J Emerg Med
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Differences in productivity between off-service residents rotating in the emergency department (ED) and their emergency medicine (EM) resident counterparts have never been directly quantified. ⋯ Shift cards can be used to foster motivation for off-service residents rotating in the ED, and is a simple and cost-effective method to improve system-based practices and utilization of resources.
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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.
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Case Reports
An Uncommon Cause of Acute Back Pain: Spinal Subarachnoid Hemorrhage Progressing to Spinal Cord Compression.
Spinal subarachnoid hemorrhage (SSH) is an uncommon occurrence responsible for <1% of all cases of subarachnoid hemorrhage (SAH). ⋯ We present the case of a 53-year-old man who presented to the emergency department (ED) with acute onset of "tearing" back pain that began during activity, and who was diagnosed with an SSH that ultimately progressed to spinal cord compression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although uncommon, the consequences of SSH are potentially devastating, yet reversible, making awareness of this condition critical. Several rare yet potentially devastating causes of acute back pain are deserving of consideration when approaching back pain in the ED setting; SSH is among them. Pain that is described as "tearing" or that is unresponsive to ordinary analgesic dosages should prompt strong consideration of vascular or other serious pathology, including arterial dissection or spinal cord compression.
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Ultrasound (US) measurement of the optic nerve sheath diameter (ONSD) has been utilized as an indirect assessment of intracranial pressure. It is usually performed by trained ultrasonographers. ⋯ Emergency physicians were capable of accurately measuring the ONSD using bedside US. Prospective studies with a larger sample size are recommended to validate these findings.
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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.