Psychiatric illness in a general urban emergency room: daytime versus nighttime population.

Two hundred adults presenting to the emergency room of an urban general hospital were interviewed by a standardized technique to evaluate the existence of a current or previous psychiatric illness. Half of the subjects presented between 8:00 a.m. and 4:00 p.m. (daytime group), and 100 presented between 12:00 a.m. and 8:00 a.m. (nighttime group). In the nighttime population 65% were judged to have current or past psychiatric illnesses. In the daytime population only 36% had current or past psychiatric illnesses. The differences between the 2 populations was highly significant. Fewer than 10% of the 200 patients presented with neuropsychiatric symptoms in their chief complaints.

Reported alcohol consumption and the serum carbohydrate-deficient transferrin test in third-year medical students.

The serum carbohydrate-deficient transferrin (CDT) test was performed on 143 third-year medical students along with questionnaires for the self-reporting of alcohol consumption during the last 2 weeks, the last 6 months, and questions on any alcohol-related untoward events. We found that the CDT test has poor sensitivity for detecting binge drinking in our population of students, despite some likely under-reporting of drinking. Self-reporting of drinking is commonly unreliable, and we found no significant correlation between the CDT concentrations in serum and the magnitude of self-reported alcohol use during 2-week and 6-month periods. Hangover was by far the commonest self-reported untoward event, and there was a highly significant relationship (P < 0.001) between drinking and untoward events. From a small population of non-drinkers, we estimated the reference ranges for CDT to be <27 U/l for men and <35 U/l for women.

Faculty development in emergency medicine.

Faculty development is an important, multifaceted topic in academic medicine. In this article, academic emergency physicians discuss aspects of faculty development, including: 1) a department chair's method for developing individual faculty members, 2) the traditional university approach to promotion and tenure, 3) faculty development in a new department, and 4) personal development.

Emergency Evaluation of Chest Pain.

In brief: Occasionally the team physician may be called on to examine someone, a spectator for example, who has chest pain. After ensuring that the person's vital signs are stable, the physician must determine whether the cause is potentially catastrophic or relatively minor. The author describes the distinguishing factors.

Asthma.

An asthma attack during a sports event or exercise can be life-threatening if appropriate drugs are unavailable for immediate treatment. A little advance planning on the part of asthmatic athletes, their physicians, and their coaches will go a long way toward prevention.

Cardiac Arrest.

In brief: Immediate cardiopulmonary resuscitation (CPR) is required to provide a victim of cardiac arrest with artificial ventilation and circulation. The author reviews the basic principles of CPR (establishing an airway, providing ventilation, and initiating cardiac massage) and discusses the underlying dysrhythmias associated with cardiac arrest. Depending on the dysrhythmia involved, appropriate treatment may include electrical therapy (defibrillation) and/or pharmacologic therapy (eg, intravenous epinephrine, lidocaine, bretylium, and sodium bicarbonate).

Opening the Airway: Equipment and Techniques.

When an airway is blocked, immediate action is necessary. Knowing what equipment to use and having it available can mean the difference between life and death.

Airway Obstruction: The Heimlich Maneuver.

Choking results in many deaths each year. Yet a simple procedure that can be performed by almost anyone, even the victims, could prevent this from happening.

Attitudes of the emergency physician toward and diagnostic evaluation of suicide attempters.

The negative attitudes of emergency medical personnel toward suicide attempters are well documented in recent studies. Part of the reason for such negative attitudes may involve the emergency medical professional's lack of knowledge about the variety of psychiatric conditions present in the patient who attempts suicide. Information about such conditions and the emotional reactions certain personalities generate might alter these attitudes. Questioning the patient about the feelings and thoughts experienced during the attempt often provides some of the most helpful data about the patient's psychiatric condition, treatment needs, and prognosis. Proper guidelines and education for the emergency physician should help improve the early management of the suicide attempters.

Nonobstetric conditions causing hypoxia during pregnancy: asthma and epilepsy.

Nonobstetric medical emergencies of hypoxia may be difficult to recognize in pregnant patients whose normal physiologic condition is altered by the pregnant state. Keys to early recognition of hypoxia in pregnancy may result in appropriate medical interventions for treatment of asthma and seizures that minimize ill effects to mother and fetus. Preventive measures and patient education are important to reducing the incidence of emergencies such as status asthmaticus and status epilepticus.

Nonobstetric emergencies in pregnancy: trauma and surgical conditions.

Nonobstetric surgical emergencies may be difficult to recognize in pregnant patients whose normal physiologic state is altered by pregnancy. Early suspicion and serial examination in pregnancy may result in appropriate interventions for appendicitis, cholecystitis, pancreatitis, and bowel obstruction. Treatment in pregnant patients who experience trauma must be systematic so that situations at risk for maternal and fetal loss can be recognized.

Alcohol use and psychiatric illness in emergency patients.

Screening for alcoholism and associated psychiatric disorders using preselected research criteria demonstrated an overall prevalence of alcoholism of 20% in 200 emergency department patients. The nighttime prevalence of alcoholism was 29%, while the daytime prevalence was 11%. The psychiatric disorders most frequently associated with alcoholism were primary affective disorder (depression) and antisocial personality. The alcoholics had chief complaints relating to trauma in 63% of the cases, vague neuropsychiatric complaints in 23% of the cases, and complaints directly related to alcohol in 8% of the cases. Screening for alcoholism and associated psychiatric illnesses is important in determining an overall treatment strategy for emergency patients.

American Board of Emergency Medicine Longitudinal Study of Emergency Physicians.

STUDY OBJECTIVE: The American Board of Emergency Medicine (ABEM) Longitudinal Study of Emergency Physicians (LSEP) was initiated to describe the development of a new medical specialty through the continuing study of the lives of representative emergency physicians. The study is designed to gather data periodically over many years to come. The primary purpose of this article is to provide a baseline for the information obtained and the methods used to develop the ABEM LSEP. METHODS: Stratified, random sampling was used to select emergency physicians who represent different stages in the development of the specialty. Major data collections are conducted using a comprehensive questionnaire in 5-year intervals. Practice profiles were developed and analyzed. Homogeneous scales were created in 9 survey categories and analyzed. RESULTS: The survey was returned by 95% (958/1,008) of the emergency physicians. They are primarily middle-aged, family- and community-oriented, satisfied with their careers, and find that work stress is not a serious problem. Those who are trained in emergency medicine are the most likely to be involved in academic emergency medicine. CONCLUSION: The LSEP is a broad-reaching investigation of emergency physicians. Over time the study will describe (1) the individuals who move the specialty forward at different stages in the growth of the specialty, (2) the realities of practice in the specialty, (3) the relationship of the specialty to the personal lives and well-being of the specialty physicians, and (4) the changes seen in these factors over time.