Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The emergency management of cerebral concussion typically centers on the decision to perform a head computed tomography (CT) scan, which only rarely detects hemorrhagic lesions requiring neurosurgery. The absence of hemorrhage on CT scan often is equated with a lack of brain injury. However, observational studies revealing poor long-term cognitive outcome after concussion suggest that brain injury may be present despite a normal CT scan. ⋯ The authors discuss the strengths and weaknesses of the evidence in each case. These reports make a compelling case for the existence of concussion as a clinically relevant disease with demonstrable neurologic pathology. Areas for future emergency medicine research are suggested.
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To characterize emergency medicine (EM) program directors (PDs) and compare the data, where possible, with those from other related published studies. ⋯ Emergency medicine PDs generally are very satisfied with the position of PD, perhaps because of increased support and resources. Although PD turnover remains an issue, PDs intend to remain in the position for a longer period of time than noted before this study. This may reflect the overall satisfaction with the position as well as the increased resources and support now available to the PD. PDs have greater satisfaction if they have been mentored for the position.
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To describe the characteristics of nonfatal sledding-related injuries in U.S. children resulting in emergency department (ED) visits in 2001/2002 and to explore the implications of these findings for injury prevention efforts. ⋯ Sledding injuries resulting in ED visits predominantly affect children and are a source of measurable morbidity in this population. An increase in injury prevention efforts for this activity is warranted.
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The goal of this study was to examine how physicians in the emergency department ask questions of patients presenting with chest pain and whether this varies by patient demographics. ⋯ The variability in questions about behavioral factors associated with chest pain etiology as reported by patients may indicate a possible cultural bias by physicians. Differences in risk identification may lead to differences in treatment decisions.
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Delta opioids have been shown to confer ischemic preconditioning and pharmacologic ischemic preconditioning to the myocardium. However, their role in providing extended pharmacologic ischemic preconditioning in hemorrhagic shock has not been explored. The authors examined the effects of 24-hour preinfusions of a selective delta opioid receptor agonist, Deltorphin-Dvariant (Delt-Dvar), on hemodynamic stability and duration of survival in a rat model of severe hemorrhagic shock. ⋯ Twenty-four-hour pretreatment with Delt-Dvar decreases plasma lactate levels and improves hemodynamic stability and survival during hemorrhagic shock. The use of delta-specific opioids may improve survival from hemorrhagic shock and have clinical utility in providing ischemic protection in scenarios of planned ischemia.