Alcohol and substance abuse training for emergency medicine residents: a survey of U.S. programs.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
S Krishel
Publications and source records attributed to S Krishel.
Environmental emergencies.
This article reviews the pearls and pitfalls of high-altitude sickness, decompression sickness, and barotrauma; new findings relevant to the near-drowning patient; continued controversies on hyperbaric oxygen for carbon monoxide poisoning; pitfalls in hypothermia management; and updates on the management of venomous snakebites.
Altitude Sickness↗
Feasibility of routine screening of patients for alcohol abuse.
Explore the source record for details and available documents.
Alcoholism↗
Effect of emergency department information on patient satisfaction.
STUDY HYPOTHESIS: Patient satisfaction with emergency department care is enhanced by information distributed to patients on ED arrival. PARTICIPANTS AND SETTING: A convenience sample of 200 alert, English-speaking, adult ED patients. DESIGN AND INTERVENTION: ED information was distributed on alternate days to all ED patients. The ED information described ED function and patient evaluation time. Patients not receiving ED information served as controls. A research assistant administered a satisfaction questionnaire to all patients immediately after discharge. MEASUREMENTS AND MAIN RESULTS: Patients who received ED information rated their overall satisfaction higher than did the control group (P < .0001). Other items rated significantly higher were physician skill and competence (P = .0112), physician concern and caring (P = .0062), whether the patient would use the same ED again (P < .0001), appropriateness of ED time (P = .01), information received (P < .0001), ability of staff to decrease anxiety (P < .0001), physician's explanation of illness and treatment (P = .0366), and ease and convenience of care (P = .0014). CONCLUSION: ED information has a significant effect on patients' perceptions of the quality of care and overall satisfaction.
Adult↗
Endotracheal tube whistle: an adjunct to blind nasotracheal intubation.
To perform blind nasotracheal intubation, the physician feels or listens for air movement through the endotracheal tube to facilitate the tube's passage into the trachea. The tube whistle is a device that attaches to the endotracheal tube adapter and produces whistle sounds of different pitches during inspiration and expiration, enhancing the detection of air movement and possibly allowing for easier intubation. This article describes the use of the whistle and presents information collected from a nine-month prospective study of the endotracheal tube whistle.
Emergency Medical Services↗
Cyclic antidepressants, lithium, and neuroleptic agents. Pharmacology and toxicology.
Cyclic antidepressants, lithium, and phenothiazines are frequently prescribed to psychiatric patients. Emergency department physicians must be familiar with these medications, and the pharmacologic and toxicologic characteristics of them are discussed. Cyclic antidepressants are the primary cause of drug-related death in the United States, with sodium bicarbonate recognized as the treatment of choice. Lithium toxicity may be subtle, and treatment is generally supportive in addition to volume replacement with normal saline and hemodialysis for significant intoxications. A neuroleptic overdose is managed primarily with supportive care. Neuroleptic malignant syndrome must be considered in any psychiatric patient presenting to the Emergency Department.
Antidepressive Agents, Tricyclic↗
Dual AV nodal paths leading to AV nodal reentrant tachycardia.
A 27-year-old white female with a history of paroxysmal supraventricular tachycardia presented to the emergency department complaining of intermittent palpitations. Although no tachydysrhythmia was present, she was noted to have two distinct PR intervals during normal sinus rhythm while in the emergency department. The patient was referred for electrophysiologic study. This study demonstrated dual AV nodal paths, and AV nodal reentrant tachycardia was induced and terminated. She was placed on flecainide for outpatient management of her dysrhythmia. Dual AV nodal pathways leading to AV nodal reentrant tachycardia is discussed.
Adult↗
Intravenous vitamins for alcoholics in the emergency department: a review.
It is common practice for emergency physicians to provide i.v. vitamin replacements for alcoholics who present to the emergency department (ED). This article describes vitamin deficiencies in alcoholics and reviews the utility and utilization of vitamins in the emergency department. We conclude that the current data do not support the routine administration of i.v. vitamins to alcoholics who present to the ED and we do not recommend this practice.
Alcoholism↗
Preventive health pamphlets in the emergency department.
We conducted a prospective clinical trial to determine the effectiveness of an emergency department informational pamphlet in improving patients' compliance with recommendations that they receive Pap smears, mammograms, and a pneumococcal vaccination. Informational pamphlets were distributed to 1,000 consecutive patients who presented to a university-affiliated emergency department (ED). The pamphlet contained information stating the indications for obtaining routine Pap smears, mammograms, and a pneumococcal vaccination. Target individuals were women 18 years and older and men 65 years and older. Target patients were called approximately 2 months after their ED visits to obtain follow-up data. There were 464 target patients obtained from the 1,000 pamphlets distributed (409 female/55 male), and 68% (316) of the 464 were contacted by telephone for follow-up data. Significantly more women than men had read the pamphlet (62% vs. 8%). Of the women contacted (279), 31.9% (89) were not up to date (UTD) with Pap smears, and 11.2% (10) stated that they had scheduled an appointment for a Pap smear; 14.5% (11) of the women were not UTD with mammograms, and none had scheduled an appointment to receive care. Of the patients over age 65, 67% were not UTD with a pneumococcal vaccination, and no appointments were scheduled to obtain one. We conclude that a significant number of patients who present to this ED are in need of preventive health care. Emergency department informational pamphlets may have a role in improving Pap smear compliance. Women may be more likely then men to read informational pamphlets distributed in the ED.
Adult↗
Nasotracheal intubation in the emergency department, revisited.
This retrospective study was designed to investigate the current practice of nasotracheal intubation (NTI) in the Emergency Department (ED) at the University of California, San Diego Medical Center. Over a 5-year period, 21% (105/501) of patients intubated in the ED had at least one NTI attempt. The most frequent primary diagnoses in these patients included drug overdose, congestive heart failure, and chronic obstructive pulmonary disease. We report an overall NTI success rate of 79% (83/105). Sixty-one percent (64/105) of the patients were nasally intubated on the first NTI attempt. Nasal dilators, topical neosynephrine, and sedation improved NTI success rates. Epistaxis and improper tube position were the most common immediate complications. Sinusitis, pneumonia, and sepsis were the most frequent late complications. Patients receiving thrombolytic therapy were at risk of developing severe epistaxis. A prior history of sinus disease may predispose a nasally intubated patient to sinusitis. The complication rates reported here are similar to those of previous studies. A survey of emergency medicine (EM) residency programs found that EM residents throughout the country perform an average of 2.8 NTIs during their residency training. Thus, there is limited exposure to this intubation technique in EM residency programs. Nasotracheal intubation is a useful alternative to oral intubation, particularly when oral access is compromised. While not the optimal approach, we conclude that NTI is still a valuable method for establishing an airway and should remain among the emergency physician's arsenal of intubation techniques.
Adolescent↗
A public health approach to emergency medicine: preparing for the twenty-first century.
This paper focuses on the implications of an inadequate public health/preventive health care system for emergency medicine (EM), the role that EM providers can play in remedying critical health problems, and the benefits gained from a public health approach to EM. A broad definition of public health is adopted, suggesting shared goals of public health and EM. Critical problems posed for EM include alcohol, tobacco, and other drug abuse; injury; violence; sexually transmitted diseases and human immunodeficiency virus (HIV) infection occupational and environmental exposures; and the unmet health needs of minorities and women. A blueprint for future merging of public health issues with EM is presented that includes the application of public health principles to 1) clinical practice; 2) public education, community involvement, and public policy advocacy; 3) development of medical school and residency public health/prevention curricula and teaching methods; and 4) research opportunities and surveillance. Finally, recommendations are proposed that require restructuring the present health care system to provide resources, incentives, and organizational changes that promote an integration of public health and preventive services in the practice of EM.
Emergency Medicine↗