Evaluation of a residency program's experience with a one-week emergency medicine resident rotation at a medical liability insurance company.

INTRODUCTION: The authors' residency program implemented a one-week rotation at the office of a medical liability insurance company. Residents examined 30 closed malpractice claims cases and sat in on settlement discussions. OBJECTIVE: To review the residents' evaluations of their experiences and to determine whether this was a worthwhile addition to the emergency medicine (EM) residency curriculum. METHODS: This was a five-year retrospective study that reviewed residents' annual evaluations from 1994 to 1999 regarding the medical liability rotation. A five-point scale was used to score specific categories in the rotation and an open-ended section was used to collect general comments. RESULTS: A total of 179 resident evaluations were reviewed. The quality of teaching ranked in the 80th percentile, the clinical caseload ranked in the 85th percentile, and level of responsibility ranked in the 79th percentile for all EM rotations. Specific comments included "All MDs should do this in their training"; "Quite an eye opener"; and "Good exposure to legal aspects of EM." CONCLUSIONS: Overall, EM residents found the one-week rotation to be invaluable and a good learning experience. This rotation ranked above average when compared with all of our other EM residency rotations.

Entrance and exit gunshot wounds: incorrect terms for the emergency department?

Gunshot wounds (GSWs) pose significant medicolegal and forensic issues. Mistakes have been made regarding identification of gunshot wounds. We present a case of an atypical gunshot wound and review contact, near contact, intermediate, and distant wounds. There is an objective terminology to describe GSWs in the Emergency Department.

The use of inhaled nebulized atropine for the treatment of malathion poisoning.

Malathion is an organophosphate insecticide that is toxic to humans. Deaths are related to respiratory failure. The traditional treatment has included oxygen, ventilatory support, and intravenous administration of atropine. A case is presented in which a patient with moderate to severe malathion poisoning was also treated with inhaled nebulized atropine with apparently favorable results. The rationale for this approach to therapy is discussed.

A modified wire-guided technique for venous cutdown access.

The use of a guidewire to facilitate the placement of an IV cannula through a cutdown is described. This technique was taught to 24 novice operators (medical students and first-year residents). In a randomized, prospective, crossover study, their performance of this technique in an animal model was compared with the use of the classic cutdown technique. The modified technique was performed 22% (two minutes, 13 seconds) more rapidly, on average, than the classic technique (P less than .05). Other potential advantages of this technique are discussed.

Avalanche deaths in the United States: a 45-year analysis.

OBJECTIVE: To describe the demographic characteristics and patterns of death of persons killed in snow avalanches over a 45-year study period. METHODS: The national avalanche database was the source of data in this retrospective, descriptive study. RESULTS: A total of 440 victims were killed in 324 fatal avalanches, of which 87.7% were fully buried, 4.7% were partially buried, and 7.6% were not buried. The average age was 27.6 +/- 10.6 years, and 87.3% were men. Victims who died included climbers (25.5%), backcountry skiers (22.7%), out-of-bounds skiers (10.0%), snowmobilers (6.8%), in-bounds skiers (5.2%), residents (4.5%), ski patrollers (3.6%), workers (3.6%), and motorists (3.0%). Over the 45-year study period there appear to be decreases in the deaths of in-bounds skiers, highway workers, and motorists. Increasing fatalities were observed among out-of-bounds skiers, snowmobilers, ski patrollers, and backcountry skiers. Most deaths occurred in Colorado (33.0%), Washington (13.2%), and Alaska (12.0%). CONCLUSIONS: Avalanche fatalities have increased over the last 45 years. Climbers, backcountry skiers, out-of-bounds skiers, and more recently snowmobilers constitute the majority of the victims. The decrease in deaths among groups that benefit from avalanche control programs supports the benefit of avalanche prevention strategies. Further study is needed to assess the impact of avalanche safety education for individuals who travel in remote and uncontrolled terrain.