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1.
J Emerg Med ; 57(5): e157-e160, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31279638

RESUMO

Although the majority of U.S. medical students predominantly apply to only one specialty, some apply to more than one. When it comes to emergency medicine (EM), applicants may apply to additional specialties due to several reasons: being international medical graduates as well as their inability to make a decision regarding the choice of specialty, fear from the growing competitiveness of EM, or the desire to stay in a specific geographic area. Accordingly, in this article we aim to guide medical students through the process of applying to more than one specialty, including using the Electronic Residency Application Service application, writing a personal statement, getting letters of recommendation, and an Early Match. Moreover, we elaborate on the effect of applying to more than one specialty on a student's application to a residency in EM.


Assuntos
Escolha da Profissão , Medicina/tendências , Estudantes de Medicina/psicologia , Educação de Pós-Graduação em Medicina/métodos , Humanos , Internato e Residência/tendências , Estudantes de Medicina/estatística & dados numéricos
2.
J Emerg Med ; 56(5): e95-e101, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30904381

RESUMO

Program directors (PDs) are faced with an increasing number of applicants to emergency medicine (EM) and a limited number of positions. This article will provide candidates with insight to what PDs look for in an applicant. We will elaborate on the performance in the emergency medicine clerkship, interview, clinical rotations (apart from EM), board scores, Alpha Omega Alpha membership, letters of recommendation, Medical Student Performance Evaluation or dean's letter, extracurricular activities, Gold Humanism Society membership, medical school attended, research and scholarly projects, personal statement, and commitment to EM. We stress the National Resident Matching Program process and how, ultimately, selection of a residency is equally dependent on an applicant's selection process.


Assuntos
Seleção de Pessoal/métodos , Critérios de Admissão Escolar/tendências , Comportamento de Escolha , Medicina de Emergência/educação , Humanos , Estados Unidos
3.
J Emerg Med ; 52(3): 324-331, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27979641

RESUMO

BACKGROUND: Many emergency physicians gain familiarity with the laryngeal anatomy only during the brief view achieved during rapid sequence induction and intubation. Awake laryngoscopy in the emergency department (ED) is an important and clinically underutilized procedure. DISCUSSION: Providing benefit to the emergency physician through a slow, controlled, and deliberate examination of the airway, awake laryngoscopy facilitates confidence in the high-risk airway and eases the evolution to intubation, should it be required. Emergency physicians possess all the tools and skills required to effectively perform this procedure, through either the flexible endoscopic or rigid approaches. The procedure can be conducted utilizing local anesthesia with or without mild sedation, such that patients protect their airway. CONCLUSION: We discuss two clinical scenarios, indications/contraindications, patient selection, and steps to performing two approaches to awake laryngoscopy in the ED.


Assuntos
Estado de Consciência/classificação , Laringoscopia/métodos , Administração Tópica , Idoso , Manuseio das Vias Aéreas/métodos , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Anestesia/métodos , Contraindicações , Dexmedetomidina/farmacologia , Dexmedetomidina/uso terapêutico , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Hipnóticos e Sedativos/farmacologia , Hipnóticos e Sedativos/uso terapêutico , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Ketamina/farmacologia , Ketamina/uso terapêutico , Laringoscopia/instrumentação , Lidocaína/farmacologia , Lidocaína/uso terapêutico , Midazolam/farmacologia , Midazolam/uso terapêutico , Pessoa de Meia-Idade
4.
Emerg Med Clin North Am ; 34(1): 15-37, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26614239

RESUMO

Acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations are the most common respiratory diseases requiring emergent medical evaluation and treatment. Asthma and COPD are chronic, debilitating disease processes that have been differentiated traditionally by the presence or absence of reversible airflow obstruction. Asthma and COPD exacerbations impose an enormous economic burden on the US health care budget. In daily clinical practice, it is difficult to differentiate these 2 obstructive processes based on their symptoms, and on their nearly identical acute treatment strategies; major differences are important when discussing anatomic sites involved, long-term prognosis, and the nature of inflammatory markers.


Assuntos
Manuseio das Vias Aéreas/métodos , Asma/diagnóstico , Asma/terapia , Serviço Hospitalar de Emergência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Doença Aguda , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Broncodilatadores/uso terapêutico , Gerenciamento Clínico , Progressão da Doença , Dispneia/diagnóstico , Dispneia/terapia , Humanos , Respiração Artificial/métodos
5.
Artigo em Inglês | MEDLINE | ID: mdl-22190848

RESUMO

BACKGROUND: For more than 20 years, medical literature has increasingly documented the need for students to learn, practice and demonstrate competence in basic clinical knowledge and skills. In 2001, the Louisiana State University Health Science Centers (LSUHSC) School of Medicine - New Orleans replaced its traditional Introduction in to Clinical Medicine (ICM) course with the Science and Practice of Medicine (SPM) course. The main component within the SPM course is the Clinical Skills Lab (CSL). The CSL teaches 30 plus skills to all pre-clinical medical students (Years 1 and 2). METHODS: Since 2002, an annual longitudinal evaluation questionnaire was distributed to all medical students targeting the skills taught in the CSL. Students were asked to rate their self- confidence (Dreyfus and Likert-type) and estimate the number of times each clinical skill was performed (clinically/non-clinically). Of the 30 plus skills taught, 8 were selected for further evaluation. RESULTS: An analysis was performed on the eight skills selected to determine the effectiveness of the CSL. All students that participated in the CSL reported a significant improvement in self-confidence and in number performed in the clinically/non-clinically setting when compared to students that did not experience the CSL. For example, without CSL training, the percentage of students reported at the end of their second year self-perceived expertise as "novice" ranged from 21.4% (CPR) to 84.7% (GU catheterization). Students who completed the two-years CSL, only 7.8% rated their self-perceived expertise at the end of the second year as "novice" and 18.8% for GU catheterization. CONCLUSION: The CSL design is not to replace real clinical patient experiences. It's to provide early exposure, medial knowledge, professionalism and opportunity to practice skills in a patient free environment.


Assuntos
Competência Clínica , Simulação por Computador , Currículo , Desenvolvimento de Programas , Feminino , Humanos , Masculino , Nova Orleans , Avaliação de Programas e Projetos de Saúde , Faculdades de Medicina , Autoeficácia , Estudantes de Medicina , Inquéritos e Questionários
7.
Acad Emerg Med ; 16 Suppl 2: S19-24, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20053204

RESUMO

BACKGROUND: Four distinct generations of physicians currently coexist within the emergency medicine (EM) workforce, each with its own unique life experience, perspective, attitude, and expectation of work and education. To the best of our knowledge, no investigations or consensus statements exist that specifically address the effect of intergenerational differences on undergraduate and graduate medical education in EM. OBJECTIVES: To review the existing literature on generational differences as they pertain to workforce expectations, educational philosophy, and learning styles and to create a consensus statement based on the shared insights of experienced educators in EM, with specific recommendations to improve the effectiveness of EM residency training programs. METHODS: A group of approximately one hundred EM program directors (PDs), assistant PDs, and other academic faculty attending an annual conference of emergency physician (EP) educators gathered at a breakout session and working group to examine the literature on intergenerational differences, to share insights and discuss interventions tailored to address these stylistic differences, and to formulate consensus recommendations. RESULTS: A set of specific recommendations, including effective educational techniques, was created based on literature from other professions and medical disciplines, as well as the contributions of a diverse group of EP educators. CONCLUSIONS: Recommendations included early establishment of clear expectations and consequences, emphasis on timely feedback and individualized guidance during training, explicit reinforcement of a patient-centered care model, use of peer modeling and support, and emphasis on more interactive and small-group learning techniques.


Assuntos
Medicina de Emergência/educação , Relação entre Gerações , Estilo de Vida , Competência Clínica , Avaliação Educacional , Humanos , Internato e Residência/organização & administração , Internato e Residência/normas , Mentores
9.
Am J Emerg Med ; 26(6 Suppl): 1-11, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18603170

RESUMO

Traditionally, pneumonia is categorized by epidemiologic factors into community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Microbiologic studies have shown that the organisms which cause infections in HAP and VAP differ from CAP in epidemiology and resistance patterns. Patients with HAP or VAP are at higher risk for harboring resistant organisms. Other historical features that potentially place patients at a higher risk for being infected with resistant pathogens and organisms not commonly associated with CAP include history of recent admission to a health care facility, residence in a long-term care or nursing home facility, attendance at a dialysis clinic, history of recent intravenous antibiotic therapy, chemotherapy, and wound care. Because these "risk factors" have health care exposure as a common feature, patients presenting with pneumonia having these historical features have been more recently categorized as having health care-associated pneumonia (HCAP). This publication was prepared by the HCAP Working Group, which is comprised of nationally recognized experts in emergency medicine, infectious diseases, and pulmonary and critical care medicine. The aim of this article is to create awareness of the entity known as HCAP and to provide knowledge of its identification and initial management in the emergency department.


Assuntos
Infecção Hospitalar , Tratamento de Emergência/métodos , Pneumonia Bacteriana , Acetamidas/uso terapêutico , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/uso terapêutico , Cefalosporinas/uso terapêutico , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/terapia , Tratamento de Emergência/normas , Ertapenem , Feminino , Humanos , Tempo de Internação , Linezolida , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Minociclina/análogos & derivados , Minociclina/uso terapêutico , Oxazolidinonas/uso terapêutico , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/terapia , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Pneumonia Associada à Ventilação Mecânica/terapia , Guias de Prática Clínica como Assunto , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Fatores de Risco , Índice de Gravidade de Doença , Tigeciclina , beta-Lactamas/uso terapêutico
10.
Am J Med ; 118 Suppl 7A: 7S-13S, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15993672

RESUMO

In the outpatient setting, genitourinary infections (GUIs) remain costly to treat and are a significant cause of morbidity. Recent evidence supports more substantial roles for pathogens other than Escherichia coli, particularly gram-positive pathogens, in the pathogenesis of GUIs. Broad-spectrum agents should be considered in order to address this etiologic change appropriately. Criteria for antimicrobial selection set forth by the Council for Appropriate and Rational Antibiotic Therapy (CARAT) recommend using antibiotics that are supported by strong clinical evidence, have good susceptibility profiles, are safe, are cost-effective, and are used for the optimal duration. Evidence-based guidelines recommend considering local E coli resistance rates to trimethoprim-sulfamethoxazole and using fluoroquinolones as second-line therapy when resistance is high. Fluoroquinolones are recommended for the treatment of pyelonephritis and prostatitis. Among the fluoroquinolones, levofloxacin and gatifloxacin offer coverage for the gram-negative and gram-positive pathogens, which may make them preferable in treating urinary tract infections empirically in such patient groups. For the treatment of bacterial prostatitis, only trimethoprim and the fluoroquinolones possess both the appropriate bactericidal activity and the ability to diffuse into the prostate. Levofloxacin shows particularly good penetration into prostatic tissue. Safety issues to consider include imbalances in intestinal microflora caused by antimicrobial agents that may lead to overgrowth of vancomycin-resistant enterococci and Clostridium difficile-associated diarrhea. Once the optimal agent is identified, the optimal duration of treatment should be determined to maximize treatment success while minimizing the potential for resistance. Finally, cost considerations include the costs of treatment failure due to inappropriate therapy or nonadherence to the therapeutic regimen.


Assuntos
Assistência Ambulatorial , Antibacterianos/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Antibacterianos/administração & dosagem , Antibacterianos/economia , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Prostatite/diagnóstico , Prostatite/tratamento farmacológico , Prostatite/microbiologia , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia
11.
Emerg Med Clin North Am ; 21(2): 239-58, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12793613

RESUMO

Evaluation of the patient in acute respiratory distress poses a complex problem to the emergency physician. Because of the heterogeneity of the population of patients presenting in acute respiratory distress, there is a paucity of evidence-based medicine recommendations. Practice habit dictates most of our diagnostic and therapeutic approach. It is of paramount importance to understand the limitations of history, physical examination, and diagnostic screening studies in evaluating and treating patients with respiratory distress. The emergency physician should become aware of the benefits of NPPV in the management of respiratory failure. Essential to the management of these patients is the ability to anticipate difficulty in airway management and the formulation of alternative airway strategies.


Assuntos
Serviços Médicos de Emergência/métodos , Insuficiência Respiratória/terapia , Adolescente , Adulto , Gasometria/métodos , Criança , Diagnóstico Diferencial , Humanos , Intubação Intratraqueal/métodos , Exame Físico/métodos , Respiração com Pressão Positiva/métodos , Radiografia Torácica/métodos , Testes de Função Respiratória/métodos , Insuficiência Respiratória/sangue , Insuficiência Respiratória/diagnóstico
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