J Emerg Med
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In the emergency department (ED), hyperkalemia in the presence of hemolysis is common. Elevated hemolyzed potassium levels are often repeated by emergency physicians to confirm pseudohyperkalemia and to exclude a life-threatening true hyperkalemia. ⋯ In the setting of hemolysis, GFR ≥ 60 mL/min in conjunction with a normal ECG is a reliable predictor of pseudohyperkalemia and may eliminate the need for repeat testing. In patients with a normal GFR who are otherwise deemed safe for discharge, our results indicate there is no need for repeat testing.
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Observational Study
Medical Student Education in Emergency Medicine: Do Students Meet the National Standards for Clinical Encounters of Selected Core Conditions?
Establishing a core curriculum for undergraduate Emergency Medicine (EM) education is crucial to development of the specialty. The Clerkship Directors in Emergency Medicine (CDEM) National Curriculum Task Force recommended that all students in a 4(th)-year EM clerkship be exposed to 10 emergent clinical conditions. ⋯ Most students do not encounter all 10 conditions during patient encounters throughout a 4-week EM rotation, although most have exposure to at least eight. Certain conditions are far less likely than others to be encountered, and may need to be taught in a nonclinical setting.
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Increasing numbers of emergency medicine (EM) residents and fellows are completing additional training with the intention of pursuing careers in global emergency medicine (GEM). At the same time, many academic emergency departments (EDs) are investing in the development of GEM divisions and global/international EM fellowship programs. However, the path for a successful career in this subspecialty has still not been defined. ⋯ Our survey provides an understanding of the amount of time that emergency physicians in GEM spend abroad and the types of activities in which they are currently engaged, as well as the barriers that need to be overcome in order to achieve fulfilling careers in this field.
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Pesticides are highly toxic to human beings, and pesticide poisoning is associated with high morbidity and mortality. The identification of powerful prognostic markers is important for the management of patients with pesticide poisoning in emergency settings. ⋯ Leukocyte counts, neutrophil counts, and neutrophil-lymphocyte ratios measured within the first 24 h after admission to the ED are useful and easy-to-use parameters for estimating prognosis in the follow-up of patients with pesticide poisoning.
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Evidence for a standard x-ray study and cast immobilization in emergency department (ED) management and follow-up of children with bicycle spoke injury (BSI) is absent. ⋯ A quarter of ED patients with BSI have a fracture with no clinical signs that could predict the presence of a fracture, justifying a standard x-ray study in ED management. Only 12% of ED patients with BSI have no fracture and no signs that predict long-term follow-up. In this group, further studies are warranted to investigate the benefit of cast immobilization for fractures and soft tissue injury.