Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To evaluate the use of practice tracks by each of the 24 medical specialty boards and to compare this with the experience in emergency medicine (EM). ⋯ Practice tracks were common in the early years of most specialties and most were limited by duration. The history of the practice track in EM is not dissimilar to those of other specialties.
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To evaluate the diagnostic utility of abdominal diagnostic ultrasonography (DUS) performed by emergency physicians for intraperitoneal fluid caused by blunt abdominal trauma (BAT). ⋯ Emergency physicians with minimal training can use DUS with fair sensitivity and good specificity and accuracy to detect free intraperitoneal fluid in both pediatric and adult BAT victims. The hepatorenal view provides the highest sensitivity for intraperitoneal fluid, although the 3-view series (with hepatorenal, bladder-rectal, and splenorenal spaces) can typically be performed within 5 minutes and may increase the specificity and accuracy.
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Child sexual abuse is an increasingly common problem. This article reviews the current clinical and behavioral indicators that will aid the emergency physician when evaluating and managing this condition. The most common differential diagnoses are described and a general approach to this diagnosis is suggested. Adopting a multidisciplinary method when evaluating this problem will lessen the anxiety facing the examining physician and provide a better outcome for the child, parents, and community.
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To determine the effects of aggressive fluid administration vs permissive hypotension on survival, blood loss, and hemodynamics in a model of uncontrolled hemorrhage in which bleeding has been shown to be continuous. ⋯ In this model of continuous uncontrolled hemorrhage, the difference in survival between the animals left hypotensive and the animals receiving fluid resuscitation was not statistically significant. Increases in MAP and CO with fluid resuscitation were transient and were offset by larger volumes of blood loss. In contrast to the aortotomy model (where thrombosis is likely and hypotensive resuscitation has proven beneficial), this model suggests that in continuous bleeding avoiding fluid resuscitation has a much smaller effect on outcome. Much of the benefit from hypotensive resuscitation may depend on having an injury that can stop bleeding.