J Emerg Med
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Simulation use for training residents has become an expectation in emergency medicine in order to improve the educational dimensions of cognitive knowledge, critical thinking, psychomotor skills, and clinical performance. ⋯ SimWars gives educators an opportunity to watch the decision-making process of the learners as they manage simulated complex scenarios in a cooperative competitive environment.
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Acute coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death" together with hypothermia and acidosis. ⋯ Acute coagulopathy is present on admission to the ED and is associated with injury severity and significantly higher mortality.
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Adolescent patients comprise the highest rate of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) in the United States. These patients often initially present to the emergency department (ED) with vague symptoms. ⋯ The majority of adolescent women found to have GC or CT or both in the ED were not treated at presentation.
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There are few studies researching the effect of fresh frozen plasma (FFP) transfusion on international normalized ratio (INR) in patients with coagulation abnormality. ⋯ A significant improvement in INR was observed in patients with higher pretransfusion INR. While determining FFP dose for patients admitted to the ED due to coagulation defect, pretransfusion INR value should be taken into account.
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Obese and overweight people have higher rates of ankle injury, particularly operative ankle fractures. The initial management of unstable ankle fractures includes closed reduction and splinting to limit soft tissue injury and articular cartilage damage until definitive operative fixation can be performed. Adequate reduction can be more difficult in the obese patient due to the weight and additional padding provided by the larger soft tissue envelope. ⋯ Obese patients have unique musculoskeletal injury profiles and special considerations in their management. The authors have found this technique useful in the management of their ankle fractures.