Compartment Syndrome of the Hand: A Little Thought about Diagnosis.

Compartment syndrome of the forearm is a well described entity but there have been relatively few case reports in the emergency medicine literature of hand compartment syndromes (HCS). Prompt recognition and treatment of this potential limb threat are essential to minimize morbidity and mortality. Presented is a case of a documented hand compartment syndrome following a motor vehicle collision.

Tracheal Rupture: A Rare Complication of Endotracheal Intubation.

There are numerous immediate and delayed complications associated with endotracheal intubation. Tracheal rupture is a rare complication whose diagnosis is often delayed. This can result in significant morbidity and mortality. We present a case of therapeutic misadventure resulting in a significant tracheal rupture in a child intubated by helicopter emergency medical services after a near-drowning. This is followed by a review of endotracheal intubation related tracheal rupture.

Grisel Syndrome: An Unusual and Often Unrecognized Cause of Torticollis.

Torticollis can be due to many different etiologies. Torticollis is not a diagnosis, but a symptom of many conditions. We present a case of persistent torticollis in a child that was misdiagnosed during multiple visits to the pediatrician, otolaryngologist, and 3 different emergency departments. Grisel syndrome must be included in the differential diagnosis of any patient with torticollis after a head and neck infection, upper respiratory infection, or postoperative from head and neck surgery. Early diagnosis allows for appropriate management and can prevent significant morbidity.

A comparison of two techniques for tungsten carbide ring removal.

INTRODUCTION: Emergency physicians may have difficulty removing modern rings made of hard metals such as titanium and tungsten carbide. These metals are exceptionally difficult or impossible to remove using standard ring cutters. Numerous alternative techniques for removal have been described, including the "umbilical tape" or "string technique" and, in the case of tungsten carbide, breaking the ring using locking pliers. OBJECTIVE: We sought to compare the speed and effectiveness of tungsten carbide ring removal using these two techniques. METHODS: Ten tungsten carbide rings were placed upon the finger of a standard medical simulation mannequin. The rings chosen were one-half size smaller than the mannequin's finger. Edema distal to the ring was simulated using foam tape. A single novice operator performed 10 trials using each of the techniques after a 10-minute orientation session. The success or failure of the technique and the time for removal were recorded for each trial. The mean removal times for the trials were compared using a paired t test. RESULTS: All trials were successful. The rings were removed substantially faster using the locking pliers method (mean 23.1 seconds [95% CI 15.4-30.8] vs. mean 135.4 seconds [95% CI 130.2-150.6]). However, the locking pliers technique destroyed all rings and caused sharp ring fragments to be thrown up to 37 in. CONCLUSIONS: Both the umbilical tape or string technique and the locking pliers technique successfully removed tungsten carbide rings in our model. The locking pliers technique is significantly faster but destroys the ring and creates potentially harmful shrapnel.

Emotional intelligence and selection to administrative chief residency.

OBJECTIVE: The authors sought to determine whether emotional intelligence, as measured by the BarOn emotional quotient inventory (EQ-i), is associated with selection to administrative chief resident. METHOD: Authors invited senior-year residents at the University of Texas Health Science Center at Houston to participate in an observational cross-sectional study using the BarOn EQ-i. In October 2009 they sent an invitation e-mail to 66 senior residents, with a reminder e-mail 1 month later. The study was designed to detect a 15-point difference in EQ-i scores with 80% power. RESULTS: Of the 66 invited residents, 69.6% participated in the study. Average total EQ-I score was 104.9. Among senior-year residents, there were no statistically significant differences in EQ-i scores between administrative chief residents (at 109) and non-administrative chief residents (at 103.2). CONCLUSION: Administrative chief residents do not demonstrate higher Emotional Intelligence, as measured by the EQ-i, than other senior-year residents.

Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations.

OBJECTIVE: Poor communication and teamwork may contribute to errors during neonatal resuscitation. Our objective was to evaluate whether interns who received a 2-hour teamwork training intervention with the Neonatal Resuscitation Program (NRP) demonstrated more teamwork and higher quality resuscitations than control subjects. METHODS: Participants were noncertified 2007 and 2008 incoming interns for pediatrics, combined pediatrics and internal medicine, family medicine, emergency medicine, and obstetrics and gynecology (n = 98). Pediatrics and combined pediatrics/internal medicine interns were eligible for 6-month follow-up (n = 34). A randomized trial was conducted in which half of the participants in the team training arm practiced NRP skills by using high-fidelity simulators; the remaining practiced with low-fidelity simulators, as did control subjects. Blinded, trained observers viewed video recordings of high-fidelity-simulated resuscitations for teamwork and resuscitation quality. RESULTS: High-fidelity training (HFT) group had higher teamwork frequency than did control subjects (12.8 vs 9.0 behaviors per minute; P < .001). Intervention groups maintained more workload management (control subjects: 89.3%; low-fidelity training [LFT] group: 98.0% [P < .001]; HFT group: 98.8%; HFT group versus control subjects [P < .001]) and completed resuscitations faster (control subjects: 10.6 minutes; LFT group: 8.6 minutes [P = .040]; HFT group: 7.4 minutes; HFT group versus control subjects [P < .001]). Overall, intervention teams completed the resuscitation an average of 2.6 minutes faster than did control subjects, a time reduction of 24% (95% confidence interval: 12%-37%). Intervention groups demonstrated more frequent teamwork during 6-month follow-up resuscitations (11.8 vs 10.0 behaviors per minute; P = .030). CONCLUSIONS: Trained participants exhibited more frequent teamwork behaviors (especially the HFT group) and better workload management and completed the resuscitation more quickly than did control subjects. The impact on team behaviors persisted for at least 6 months. Incorporating team training into the NRP curriculum is a feasible and effective way to teach interns teamwork skills. It also improves simulated resuscitation quality by shortening the duration.

Undiagnosed Takayasu's arteritis mimicking an acute aortic dissection.

Takayasu's arteritis (TA) is a vasculitis involving the aorta and its branches. We report a case of undiagnosed TA that presented to the Emergency Department with a chief complaint of chest pain and signs consistent with an aortic dissection.