Severe hyperglycemic hyperosmolar nonketotic coma in a nondiabetic patient receiving aripiprazole.

Aripiprazole is commonly used as an atypical antipsychotic. It has been associated with abnormalities in glucose metabolism. Severe diabetic complications associated with its use occur rarely. We present a case of a patient without a history of diabetes mellitus who presented to the emergency department in severe hyperosmolar nonketotic coma while using aripiprazole.

A review of clinically relevant human anatomy in emergency medicine.

The objectives of this project were to establish a practical model for the review of clinical anatomy relevant to the assessment and care of the ill and injured patient, and to design practice models for invasive procedures using human cadaver, porcine cadaver, and plastic model material. A practical course based on the human gross anatomy of the face, neck, thorax, airway, arm, and leg was designed. Regional anesthesia techniques, arthrocentesis, saphenous vein cutdown, central venous and arterial cannulation, surgical airway, thoracostomy tube placement and thoracotomy were integrated into the appropriate practice stations. A syllabus was developed. A clinically relevant, online anatomy atlas demonstrating all of the above was developed. In conclusion, an anatomy review course combining clinically relevant, human, gross anatomy and procedure practice stations was established.

The use of a dissected bovine heart to teach cardiac sonography.

OBJECTIVES: To create and test a dissected bovine heart model (BHM) to facilitate the interpretation of cardiac sonography (CS). METHODS: After a pretest and an instructional video on CS, emergency physicians (EPs) were randomized into two groups. Group 1 viewed two-dimensional (2D) anatomic pictures of human hearts. Group 2 examined the BHM and the same anatomic pictures as group 1. The EPs retook the pretest. The differences between the raw pretest and posttest scores of the groups were compared with an unpaired Student's t-test. Multiple linear regression was used to adjust for confounding by variation in education and initial test scores. EPs with previous experience in CS were excluded from the analysis. RESULTS: Thirty-five participants met the inclusion criteria, 16 in group 1 and 19 in group 2. The groups were well balanced with respect to postgraduate year training. The EPs in group 1 had a higher average pretest score of 11.6 versus 8.1 in group 2. Compared with the pretest scores, the average improvements in group 1 and group 2 were 7.6 and 11.3 points, respectively. Group 2 improved an average of 3.7 points (95% confidence interval [95% CI] = 0.7 to 6.7; p = 0.016) more than group 1. After adjusting for confounding by the difference in initial scores, group 2 improved 1.8 (95% CI = -1.1 to 4.8; p = 0.22) more points on average than group 1. CONCLUSIONS: A dissected bovine heart model did not significantly improve the ability of EPs to label structures on static ultrasounds over inspection of static-labeled anatomic pictures alone.