Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To survey physician and nurse attitudes regarding parental presence during painful procedures on children performed in the emergency department (ED) and who should make that decision. ⋯ A majority of emergency physicians and nurses indicated parents should be present for some invasive pediatric procedures. However, as the invasiveness of the pediatric procedures increased, fewer physicians and nurses believed that parents should be present.
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To determine the ability of pediatric emergency department (ED) nurses to accurately apply the Ottawa Ankle Rules (OAR) and to evaluate whether the rate of negative ankle radiographs can be reduced by incorporating the OAR into an existing collaborative practice protocol (CPP). ⋯ Trained nurses can accurately apply and interpret the OAR. The incorporation of the OAR into the nursing assessment of children with acute ankle injuries may reduce the number of radiographs ordered.
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To evaluate observation unit (OU) prevalence, emergency medicine (EM) resident exposure in observation medicine (OM), EM faculty/residency director (RD) OM training, and RD attitudes toward OM. ⋯ Nearly two-thirds of EM programs have or are planning an OU. Resources are lagging behind. This survey describes current OM education strategies to teach OM.
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Medical education has adopted the use of digital photography and other computer technology, which has changed the face of the classroom. Today's presentations couple a computer and digital projection system to create powerful teaching tools. Integration of quality medical images enhances presentations in a way never before possible and at a much lower cost. ⋯ Services are available on the Internet that offer images for sale, but the cost to obtain images is high. Many institutions of higher learning provide images on the Internet for free, but the quality, number of available images, server capacity, and issues of consent limit the availability of these images. The authors describe their experience in collecting more than 20,000 clinical photographs, and provide examples of their use in emergency medicine education.
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The assessment of pre-procedure fasting and control of sedation depth are prominent elements of widely disseminated procedural sedation guidelines and of the Joint Commission on Accreditation of Healthcare Organizations' standards. Both exist primarily to minimize the risk of pulmonary aspiration of gastric contents. This paper critically examines the literature on pre-procedure fasting and controlling sedation depth in association with pulmonary aspiration, and interprets this evidence in the context of modern emergency medicine practice. ⋯ It is noted that aspiration during ED PSA has not been reported in the medical literature and that aspiration during general anesthesia and labor and delivery is uncommon. The literature provides no compelling evidence to support specific fasting periods for either liquids or solids prior to PSA, and existing guidelines for elective patients are of necessity arbitrary and based upon consensus opinion. The article discusses the implications in the areas of training and preparedness, monitoring, and research for the emergency physician practicing PSA.