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1.
Emerg Med Clin North Am ; 40(1): 135-148, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34782084

RESUMO

Immunotherapy is a treatment modality that has a broad and rapidly growing range of applications to treat both chronic and acute diseases, including rheumatoid arthritis, Crohn disease, cancer, and COVID-19. Emergency physicians must be aware of the breadth of applications and be able to consider the effects of immunotherapies when patients on these treatments present to the hospital. This article provides a review of the mechanisms of action, indications for use, and potential complications of immunotherapy treatments that are relevant in the emergency care setting.


Assuntos
Medicina de Emergência/tendências , Imunoterapia/métodos , Medicina de Emergência/métodos , Humanos , Imunoterapia/efeitos adversos , Imunoterapia/tendências , Literatura de Revisão como Assunto
2.
Emerg Med Clin North Am ; 40(1): 19-32, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34782088

RESUMO

Anaphylaxis is a potentially life-threatening, multisystem allergic reaction that can cause airway, breathing, or circulatory compromise. Intramuscular epinephrine is the immediate treatment of all patients. Intravenous epinephrine should be used in patients in shock, either as a bolus or infusion, along with fluid resuscitation. Airway obstruction must be recognized, and early intubation may be necessary. For shock that is refractory to epinephrine, additional vasopressors may be needed. Disposition depends on patient presentation and response to treatment. Mandatory observation periods are not necessary, because biphasic reactions are difficult to predict and may occur outside of typical observation periods.


Assuntos
Anafilaxia/terapia , Manuseio das Vias Aéreas/métodos , Anafilaxia/classificação , Anafilaxia/fisiopatologia , Medicina de Emergência/métodos , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Hidratação , Humanos , Fatores de Risco , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico
3.
Emerg Med Clin North Am ; 40(1): 57-67, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34782091

RESUMO

Food allergies are a common and serious cause of illness, accounting for an increasing number of emergency department visits annually. Although definite diagnosis lays outside of an emergency department visit, the clinical management of the most serious food allergies highlights emergency care. The staple of acute care remains epinephrine in association with antihistamines and steroids. The greatest threat remains undertreatment for this group of disorders and underutilization of epinephrine. Those who have been treated for a food allergy need a follow-up allergist evaluation, guidance of food avoidance, and avoidance of foods with cross-sensitivities as well as ready access to epinephrine.


Assuntos
Hipersensibilidade Alimentar/terapia , Medicina de Emergência/métodos , Serviço Hospitalar de Emergência/organização & administração , Epinefrina/uso terapêutico , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/epidemiologia , Humanos
4.
J Grad Med Educ ; 13(5): 699-710, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34721800

RESUMO

Background: Leaders in graduate medical education must provide robust clinical and didactic experiences to prepare residents for independent practice. Programs traditionally create didactic experiences individually, requiring tremendous resources with variable content exposure and quality. Objective: We sought to create and implement a free, open access, learner-centric, level-specific, emergency medicine (EM) residency curriculum. Methods: We developed Foundations of Emergency Medicine (FoEM) Foundations I and II courses using Kern's model of curriculum development. Fundamental topics were identified through content guidelines from the American Board of Emergency Medicine. We incorporated learner-centric strategies into 2 flipped classroom, case-based courses targeting postgraduate year (PGY) 1 and PGY-2 residents. The curriculum was made freely available online in 2016. Faculty and resident users were surveyed annually for feedback, which informed iterative refinement of the curriculum. Results: Between 2016 and 2020, registration for FoEM expanded from 2 sites with 36 learners to 154 sites and 4453 learners. In 2019, 98 of 102 (96%) site leaders and 1618 of 2996 (54%) learners completed the evaluative survey. One hundred percent of responding leaders and 93% of learners were "satisfied" or "very satisfied" with FoEM content. Faculty and residents valued FoEM's usability, large volume of content, quality, adaptability, organization, resident-faculty interaction, and resident-as-teacher opportunities. Challenges to implementation included resident attendance, conference structure, technology limitations, and faculty engagement. Conclusions: We developed and implemented a learner-centric, level-specific, national EM curriculum that has been widely adopted in the United States.


Assuntos
Medicina de Emergência , Internato e Residência , Acesso à Informação , Currículo , Educação de Pós-Graduação em Medicina , Medicina de Emergência/educação , Humanos , Estados Unidos
6.
MMW Fortschr Med ; 163(20): 67-69, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34767228
7.
Emerg Med Clin North Am ; 39(4): 689-702, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600631

RESUMO

The physical examination of the patient is the cornerstone of the practice of medicine, and the skills to complete a thorough abdominal examination are critical in the care of patients. When performed correctly, the abdominal examination can be revealing when it comes to the overall health of the patient as well as acute pathology. The examination of the abdomen has the potential to minimize further testing or radiation and serves as a key diagnostic tool. In this article, we will discuss each portion of the abdominal examination in detail as well as pathologic findings, abdomen-specific signs, special patient populations, and clinical pearls.


Assuntos
Abdome , Exame Físico/métodos , Auscultação , Exame Retal Digital , Medicina de Emergência , Genitália/anatomia & histologia , Humanos , Palpação , Percussão
8.
Emerg Med Clin North Am ; 39(4): 769-780, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600636

RESUMO

Abdominal vascular emergencies are an uncommon entity in emergency medicine, but when they present, they are often catastrophic. These time-sensitive and life-threatening diagnoses are often hidden in nonspecific complaints such as nausea, vomiting, or flank pain, so the emergency physician must remain diligent and consider these in the differential diagnoses. The following is an overview of the more common of these abdominal vascular emergencies, in the hope that they help the Emergency Physician avoid the misdiagnosis and subsequent vascular catastrophe that would follow.


Assuntos
Abdome/irrigação sanguínea , Erros de Diagnóstico/prevenção & controle , Traumatismos Abdominais/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Estenose da Valva Aórtica/diagnóstico , Arteriopatias Oclusivas/diagnóstico , Técnicas de Diagnóstico do Sistema Digestório , Medicina de Emergência , Humanos , Intestinos/irrigação sanguínea , Isquemia/diagnóstico , Isquemia/terapia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/terapia , Lesões do Sistema Vascular/diagnóstico
9.
Rev Med Suisse ; 17(756): 1826-1829, 2021 Oct 27.
Artigo em Francês | MEDLINE | ID: mdl-34704678

RESUMO

This article has been brought to you by clinicians in general internal medicine passionate about ultrasound, using it for many years daily and having long been committed to training in abdominal ultrasound. The term POCUS, Point-Of-Care Ultrasound or targeted ultrasonography, has appeared in recent years, quickly establishing itself as an essential tool in certain specialties, such as emergency medicine. Since 2018, the Swiss Institute for Medical postgraduate and continues Education (ISFM) delegates training and accreditation of POCUS in various specialties to the Swiss Society of Ultrasound in Medicine (SSUM). However, we did not wait for the term POCUS to use it, our daily medical life leading us to regularly use this tool in a very targeted manner, depending on the requirements of our patients.


Assuntos
Medicina de Emergência , Clínicos Gerais , Humanos , Medicina Interna , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia
10.
Glob Health Sci Pract ; 9(3): 690-697, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593591

RESUMO

Emergency medicine (EM) is rapidly being recognized as a specialty around the globe. This has particular promise for low- and middle-income countries (LMICs) that experience the largest burden of disease for emergency conditions. Specialty education and training in EM remain essentially an apprenticeship model. Finding the required expertise to educate graduate learners can be challenging in regions where there are low densities of specialty providers.We describe an initiative to implement a sustainable, bidirectional partnership between the Emergency Medicine Departments of Weill Cornell Medicine (WCM) in New York, NY, USA, and Bugando Medical Center (BMC) in Mwanza, Tanzania. We used synchronous and asynchronous telecommunication technology to enhance an ongoing emergency medicine education collaboration.The Internet infrastructure for this collaboration was created by bolstering 4G services available in Mwanza, Tanzania. By maximizing the 4G signal, sufficient bandwidth could be created to allow for live 2-way audio/video communication. Using synchronous and asynchronous applications such as Zoom and WhatsApp, providers at WCM and BMC can attend real-time didactic lectures, participate in discussion forums on clinical topics, and collaborate on the development of clinical protocols. Proof of concept exercises demonstrated that this system can be used for real-time mentoring in EKG interpretation and ultrasound technique, for example. This system was also used to share information and develop operations flows during the COVID-19 pandemic. The use of telecommunication technology and e-learning in a format that promotes long-term, sustainable interaction is practical and innovative, provides benefit to all partners, and should be considered as a mechanism by which global partnerships can assist with training in emergency medicine in LMICs.


Assuntos
Currículo , Educação à Distância/métodos , Educação de Pós-Graduação em Medicina/métodos , Medicina de Emergência/educação , Medicina de Emergência/métodos , Centros Médicos Acadêmicos , Serviço Hospitalar de Emergência , Humanos , Aplicativos Móveis , Cidade de Nova Iorque , Mídias Sociais , Tanzânia
11.
Can J Rural Med ; 26(4): 169-175, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643556

RESUMO

Introduction: Point-of-care ultrasound (POCUS) use is the standard of care in emergency medicine (EM), but rural physicians face barriers to obtaining and retaining this skill and cite low confidence in their use of POCUS. Without access to high-quality educational opportunities, this important clinical tool may not be used to its full potential in rural hospitals. The Hands-On Ultrasound Education (HOUSE) programme, launched in 2015 by the University of British Columbia's (BC) Division of Rural Continuing Professional Development, is a rurally focused POCUS training and education programme that travels to rural and remote communities and aims to build a rural POCUS community of practice within BC. In this study, we present and evaluate the HOUSE programme. Methods: The HOUSE programme is described. A comprehensive qualitative evaluation of semi-structured interviews pertaining to HOUSE was conducted in the 4th year of the programme to assess participant experience and programme outcomes. Results: Results from 52 semi-structured interviews indicate that there is a significant increase in self-reported confidence on specific POCUS applications and increased POCUS use after completion of the course, and we report positive experiences with the HOUSE programme. Conclusion: By providing a customizable, accessible, hands-on training opportunity, the HOUSE programme removes barriers to POCUS training and education for physicians in rural and remote BC. The rurally focused elements have contributed to education for rural participants that demonstrates increased confidence and the use of POCUS as a clinical tool.


Assuntos
Medicina de Emergência , Médicos , Serviço Hospitalar de Emergência , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia
12.
Scand J Trauma Resusc Emerg Med ; 29(1): 150, 2021 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-34656150

RESUMO

BACKGROUND: In the pre-hospital setting, non-urgent patients with non-specific chief complaints pose assessment challenges for the emergency medical systems (EMS). Severely ill patients should be identified among these patients, and unnecessary transport to the emergency department (ED) should be avoided. Unnecessary admissions burden EDs, deplete EMS resources and can even be harmful to patients, especially elderly patients. Therefore, tools for facilitating pre-hospital decision-making are needed. They could be based on vital signs or point-of-care laboratory biomarkers. In this study, we examined whether the biomarker soluble urokinase plasminogen activator receptor (suPAR), either alone or combined with C-reactive protein (CRP) and/or lactate, could predict discharge from the ED and act as a pre-hospital support tool for non-conveyance decision-making. METHODS: This was a prospective, observational study of adult patients with normal or near-normal vital signs transported by an EMS to an ED with a code referring to deteriorated general condition. The levels of suPAR, CRP and lactate in the patients' pre-hospital blood samples were analysed. The values of hospitalized patients were compared to those of discharged patients to determine whether these biomarkers could predict direct discharge from the ED. RESULTS: A total of 109 patients (median age: 81 years) were included in the study. Of those, 52% were hospitalized and 48% were discharged from the ED. No statistically significant association was found between suPAR and the ED discharge vs hospitalization outcome (OR: 1.04, 95% CI 0.97-1.13, AUROC: 0.58, 95% CI 0.47-0.69). Adding CRP (AUROC: 0.64, 95% CI 0.54-0.75) or lactate (AUROC: 0.60, 95% CI 0.49-0.71) to the regression models did not improve their diagnostic accuracy. None of the patients with a suPAR value of less than 2 ng/ml were admitted to hospital, while 64% of the patients with a suPAR value of more than 6 ng/ml were hospitalized. CONCLUSION: Pre-hospital suPAR measurements alone or combined with CRP and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints and normal or near-normal vital signs.


Assuntos
Ácido Láctico , Receptores de Ativador de Plasminogênio Tipo Uroquinase , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Proteína C-Reativa , Medicina de Emergência , Hospitais , Humanos , Estudos Prospectivos
13.
Ann Med ; 53(1): 1520-1530, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34612105

RESUMO

OBJECTIVE: During the COVID-19 pandemic, emergency medicine (EM) teachers had to employ innovative methods to ensure the continuity of the education process. The purpose of this study was to explore the adequacy of the 360-degree video (video 360) technology in EM education in the context of: (a) students' attitudes towards the video 360; (b) students' academic performance in their required examination at the end of the EM course compared to the assessment results of students from the previous academic year. METHODS: A mixed-method research project enrolled the fourth-year medical students who attended the required EM course during the first semester of the academic year 2020-2021 when all activities with undergraduate students went online and teaching scenarios recorded in the video 360 format were employed. Data collection was two-fold: (a) anonymous questionnaires, complemented with basic YouTube analytics; (b) multiple-choice questionnaires (MCQ) and oral examination, contrasting the results with those in 2019-2020. Data analysis used descriptive statistics and non-parametric methods. RESULTS: Seventy-nine students (53 females and 26 males) participated in the project and all completed the EM course. Students' interest in and their acceptance of the video 360 technology were high (total scoring in the upper 20% of the respective scales), with consistently good performance in two parallel, independent, interview-based oral/practical evaluations (Spearman correlation coefficient R = 0.665, p < .001). The majority scored over 90% in the summative MCQ, with higher values compared to their colleagues' during the previous academic year (with on-site teaching): scoring percentages with mean ± standard deviation of 92.52 ± 4.57 and 76.67 ± 18.77, respectively. CONCLUSION: Our project showed that the video 360 scenarios were effective in teaching EM. In the long term, employing this accessible and inexpensive educational approach would add value to on-site training by enriching the exposure to a specific ED environment.KEY MESSAGESMedical students valued the 360-degree video scenarios as contributing substantially to their EM knowledge and preparedness.Examination results confirmed the 360-degree video scenarios as viable in EM teaching.The 360-degree video technology would be a sustainable solution for hybrid medical teaching in the long term.


Assuntos
COVID-19/epidemiologia , Educação de Graduação em Medicina/métodos , Medicina de Emergência/educação , Estudantes de Medicina/estatística & dados numéricos , Realidade Virtual , Avaliação Educacional , Feminino , Humanos , Masculino
14.
BMC Med Educ ; 21(1): 536, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34686161

RESUMO

BACKGROUND: Integration of clinical skills, ethical decision-making, and reflection skills have emerged as cornerstones of clinical teaching in medical schools. This study aimed to detect whether a multimodal learning environment approach consisting of lectures, a drill, post-drill video debriefing, and written reflection in an emergency medicine rotation boot camp improves interns' patient management skills, ethical decision-making, and reflection skills. METHODS: A multimodal learning environment was created by the collaboration of emergency medicine, ethics, and medical education specialists. Multiple educational techniques involving lectures, case discussions, and role-playing a crisis scenario were applied. Pre-test and post-test, debriefing on performances on video records, video-recorded performance assessment, and reflective essays about their own and group's performances were used to assess various aspects of the student performances. Additionally, a meeting was organized with the presence of the authors to create qualitative data obtained through the program evaluation meeting conducted on three themes: influences of teaching methods, students' performances, and common achievements and mistakes of students. RESULTS: 133 students participated. Post-test multiple-choice question (MCQ) test scores were slightly higher than pre-test. A low and medium correlation was detected among pre-test and post-test patient management problem (PMP) and reflection scores, which was more prominent for female students. Multiple linear regression showed that pre-test and post-test PMP scores significantly contributed to reflection scores. These results might support that better patient management predicts more robust reflective practice. Teachers observed that students appreciated being inspired by well-performing peers, particularly noting the empathic needs of patients, companions, and other health professionals. However, students overlooked summoning forensic or social services and were inhibited by the pressure of the contextual traits of the drill. CONCLUSION: The multimodal learning environment created by multidisciplinary collaboration contributed to the improvement of components of situational awareness of the interns: patient management skills, ethical decision-making, and reflective practice. During this research, we created a toolbox better to capture the richness and diversity of student interactions. Considering the scarcity of context-specific assessment methods and widespread use of MCQs or generic scales for higher-order thinking skills in medicine, this study might be regarded as a step forward in that context.


Assuntos
Medicina de Emergência , Competência Clínica , Feminino , Pessoal de Saúde , Humanos , Aprendizagem , Pensamento
18.
Age Ageing ; 50(6): 1997-2003, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-34673884

RESUMO

BACKGROUND: Emergency physicians (EPs) provide care to older adults with complex health problems. Treating these patients is challenging for many EPs, which might originate from modest geriatric education. OBJECTIVE: Our aim was to assess EPs' self-perceived needs regarding geriatric emergency medicine (GEM) education, factors determining these needs and the utilization of this education. Our secondary aim was to assess emergency department (ED) managers' view and support for GEM education. METHODS: All EPs and ED managers in the Netherlands received a survey by e-mail. The questionnaires focused on EPs' needs in GEM education, EPs' utilization of GEM education and managerial support for GEM education. We used descriptive statistics to analyse needs, utilization of- and support for GEM education. Regression analyses were used to identify factors associated with EPs' need for GEM education. RESULTS: EPs reported to need better training in diagnosing, treating and communicating with older adults. Seventy percent of EPs reported no GEM education program in their hospital, and 83% reported no utilization of GEM education outside their hospital. EPs working in EDs with a possibility for geriatric consultation, and EPs aware of actual GEM education programs, had lower educational needs. Of responding managers, 86.2% reported the care for older adults as an important topic; lack of finances and time were obstacles to provide GEM education for EPs. CONCLUSION: EPs in the Netherlands feel insufficiently educated to treat older adults. ED managers largely recognize this educational challenge. This nationwide survey underlines the need to prioritize GEM education for EPs.


Assuntos
Medicina de Emergência , Geriatria , Médicos , Idoso , Serviço Hospitalar de Emergência , Humanos , Inquéritos e Questionários
19.
Ann Emerg Med ; 78(5): 587-592, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34598829

RESUMO

We, emergency physicians of color, are not okay. We are living and working through a pandemic that has disproportionately affected our communities and a year in which we cannot escape our lived experiences of police brutality. We see you, dear White people in emergency medicine, and are glad you want to support us. However, let us guide you in supporting our cause.


Assuntos
Afro-Americanos/psicologia , Medicina de Emergência , Grupo com Ancestrais do Continente Europeu , Cultura Organizacional , Médicos/psicologia , Racismo , COVID-19/epidemiologia , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologia , Violência
20.
MedEdPORTAL ; 17: 11182, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34557588

RESUMO

Introduction: Interruptions are an inevitable part of working as an emergency physician, yet these can increase cognitive load and precipitate medical error. Emergency physicians learn to balance these responsibilities using a process called task switching. Yet residents have little exposure to exercises that purposefully integrate task switching during their training. We addressed this gap by exposing emergency medicine (EM) trainees to task-switching events in the form of critical ECG interpretation while they were engaged in concurrent, parallel activities. Methods: The curriculum was carried out in three phases. First, 12 PGY 2 residents engaged in a small-group session testing their baseline confidence and ECG interpretation skills. The second phase was longitudinal: During concurrent educational activities, investigators interrupted tasks and asked trainees to interpret ECGs in 10 seconds or less. The curriculum's final phase was used to review the ECGs and answer any questions. Results: Confidence and percentage of correct interpretations were compared from phase 1 to phase 2. Participants showed improved confidence (M = 2.5, SD = 0.6, to M = 2.9, SD = 0.6; p = .02; 5-point Likert scale) and increased mean percent correct (M = 0.7, SD = 0.1, to M = 0.8, SD = 0.1; p = .01) following the curriculum. Discussion: Our curriculum provides a pragmatic, reproducible approach to enhancing critical ECG interpretation with task switching in a way that mirrors the EM practice environment, promoting a reduction of cognitive load and highlighting the skills learners will need as they develop expertise.


Assuntos
Medicina de Emergência , Internato e Residência , Competência Clínica , Currículo , Eletrocardiografia , Medicina de Emergência/educação , Humanos
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