Issues In Emergency Medicine Research Articles

In defense of the use of lidocaine in rapid sequence intubation

Opposing authors provide succinct, authoritative discussions of controversial issues in emergency medicine. Authors are provided the opportunity to review and comment on opposing presentations. Each topic is accompanied by an Editor’s Note that summarizes important concepts. Participation as an authoritative discussant is by invitation only, but suggestions for topics and potential authors can be submitted to the section editors.

Professional issues in emergency medicine: UK perspective

The present paper describes the history, the professional development and current state of the specialty of emergency medicine in the UK, and outlines the role of parent bodies that administer the specialty.

Acute Phenytoin Intoxication: Causes, Symptoms, Misdiagnoses, and Outcomes

Phenytoin is a commonly prescribed antiepileptic drug. Due to its saturation (zero-order) pharmacokinetics, phenytoin carries a special risk of dose-related toxicity that is an important issue in emergency medicine. The purpose of this cross-sectional case-series study was to investigate the causes, symptoms, misdiagnoses, and outcomes of acute phenytoin intoxication. It was based on a retrospective chart review of 30 inpatients (mean age, 41.6 +/- 22.8 years) with 36 episodes of acute phenytoin intoxication at our university hospital in the past 13 years. The average initial serum phenytoin level was 47.3 +/- 9.7 microg/mL (range, 27.9-70.4 microg/mL). Excessive self-medication, misunderstanding of the prescription order, and probable drug interaction were the three leading causes of acute phenytoin intoxication. Unsteady gait, dizziness/vertigo, nausea/vomiting, general weakness, and drowsiness were the most common presenting symptoms. The tentative diagnostic accuracy was 67%. The most common initial misdiagnosis was brainstem or cerebellum stroke (14%). The clinical course in all patients was uneventful under temporary withdrawal of phenytoin and supportive care. We concluded that acute phenytoin intoxication was relatively under-diagnosed in the emergency service. Although acute phenytoin intoxication causes no mortality and has a good outcome, the unsteady gait increases the risk of injuries caused by falls. The management of acute phenytoin intoxication includes temporary withdrawal of phenytoin and supportive care.

Political issues in emergency medicine: The United Kingdom

A recent issue of this Journal published two papers on political issues facing the specialty of emergency medicine in the USA and in Canada. This paper continues the theme from a UK perspective. In recent years there has been significant change in the National Health Service, which has had (or will have) both direct and indirect consequences for the specialty of emergency medicine and the delivery of emergency care in the UK. This article describes some of the recent National Health Service initiatives and their implications for emergency medicine.

Political issues in emergency medicine: The United States.

The format of the paper is to allow three authors to discuss what they believe are the most significant political issues facing emergency medicine (EM) in their country or region. Each author writes independently and does not see any other contributing author's work, therefore potential overlap of subject matter is inevitable. However, we were soliciting their individual opinions about the serious issues confronting us today, rather than a consensus. An additional author, well familiar with the topics being discussed, wrote the Commentary from an overview perspective on the writings of the other authors. This supplemental opinion was offered as a method for enhanced cohesiveness in describing the political situations impacting the specialty of emergency medicine. The three authors for the United States are James Hoekstra, Professor and Chair, Wake Forest University Health Sciences; Robert McNamara, Professor and Chair, Temple University School of Medicine, and Robert Schafermeyer, Associate Chair, Department of Emergency Medicine, North Carolina School of Medicine. Between them, they represent more than 50 years experience in clinical and academic emergency medicine. They write from a personal perspective. Their views are their own, and do not represent any organization(s) with which they may have or had affiliations.

Training of Medical Professionals and the Delivery of Health Care as Related to Cultural Identity Groups

Academic Emergency MedicineVolume 10, Issue 11 p. 1149-1152 Free Access Training of Medical Professionals and the Delivery of Health Care as Related to Cultural Identity Groups First published: 28 June 2008 https://doi.org/10.1197/S1069-6563(03)00481-0Citations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 BD Smedley, AY Stith, AR Nelson, (eds). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington , DC : Institute of Medicine, National Academy Press, 2002. 2 Rosen P, Scott CJ. Ethical issues in emergency medicine. Workshop for Residency Directors. Dallas , TX : American College of Emergency Physicians, 1993. 3 Scott CJ, Ling L, Hogan T. Towards a multicultural environment for the delivery of emergency care services. Workshop. Dallas , TX : American College of Emergency Physicians, 1994. 4 Scott CJ, Martin M, Hogan T. Increasing underrepresented minorities in emergency medicine. Workshop. Dallas , TX : American College of Emergency Physicians, 1995. 5 Scott CJ. Ethnicity, culture, and the delivery of health care services: enhancing system outcomes in a multicultural environment. In: P Rosen, (ed). Emergency Medicine: Concepts and Clinical Practice. St. Louis : Mosby, 1998, pp 2921– 30. 6 Scott CJ. Ethnicity, culture, and the delivery of health care services. In: E Bernstein, J Bernstein, (eds). Case Studies in Emergency Medicine and the Health of the Public. Sudbury , MA : Jones and Bartlett, 1996. 7 Todd KH, Lee T, Hoffman JR. The effect of ethnicity on physician estimates of pain severity in patients with isolated extremity trauma. JAMA. 1994; 271: 925– 8. 8 Task Force on the Core Content for Emergency Medicine Revision. Core content for emergency medicine. Ann Emerg Med. 1997; 29: 792– 811. 9 James T, On Behalf of the SAEM Diversity Interest Group. SAEM diversity position statement. Acad Emerg Med. 2000; 7: 1055. 10 Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978; 88: 251– 8. 11 Lavizzo-Mourey R, Mackenzie ER. Cultural competence: essential measurements of quality for managed care organizations. Ann Intern Med. 1996; 124: 919– 20. 12 Lawson WB. The art and science of the psychopharmacotherapy of African Americans. Mt Sinai J Med. 1996; 63: 301– 5. 13 Moffic HS, Kinzie JD. The history and future of cross-cultural psychiatric services. Community Ment Health J. 1996; 32: 581– 92. 14 Cross TL, Bazron BJ, Dennis KW, Isaacs MR. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Washington , DC : CASSP Technical Assistance Center, Georgetown University Child Development Center, 1989. 15 Denboba KL Bragdon JL, Epstein LG, Grathright K, Goldman TM. Reducing health disparities through cultural competence. J Health Edu. 1998; 29(5 suppl): S47– 53. 16 Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998; 9: 117– 125. 17 Kennedy S, Stubblefield-Tave B, Smith C. Report on Recommendations for Measures of Cultural Competence for the Quality Improvement System for Managed Care. Cambridge , MA : Abt Associates, 1999. 18 Richardson LD. Patients' rights and professional responsibilities: the moral case for cultural competence. Mt Sinai J Med. 1999; 66: 267– 70. 19 Brach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000; 57 (suppl 1): 181– 217. Citing Literature Volume10, Issue11November 2003Pages 1149-1152 ReferencesRelatedInformation

The future of emergency medicine in Canada: submission from CAEP to the Romanow Commission. Part 2

In April 2001, the Commission on the Future of Health Care in Canada was established. The Honorable Roy Romanow was given the mandate to “inquire into and undertake dialogue with Canadians on the future of Canada’s public health care system” and “to develop recommendations that will ensure the long-term sustainability of a high quality, universally accessible, publicly administered health care system, for all Canadians.” The Canadian Association of Emergency Physicians (CAEP) recognized an obligation to share in this public dialogue, to communicate the current state of emergency medicine, and to identify the components necessary to achieve excellence in emergency care. The CAEP Advocacy Committee was asked to develop a document that would educate and enlighten the Commissioner. Basic themes were identified, and authors from across the country were invited to write brief, factual essays with achievable recommendations. The resulting series of essays was presented on April 30, 2002, at the Health Care Commission’s open public hearing in Calgary, Alberta. This article, part 2 of a 2-part series, includes discussions on Emergency Department Overcrowding, Human Resources Issues in Emergency Medicine, Standardization of Care and Clinical Practice Guidelines, Informatics and the Electronic Health Record, and Research in Emergency Medicine.

State of the art: therapeutic controversies in severe acute asthma.

This is a transcript of the 1999 SAEM State-of-the-Art session on "Therapeutic Controversies in Severe Acute Asthma," presented at the 1999 SAEM annual meeting in Boston. The aim of this session was to address some of the current controversies in the management of acute asthma exacerbations, a major issue in emergency medicine. Despite many recent advances in asthma management, morbidity and mortality remain high. While many of us have strong feelings on how asthma patients should be treated, many of our assertions are not based on good science, and there are numerous areas of controversy. This discussion focuses on the controversy over beta agonist treatment for acute asthma, the physiology of corticosteroids in asthma, and the emergency use of leukotriene-modifying agents.

LAW AND ETHICS IN EMERGENCY MEDICINE

Ethical issues in emergency medicine often are accompanied by legal issues. Although the legal aspects of an ethical problem are important factors to take into consideration, the law may not directly address the problem, and following the law does not always ensure an ethical outcome. Emergency physicians should have an understanding of ethics and law, understand the legal aspects of bioethical issues in emergency medicine, and finally have a guide to analyze ethical issues, including the consideration of legal issues that may have an impact on the case.

Wellness issues in emergency medicine: Shiftwork and burnout in the emergency department

Wellness issues in emergency medicine: Shiftwork and burnout in the emergency department

INFORMED CONSENT IN EMERGENCY MEDICINE: Ethics Under Fire

Many ethical issues in emergency medicine involve the question of informed consent. In this article, the ethical basis for informed consent, the essential elements of a morally valid informed consent, and the inadequacy of the law as a moral guide for informed consent are discussed. The ways in which the nature of emergency medicine affects the application of moral principles are examined, and specific guidelines for assessing a patient's decision-making capacity regarding informed consent are provided.

A Survey of Wellness Issues in Emergency Medicine (Part 2)

[Lum G, Goldberg RM, Mallon WK, Lew B, Margulies J: Annotated bibliography: A survey of wellness issues in emergency medicine (part 2). Ann Emerg Med February 1995;25:242-248.]

A Survey of Wellness Issues in Emergency Medicine (Part 1)

[Lum G, Goldberg RM, Mallon WK, Lew B, Margulies J: A survey of wellness issues in emergency medicine (part 1). Ann Emerg Med January 1995;25:81-85.]

Future Legal Issues in Emergency Medicine

This article analyzes past legal trends in emergency medicine with an effort to project those trends and current developments into future legal issues that will confront emergency physicians and emergency departments. Special emphasis is placed on insurance trends and professional liability insurance developments along with medical malpractice claims past, present, and future. Also discussed in this article is the health care industry environment and ways that it might affect future legal challenges for emergency medicine.

Risk Management and High-Risk Issues in Emergency Medicine

Risk management in the emergency department is defined in this article. The health care professional should focus on the health and best interests of the patient.

Endocrine and Metabolic Emergencies (Series: Contemporary Issues in Emergency Medicine)

Endocrine and Metabolic Emergencies (Series: Contemporary Issues in Emergency Medicine)

Pediatric Transport Issues in Emergency Medicine

In-hospital care of seriously ill children has improved dramatically with advances in emergency medicine and pediatric intensive care. Interhospital transport is necessary for a large percentage of critically ill or injured children. The appropriateness of care received during the transport phase is a crucial component of the critical care continuum. There are few widely applicable or accepted standards in place for pediatric transport, partly because standards are in the developmental phase and partly because of the lack of uniformity of resources available in different geographical regions. A common sense approach to providing appropriate patient care should be used, keeping in mind the philosophic and practical considerations detailed above. The best interest of the individual patient should be the primary factor in making any transport decision.

Role-playing for teaching ethics in emergency medicine

Ethical issues are becoming increasingly complicated. As with all specialties, emergency medicine has ethical dilemmas unique to the field. We describe a method for teaching students to identify and analyze ethical issues in emergency medicine. The course is designed for clinical medical students and house officers and is structured around various situations in which the students role-play. The course requires about 20 to 30 hours and covers a variety of topics from consent to treatment and confidentiality to teaching and education in the emergency department.

BOOK REVIEWS

Books reviewed in this article: Obstetric Emergencies (Contemporary Issues in Emergency Medicine) edited by Guy I. Benrubi Operative Gynecologic Endoscopy (Clinical Perspectives in Obstetrics and Gynecology) edited by J. S. Sanfilippo and R. L. Levine Books received some of which may be reviewed at a later date Pregnancy Autoimmunity and Connective Tissue Disorders edited by J. S. Scott and H. A. Bird Medically Assisted Conception. An Agenda for Research report of a Study by a Committee of the Institute of Medicine Prenatal Care: Reaching Mother, Reaching Infants edited by Sarah S. Brown A Clinical Guide to Obstetric Management Muhammad Anwar Hussain The Infectious Diseases of the Female Genital Tract Second edition by Richard L. Sweet and Ronald S. Gibbs Clinical Practice of Gynecology Volume 1 No 2 1989 Human Papillomavirus Infections edited by Barbara Winkler and Ralph M Richart The Baby Challenge. A Handbook on Pregnancy for Women with a Physical Disability by Mukti Jain Campion