RESUMO
The curriculum of our freshman emergency medicine course now includes group interviews with standardized patients to introduce communication skills more effectively to students. Our goals for the standardized patient encounters are 1) to start the interview learning process in a nonthreatening environment, 2) to begin to use rudimentary techniques to obtain a history of present illness, 3) to gain insight into a patient's perception of a medical interview, and 4) to learn to project empathy and compassion when talking with patients. The standardized patients technique is one method emergency medicine educators can use to maximize effectiveness in undergraduate medical education.
Assuntos
Educação de Graduação em Medicina/métodos , Medicina de Emergência/educação , Entrevistas como Assunto/normas , Anamnese/normas , Comunicação , Currículo , Humanos , Relações Médico-PacienteRESUMO
Sternal dehiscence is a recognized complication of median sternotomy in 2.5-4.8% of patients. The authors describe the prognostic significance of a lucent midsternal stripe which was seen in 12 patients over a two-year period. Sternal dehiscence requiring surgical revision developed in 4, and radiological suspicion preceded clinical evidence of dehiscence in 3 of them. A review of 100 consecutive median sternotomies revealed that sternal dehiscence did not develop in any patient who did not have a midsternal stripe. It is suggested that this may be a useful tool in identifying those patients who are at high risk of the development of sternal dehiscence.
Assuntos
Esterno/diagnóstico por imagem , Deiscência da Ferida Operatória/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Esterno/cirurgia , Doenças Torácicas/diagnóstico por imagemRESUMO
A patient with a renal arteriovenous fistula is described. She was though to have valvular aortic stenosis because of a history of rheumatic fever, symptoms of congestive heart failure and syncope, and the presence of a harsh systolic murmur with a thrill in the aortic area. Cardiac catheterization revealed a left-to-right shunt of 8.7 L/min. Ligation of the fistula resulted in complete relief of the symptoms and attenuation of the murmur.
Assuntos
Aorta Abdominal , Estenose da Valva Aórtica/diagnóstico , Fístula Arteriovenosa/diagnóstico , Veia Cava Inferior , Idoso , Aortografia , Fístula Arteriovenosa/complicações , Cateterismo Cardíaco , Diagnóstico Diferencial , Feminino , Insuficiência Cardíaca/etiologia , Sopros Cardíacos , Humanos , Nefrectomia/efeitos adversosRESUMO
Platelets have recently been shown to trigger intrinsic coagulation by two alternative pathways, protect active clotting factors from inactivation by plasma inhibitors and catalyse intrinsic coagulation reactions on the platelet surface to form fibrin. To determine whether these platelet coagulant activities (PCA) might have a role in the pathogenesis of DVT, 29 patients have been studied before and after arthroplasty or other surgery for fractured hip or degenerative hip disease. The occurrence of DVT was detected by [125I]fibrinogen uptake in the legs and confirmed by venography. In patients who developed DVT, all PCA increased progressively and significantly on day 1 (mean rise, 146% of baseline), day 3 (228%) and day 5 (298%) after surgery before isotopic evidence of DVT appeared (mean 3.27 days postoperatively). In patients without DVT no changes in PCA were observed. Plasma coagulation factor assays were no different in patients with a without DVT. Platelet counts and total platelet antiheparin activity increased during the early postoperative period in DVT patients but not in patients without DVT. It is suggested that progressive increases in PCA concerned with triggering and catalysing intrinsic coagulation reactions may play a pathogenetic role in DVT after hip surgery.
