J Emerg Med
-
For medical students, the emergency department (ED) often presents ethical problems not encountered in other settings. In many medical schools there is little ethics training during the clinical years. The benefits of reflective essay writing in ethics and professionalism education are well established. ⋯ Medical students encounter patients with numerous ethically based issues. Frequently, they note conflicts between ethical principles. Such essays constitute an important resource for faculty, resident, and student ethics training.
-
Observational Study
Agreement Between Resident and Faculty Emergency Physicians in the Application of NEXUS Criteria for Suspected Cervical Spine Injuries.
The National Emergency X-Radiography Utilization Study (NEXUS) developed a decision rule for when cervical spine radiographs are required in the setting of trauma. To our knowledge, inter-rater reliability between resident and faculty emergency physicians has not been studied. ⋯ Based on our findings, there was considerable difference in agreement between staff physicians and residents. This could be due to the level of experience of the provider or the subjectiveness of components the criteria.
-
Observational Study
Bacteriology of Urinary Tract Infections in Emergency Patients Aged 0-36 Months.
Because urinary tract infection (UTI) is the most frequent source of serious bacterial infections in young children, we studied the bacteriology of such infections in our institution. ⋯ Age- and sex-based assumptions guiding evaluation for and treatment of UTIs in young children should be reevaluated. We may not be culturing enough young boys, risking missed UTIs with potential for renal injury in this vulnerable group. Based on their significant rate of Gram-positive infections, those boys we treat empirically might benefit more from trimethoprim/sulfamethoxazole or amoxicillin/clavulanic acid than from third-generation cephalosporins. The persistence of positive cultures in 2-year-olds suggests we should be culturing beyond 24 months in both sexes. Urine Gram stains should be more frequently considered.