J Emerg Med
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Hematochezia in the pediatric population, particularly infants, has a wide differential diagnosis ranging from benign to life-threatening causes. Obtaining a thorough history and identifying risk factors for more ominous disease is vital during the emergency department (ED) evaluation. ⋯ The patient is a 2-day-old female who presented to the ED with 8-10 episodes of bright red blood in her stools. She was otherwise asymptomatic, with an uncomplicated pregnancy and delivery. Her history was significant for a sibling who recently tested positive for Escherichia coli O157:H7 in his stool and a family history of lactose intolerance. She was exclusively formula fed. An abdominal plain film was obtained and was normal. Milk protein enterocolitis was suspected and she was transitioned to hydrolyzed formula with resolution of her symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As emergency physicians, we need to be aware of the life-threatening conditions that are associated with hematochezia, such as necrotizing enterocolitis, and act quickly. However, many patients will have benign conditions, and recognizing the key historical and diagnostic pieces of the infant's presentation will prevent unnecessary evaluations and consultations.
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There are confusing data in literature regarding oral and sublingual captopril effects over blood pressure (BP) decrease. ⋯ In our study, sublingual captopril was found to decrease BP more efficiently in the first 30 min, but this difference equalized at 60 min.
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Case Reports
Commercial Airline In-Flight Emergency: Medical Student Response and Review of Medicolegal Issues.
As the prevalence of air travel increases, in-flight medical emergencies occur more frequently. A significant percentage of these emergencies occur when there is no certified physician, nurse, or paramedic onboard. During these situations, flight crews might enlist the help of noncertified passengers, such as medical students, dentists, or emergency medical technicians in training. Although Good Samaritan laws exist, many health care providers are unfamiliar with the limited legal protections and resources provided to them after responding to an in-flight emergency. ⋯ A 78-year-old woman lost consciousness and became pulseless onboard a commercial aircraft. No physician was available. A medical student responded and coordinated care with the flight crew, ground support physician, and other passengers. After receiving a packet (4 g) of sublingual sucrose and 1 L i.v. crystalloid, the patient regained pulses and consciousness. The medical student made the decision not to divert the aircraft based on the patient's initial response to therapy and, 45 min later, the patient had normal vital signs. Upon landing, she was met and taken by paramedics to the nearest emergency department for evaluation of her collapse. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians are the most qualified to assist in-flight emergencies, but they might not be aware of the medicolegal risks involved with in-flight care, the resources available, and the role of the flight crew in liability and decision making. This case, which involved a medical student who was not given explicit protection under Good Samaritan laws, illustrates the authority of the flight crew during these events and highlights areas of uncertainty in the legislation for volunteer medical professionals.
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Randomized Controlled Trial
Peer-assisted Learning in Cardiopulmonary Resuscitation: The Jigsaw Model.
Training a large cohort of the population could, over time, increase the rate of bystander cardiopulmonary resuscitation (CPR) and survival after out-of-hospital cardiac arrest. ⋯ This study demonstrated that the jigsaw model is as effective as expert instruction to achieve the ERC 2010 guidelines. Only one difference was found between the tutor and tutee group.
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There is a continued interest in global emergency medicine (EM) training, research, and clinical program development. There are many opportunities for "voluntourism" in medicine, but many of these experiences do not have standard goals and objectives. ⋯ Global training experiences can have clear benefits. Students go to places to "learn," but can also "teach" at the same time. Setting goals and objectives helps to assure that students are gaining specific core competencies as part of the experience. Other global rotations would benefit from having a defined structure.