survey of emergency medicine residents, the program directors' estimates of resident use rates in the past year for seven substances were fairly accurate. However, the program directors estimated that only 16 (1.0%) of their current residents were impaired by alcohol; the resident survey yielded CAGE scores consistent with presumed or suspected alcoholism in 12.5% of emergency medicine residents. CONCLUSION: Emergency medicine program directors must be more attentive to potential alcohol abuse among emergency medicine residents and should receive additional education regarding chemical dependency.
Subject(s)
Emergency Medicine/education , Health Knowledge, Attitudes, Practice , Internship and Residency/statistics & numerical data , Physician Executives/psychology , Physician Impairment/statistics & numerical data , Substance-Related Disorders/epidemiology , Data Collection , Health Promotion , Humans , Organizational Policy , Physician Executives/education , Substance-Related Disorders/diagnosis , Substance-Related Disorders/prevention & control , United States/epidemiology , WorkforceABSTRACT
The course of a pregnant patient at term who was acutely exposed to carbon monoxide is described. A review of the fetal-maternal carboxyhemoglobin relationships and the differences in fetal oxyhemoglobin physiology are used to explain the recommendation that pregnant women with carbon monoxide poisoning should receive 100% oxygen therapy for up to five times longer than is otherwise necessary. The role of hyperbaric oxygen therapy is considered.
Subject(s)
Carbon Monoxide Poisoning/therapy , Pregnancy Complications/therapy , Respiratory Distress Syndrome/therapy , Adult , Carbon Monoxide Poisoning/complications , Female , Humans , Labor, Obstetric , Pregnancy , Pregnancy Trimester, Third , Respiration, Artificial , Respiratory Distress Syndrome/etiologySubject(s)
Emergency Service, Hospital/economics , Ethics, Medical , Patients , Humans , Patient AdvocacyABSTRACT
A known asthmatic patient who was 38-39 weeks pregnant was being treated for asthma in an emergency department. After treatment with subcutaneous terbutaline, she developed a hypotensive episode that lasted almost 30 minutes. Emergency physicians should understand the underlying hemodynamic changes in pregnancy and in the therapy of asthma, and should be aware of the potential for this unusual complication.
