Physical and Chemical Restraints (an Update).

Violent, combative and intoxicated patients are a common problem in the emergency department, and the emergency physician must be prepared to control the situation safely and effectively when a patient begins to exhibit dangerous behavior. This article reviews initial de-escalation techniques to reduce the need for patient restraint. It then details the 2 types of restraints (physical and chemical) and the clear indications for each type. The high-risk nature of utilization of restraints is reviewed, as well as the means by which to ensure patient and staff safety and decrease adverse outcomes.

Comparison of High-Fidelity Medical Simulation to Short-Answer Written Examination in the Assessment of Emergency Medicine Residents in Medical Toxicology.

We compared high-fidelity medical simulation to short-answer written examination in the assessment of emergency medicine residents (EMR) on a month-long medical toxicology rotation. Knowledge-based assessment tools using cases of an aspirin overdose and a tricyclic antidepressant overdose were used to assess all consecutive rotating EMR (n=53). Assessment by simulation had similar accuracy and precision but higher satisfaction rates when compared to written examination. Incorporating simulation into the ABEM certifying examination warrants further study.

A senior scholars forum can enhance the scholarship process.

BACKGROUND: The purpose of our study was to evaluate the educational value of an annual Senior Scholars Forum (SSF) of graduating Emergency Medicine resident participants and attendees. DESCRIPTION: This study was conducted at an urban academic medical center with a PGY1-4 year residency program. After completion of the 2nd annual SSF, a web-based survey instrument was sent to all resident and faculty attendees. The instrument was a 3-part tool adapted from previous studies on postgraduate scholarship. Data were analyzed using descriptive statistics. EVALUATION: Forty-two of the 44 (95%) attendees completed the survey, including 100% of the PGY4 resident presenters. Prior to the SSF, 52% of respondents did not have a full understanding of senior scholarly activities. After the SSF, 67% reported an improved understanding and 88% had a better understanding of the scope of potential scholarly projects. Sixty-four percent reported the SSF introduced them to departmental resources available for completion of their own scholarly projects, and 69% would have liked to have heard the lessons communicated earlier in residency. Most (79%) agreed the SSF demonstrated the value of communal scholarly activities. Most senior residents (67%) felt most of the department would not know about their scholarship if they had not participated in the SSF. CONCLUSIONS: Our innovative SSF enhanced the scholarship process by allowing graduating senior residents an opportunity to share their scholarly productivity with a larger audience, provided attendees critical insights into the process of scholarship, and encouraged communal learning. Because the Accreditation Council for Graduate Medical Education and Residency Review Committee require all residents to participate in scholarly activity, other training programs may benefit from a similar educational experience.

An unusual presentation of inhalant abuse with dissociative amnesia.

A 38-y-old male with occult inhalant abuse underwent an 18-mo evaluation for presumed seizure disorder. Although past medical history was significant for alcohol abuse, his wife confirmed a 6-y histoy of abstinence. His seizures were characterized as episodes of unconsciousness preceded by a feeling of "things slowing down". No muscular activity was witnessed during these episodes, and upon regaining consciousness the patient had slurred speech, disorientation, dissociative amnesia, and bizarre behavior that resolved spontaneously. Despite 4 emergency department visits, 4 hospital admissions, 5 neurologic and 7 psychiatric outpatient evaluations, extensive work-up was non-diagnostic. These episodes recurred until his wife found him huffing trichloroethylene. Questioning of the patient revealed that huffing always preceded these episodes and that he started huffing after discontinuing alcohol. The patient underwent addiction treatment. Toxic inhalants should be suspected as a substitute drug of abuse in patients attempting abstention. Disorientation clinically similar to dissociative amnesia can occur following loss of consciousness during an episode of trichloroethylene use.