Role Of Emergency Medicine Research Articles

Practicality and accuracy of prehospital rapid venous blood glucose determination

Blood glucose testing plays an important role in emergency medicine. Although the use of visual reagent test strips is widely established in this setting, the accuracy of reflectometric blood glucose determinations under emergency conditions has rarely been investigated. In a prospective study, 522 of a total of 3,217 patients undergoing emergency blood glucose testing had parallel blood glucose measurements performed using a specific enzymatic method. These 522 patients (aged 61.4 years, 54% men, 90 cases of severe hypoglycemia) had an intravenous access placed at the scene of the emergency. Venous whole blood from the introducer needle of the access was applied to the test strip and the glucose measured with a GlucoTouch reflectometer (LifeScan, Inc.). A blood sample from the intravenous access was then immediately collected in a monovette for subsequent glucose determination in a chemical laboratory (hexokinase method) within 20 to 40 minutes. The emergency glucose measurements (mean: 7.3 mmol/L [95% confidence interval [CI] 6.9 to 7.7]; range: 0.55 to 27.7) correlated well with the reference laboratory results (Pearson's r = .98; linear regression analysis: slope 1.0, axial intercept 1.74). Error grid analysis also showed good agreement between corresponding measurements: zone A 96.7%, B 2.5%, C 0% and D 0.8%. The mean difference using the Bland-Altman method was 0.14 mmol/L; 2 SD 1.8 mmol/L; minimum −7.0 mmol/L; maximum 4.4 mmol/L. The accuracy of the rapid venous blood glucose determination by constantly changing emergency teams was high. Especially in 90 hypoglycemic patients, there were no deviations from the reference method that could have led to clinically relevant wrong decisions. The method of collecting whole blood directly from the venous access is simple and robust, and is independent of the hemodynamic status of the patient. (Am J Emerg Med 2000;18:690-694.

The roles of the laryngeal mask airway in emergency medicine

AbstractThe laryngeal mask airway has a well established place in routine anaesthetic practice. Its potential role in emergency medicine is hampered by its failure to protect the airway from aspiration and to form a high pressure seal for controlled ventilation but supported by its ease of placement. This review discusses the uses of the laryngeal mask airway in the emergency situation.The laryngeal mask airway has a role as an alternative to the face mask in resuscitation. It has roles as an alternative airway when intubation has failed and as an aid to difficult intubation. In the prehospital setting, an additional specific indication for its use may be when access to a patient is limited making tracheal intubation impossible.Two recent modifications of the laryngeal mask airway are described. The intubating laryngeal mask airway is specifically designed for the difficult airway and the disposable laryngeal mask airway (Unique™) is undergoing trials in the UK for use by paramedical staff. The potential use of the intubating laryngeal mask airway in the emergency setting is discussed.

Emergency medicine in the medical school curriculum.

Academic Emergency MedicineVolume 4, Issue 11 p. 1070-1077 Free Access Emergency Medicine in the Medical School Curriculum Louis J. Ling MD, Corresponding Author Louis J. Ling MD Hennepin County Medical Center, Minneapolis, MNAssociate Medical Director for Medical Education, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415. Fax: 612–904–4401; e-mail: louis.ling@co.hennepin.mn.usSearch for more papers by this authorL. Thompson Bowles MD, PhD, L. Thompson Bowles MD, PhD National Board of Medical ExaminersSearch for more papers by this authorRichard Reynolds MD, Richard Reynolds MD Robert Wood Johnson FoundationSearch for more papers by this authorLouis Kroot MD, Louis Kroot MD the University of Kentucky, School of Medicine, Lexington, KYSearch for more papers by this authorPaul Roth MD, Paul Roth MD University of New Mexico, School of Medicine, Albuquerque, NMSearch for more papers by this author Louis J. Ling MD, Corresponding Author Louis J. Ling MD Hennepin County Medical Center, Minneapolis, MNAssociate Medical Director for Medical Education, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415. Fax: 612–904–4401; e-mail: louis.ling@co.hennepin.mn.usSearch for more papers by this authorL. Thompson Bowles MD, PhD, L. Thompson Bowles MD, PhD National Board of Medical ExaminersSearch for more papers by this authorRichard Reynolds MD, Richard Reynolds MD Robert Wood Johnson FoundationSearch for more papers by this authorLouis Kroot MD, Louis Kroot MD the University of Kentucky, School of Medicine, Lexington, KYSearch for more papers by this authorPaul Roth MD, Paul Roth MD University of New Mexico, School of Medicine, Albuquerque, NMSearch for more papers by this author First published: 29 September 2008 https://doi.org/10.1111/j.1553-2712.1997.tb03682.xCitations: 8AboutReferencesRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare 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 Henry JB. Emergency medicine and the Association of American Medical Colleges (AAMC). Am J Emerg Med. 1983; 1: 35– 42. American College of Emergency Physicians. Guidelines for undergraduate education in emergency medicine. Ann Emerg Med. 1980; 9: 222– 8. Emergency medicine core content. J Am Coll Emerg Physicians. 1979; 8: 34– 41. Society of Teachers of Emergency Medicine. Core content for undergraduate education in emergency medicine. Ann Emerg Med. 1985; 14: 474– 6. American College of Emergency Physicians. Guidelines for undergraduate education in emergency medicine. Ann Emerg Med. 1987; 16: 117– 9. Society for Academic Emergency Medicine. A model pre-clinical, clinical and graduate educational curriculum in emergency medicine for medical students and rotating residents. Ann Emerg Med. 1990; 19: 1159– 66. Bowles LT, Sirica CM (eds). The Role of Emergency Medicine in the Future of American Health Care. New York: Josiah Macy Jr. Foundation, 1995. Sanders AB, Criss E, Witzke D. et al. Survey of undergraduate emergency medical education in the United States. Ann Emerg Med. 1986; 15: 1– 5. Christakis NA. The similarity and frequency of proposals to reform US medical education. Constant concerns. JAMA. 1995; 274: 706– 11. Citing Literature Volume4, Issue11November 1997Pages 1070-1077 ReferencesRelatedInformation RecommendedEmergency Medicine in the Medical School CurriculumDavid A. Wald DO, Michelle Lin MD, David E. Manthey MD, Rob L. Rogers MD, Leslie S. Zun MD, Theodore Christopher MD, Academic Emergency MedicineInternational Federation for Emergency Medicine model curriculum for medical student education in emergency medicineCherri Hobgood MD, Venkataraman Anantharaman MD, Glen Bandiera MD, Peter Cameron MD, Pinchas Halperin MD, James Holliman MD, Nicholas Jouriles MD, Darren Kilroy MD, Terrence Mulligan DO, Andrew Singer MD, Emergency Medicine Australasia

095. Medical Support for Space Shuttle Operations: The Role of Emergency Medicine

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Space shuttle operations at the NASA Kennedy Space Center: The role of emergency medicine

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

Space shuttle operations at the nasa kennedy space center: The role of emergency medicine

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

The Role of Emergency Medicine in the Future of American Medical Care

[Josiah Macy, Jr, Foundation: The role of emergency medicine in the future of American medical care. Ann Emerg Med February 1995;25:230-233.] No reprints available from the author. author. Reprint no. 47/1/61944 The conference was held in Williamsburg, Virginia, from April 17 to April 20, 1994, to examine the future of the medical specialty of emergency medicine. The conference was chaired by L Thompson Bowles, MD, PhD. During the past 30 years, emergency care of seriously ill and injured patients has become an essential component of the US health care system. Most of this care is provided in the emergency departments of acute care hospitals in conjunction with community-based emergency medical services. Within the current health care system, EDs are the only institutional providers mandated by federal law to treat anyone who presents for care. As emergency care has dramatically saved greater numbers of patients whose lives are at risk, the demand for these services has escalated. EDs are the first responders in a society that has been increasingly concerned about violence and addiction to drugs and in which large-scale disasters seem to be more common. In addition, EDs have become principal providers of primary health care to the poor, homeless, unemployed, substance abusers, prisoners, and all others who have no regular source of health care. Providing these services has produced severe overcrowding and serious financial losses for EDs, and, although EDs are widely available, they vary considerably in quality and accessibility from region to region and, in many cases, from neighborhood to neighborhood. In recent decades, as emergency care has become more sophisticated and complex, the new medical specialty of emergency medicine has emerged. It has established standards of competence for physicians who specialize in treating acutely ill and injured patients and has developed and enforced standards for programs that educate emergency medicine specialists. In 1979, emergency medicine was officially recognized as the 23rd, and now second youngest, medical specialty. Currently, there are 16,000 members of the American College of Emergency Physicians, and 10,500 physicians are certified by the American Board of Emergency Medicine as emergency medicine specialists. In addition, approximately 2,200 physicians are being educated in the 101 accredited emergency medicine residency programs, and each year, these programs graduate about 800 physicians who are eligible to be certified as specialists. Ironically, as the specialty of emergency medicine advances both academically and clinically, it is confronted by issues that threaten its future. The role of the specialty in health care is poorly understood, and plans for health care reform have neglected emergency care. The boundaries and scope of practice of the specialty are broad and are contested by other specialties. Emergency medicine has failed to develop an agenda for research, and the specialty has received less academic recognition than most other medical specialties—emergency medicine specialists have a very limited role in the general education of physicians, especially during medical school, and during the graduate medical education of other generalist physicians. In response to this crisis, and at the request of the Society of Academic Emergency Medicine, the Josiah Macy, Jr, Foundation appointed a planning committee to organize a conference that would examine the future of the medical specialty of emergency medicine. The committee was chaired by L Thompson Bowles, MD, PhD and consisted of Raymond J Baxter, PhD; Lewis Goldfrank, MD; Louis J Ling, MD; and L Gregory Pawlson, MD. The conference focused on the specialty's role in clinical service, medical education, and medical research. The conference brought together 38 experienced and influential leaders from government, public health care advocacy groups and other medical specialties, as well as leaders from the medical specialty of emergency medicine and from other nonphysician professions that provide emergency care. The foundation commissioned the following five papers, which served as major focal points for discussion—History of Emergency Medicine, Peter Rosen, MD; What Is Clinical Emergency Medicine? Arthur L Kellermann, MD, MPH; The Emergency Department as Safety Net for Non-Emergent Care, Ron J Anderson, MD; Education in Emergency Medicine, Glenn C Hamilton, MD; The Future of Emergency Medicine Research, Gabor D Kelen, MD, and Charles G Brown, MD. These papers, together with a summary of the proceedings of the conference, will be published and distributed in March 1995 by the Josiah Macy, Jr, Foundation, New York, New York.

Nasal administration of naloxone for detection of opiate dependence

In clinical trials, nasally applied naloxone was used to identify opiate dependence in humans for the first time. Withdrawal distress was recorded, and pupillary response, pulse rate and blood pressure measured. A significant increase in withdrawal distress and pupillary dilation was observed after nasal administration of 1mg (1mg/400μl) naloxone in all subjects who also showed opiate-positive urine samples. In control subjects, no reaction to naloxone was observed. It may be concluded that the nasal route for naloxone administration is as effective as the parenteral route. This test is sensitive enough to identify the physically-dependent opiate user and might have a role in emergency medicine and withdrawal treatment.

Getting advance directives to the public: A role for emergency medicine

Advance directives are becoming more common in the health care system in the United States. Advance directives include "living wills," "durable powers of attorney for health care," "do not resuscitate orders," and the newer "medical directive." They are designed to allow individuals to determine the course of their medical care in the event that they are no longer able to transmit the information to their physician. The US Supreme Court's recent Cruzan decision increased the importance of these legal instruments by declaring that "clear and convincing" evidence may be required by states in order to terminate life support in a patient unable to express his wishes about care. Unfortunately, for many reasons, advance directives are often not completed by those who might desire them. Only 9% of Americans have executed advance directives. Emergency physicians have the opportunity to assist their patients in advance by disseminating advance directives to those who have contact with the emergency department: patients, family members, friends, health care workers, emergency medical services personnel, and police. A plan is suggested that includes education, the availability of advance directives, personnel available to help with completion of the documents, and immediate entry of the directive into a medical chart, if requested. This is in conformance with a recent policy adopted by the American College of Emergency Physicians.

Emergency medicine's role in the education of medical students: Directions for change

Emergency medicine, as a young field emphasizing basic clinical skills, should be in the forefront of the changes in undergraduate medical education. Change needs to occur in our own courses and in our role in the general education of medical students. By graduation, students completing our courses should be able to provide immediate aid, create a problem list, discuss a differential diagnosis for key problems, present a treatment plan for key diagnoses, understand issues pertaining to societal interface with emergency care, and perform essential monitor skills. The general goals of medical education that pertain to strengths of emergency physicians are the ability to use the essential tools of clinical medicine, use data base resources, select the appropriate specialties for consultation, work as a member of a health care team, and use time- and cost-efficient diagnostic adjuncts. Methods for achieving these goals are suggested.

Femoral vein cannulation: A review

The femoral vein is an excellent potential venous access site. The technique of cannulation is described and its applications and complications are reviewed. More extensive future use of this technique is necessary to determine its proper role in emergency medicine.

Emergency medicine and the Association of American Medical Colleges (AAMC): The role of emergency medicine in undergraduate and graduate medical education

Emergency medicine and the Association of American Medical Colleges (AAMC): The role of emergency medicine in undergraduate and graduate medical education

The role of emergency medicine in toxicology

The role of emergency medicine in toxicology

Professional productivity and quality assurance phases II – V

This study attempts to demonstrate that an emergency/ambulatory nurse practitioner (NP) performs her role in emergency medicine with reliability and thoroughness; that she can effectively work as part of a nurse practitioner-physician team (NP/MD), provided her capabilities are fully used and that her role is complementary to the physician's. The team effort results in a reciprocal effect as demonstrated by professional performance patterns (PPP) and a subliminal triage effect should develop between NP and the physician. A "weighted" professional productivity formula is presented that has interesting potential. Time flow data is presented along with other demographic data. The problem oriented medical record format, as adapted for emergency medicine, again demonstrated effective auditability.

Role of Emergency Medicine in Undergraduate Medical Education

Role of Emergency Medicine in Undergraduate Medical Education