Emergency medicine journal : EMJ
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In our region, it was acknowledged that the process of assessment needed to be improved, but before developing a system for this, there was a need to define the "competent or satisfactory trainee". ⋯ We believe that we achieved a consensus across our region as to what defined a satisfactory trainee and set the standard against which all our trainees would subsequently be evaluated. The use of this tool to assess trainees during the pilot period was disappointing; however, we were encouraged that most of those using the tool thought that it allowed an objective assessment of trainees and feedback on areas requiring further work. Those who used the tool identified important reasons that may have hindered widespread use of the assessment tool.
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The case of a 63-year-old woman who presented to the emergency department with epistaxis and haemodynamic instability is reported. Subsequent investigation showed renal failure and multiple pulmonary nodules. ⋯ Emergency physicians should consider Wegener's granulomatosis in patients with atypical epistaxis. In patients presenting with clinically severe, active disease early proteinase 3 antineutrophil cytoplasmic antibody testing is recommended.
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To clarify the cardiovascular mechanisms of cyanide poisoning by evaluating oxygen transport characteristics using a canine model. ⋯ Cyanide poisoning in the canine model showed two phases of injury. The first (compensated) phase had a mechanism consistent with a traditional global oxygen consumption defect. The second (decompensated) phase had a mechanism consistent with heart failure. This heart failure was due to bradycardia. These data suggest chronotropy as an avenue of further study in the temporary treatment of cyanide poisoning.