Oculocardiac Reflex as a Result of Intraorbital Trauma.

BACKGROUND: The oculocardiac reflex is a decrease in heart rate caused by ocular compression or traction upon the extraocular musculature. Multiple instances of this phenomenon have been described in anesthesia, trauma, craniofacial, and ophthalmology literature, but there is a sparsity of documentation in the emergency medicine literature. CASE REPORT: We describe the observation and management of the oculocardiac reflex in a 26-year-old man with retrobulbar hematoma and intraocular trauma caused by a self-inflicted gunshot wound. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Prompt recognition of the oculocardiac reflex is important for the emergency physician given the common occurrence of craniofacial trauma and the potentially devastating consequences if not recognized and addressed.

Impact of trainees on length of stay in the emergency department at an Academic Medical Center.

OBJECTIVES: Emergency department (ED) overcrowding remains a growing concern despite continued efforts by hospitals to improve efficiency while also maintaining quality of care and medical education. The purpose of this study was to examine whether the total number of trainees rotating in the ED affects length of stay (LOS). METHODS: This was a single-center study conducted at an urban university teaching hospital and level I trauma center that averages 65,000 adult ED visits per year. Data were collected retrospectively during a 13-month period from September 2012 to September 2013. The mean daily LOS was generated by the hospital's electronic medical record system, and the total number of trainees (medical students, postgraduate year-1 students/interns, and nurse practitioners) rotating in the ED each day was collected from monthly shift calendars. Correlations were used to examine the relation between LOS and number of trainees rotating in the ED. Independent sample t tests were conducted to compare differences in average LOS on days with and without trainees rotating in the ED. RESULTS: The mean daily LOS ranged from 3.39 to 7.13 hours (mean 4.97, standard deviation [SD] 0.59). The number of trainees rotating in the ED each day ranged from 0 to 11 (mean 5.32, SD 2.39). No significant relation was found between LOS and the number of trainees rotating in the ED (r = 0.06). Subsequent analyses using independent sample t test revealed that LOS did not vary even when no trainees were rotating in the ED (mean 4.93, SD 0.69) versus when at least one trainee was working (mean 4.97, SD 0.59). CONCLUSIONS: Findings from this study suggest that ED LOS is unaffected by the presence or total number of trainees (medical students, postgraduate year-1 students/interns, and nurse practitioners) rotating in the ED. Further research is needed to examine what, if any, adjustments are being made to accommodate trainees and whether the quality of education suffers when the trainee-to-attending ratio is high.

Improving Disaster Response Efforts Through the Development of a Disaster Health Care Response System.

We review the development of a disaster health care response system in Mississippi aimed at improving disaster response efforts. Large-scale disasters generate many injured and ill patients, which causes a significant utilization of emergency health care services and often requires external support to meet clinical needs. Disaster health care services require a solid infrastructure of coordination and collaboration to be effective. Following Hurricane Katrina, the state of Mississippi implemented best practices from around the nation to establish a disaster health care response system. The State Medical Response System of Mississippi provides an all-hazards system designed to support local response efforts at the time, scope, and scale required to successfully manage the incident. Components of this disaster health care response system can be replicated or adapted to meet the dynamic landscape of health care delivery following disasters. (Disaster Med Public Health Preparedness. 2017;11:600-604).