Pitfalls in anaphylaxis diagnosis and management at a university emergency department.

BACKGROUND: Some previous reports revealed suboptimal management of anaphylaxis (ANX) in the emergency department (ED). OBJECTIVE: To evaluate the recorded diagnosis and management of patients who presented with ANX at our university hospital ED and to assess how the management correlated with the severity of the case and the training level of the ED staff. METHODS: A descriptive study that involved reviewing the electronic medical records of patients who presented with ANX at the ED during a period of 4 years. RESULTS: When reviewing 1341 charts of potential cases, 60 met the criteria for ANX, but only 23% were correctly coded. Inaccurate coding was noted in 77%, mainly as an "allergic reaction." Systemic corticosteroids were administered in the ED to 85% of the patients and H1-antihistamines to 73%; only 20% received epinephrine. Ten patients required hospital admission, and, on discharge, only four patients (40%) were given epinephrine autoinjector prescriptions. Of the 50 who were discharged home, 48% were given epinephrine autoinjector prescriptions and 16% were given a referral for allergy evaluation. CONCLUSION: The observed low rates of appropriate diagnostic coding of ANX, of epinephrine administration, epinephrine autoinjector prescribing at discharge, and referral for allergy evaluation call for more education on these issues. Some of these pitfalls can be partly attributed to the setting in a university ED where health providers are usually busy in rendering urgent care.

The Ventriloscope: 'am I hearing things?'.

BACKGROUND: Knowledge of the benefits of incorporating medical simulation into healthcare curricula is rapidly increasing. Though impeded by the high cost of complicated technology, medical simulation devices offer the ability to provide safe and controlled training environments, exposure to rare clinical scenarios, as well as unlimited training opportunities. METHODS: This report describes a novel, inexpensive method of broadcasting normal and abnormal auscultatory findings to a relatively normal appearing stethoscope for use in training of healthcare professionals. RESULTS: Using wireless transmitter broadcasting to a stethoscope fitted with a receiver apparatus, the student is able to perform a typical medical exam with auscultation of an unlimited variety of clinical sounds from anatomically appropriate sources while being observed from another room. CONCLUSIONS: Implications of this low-cost device include limitless training possibilities worldwide and across disciplines. The simplicity and portability of this device increases potential for use in rapid training of recognition of clinical signs associated with chemical/biological warfare agents, mass casualty incidents and field military applications. This is the first device to simulate clinically relevant sounds in a realistic manner on standardized patients and mannequins. The benefits of such simulation in medical education ultimately serve to increase trainee confidence and consequently, improve patient care and safety.