Douglas L. McGee

Helium-oxygen therapy in the emergency department

Helium is an inert gas with unique physical properties that allow it to be used for various respiratory emergencies. Because of its low specific gravity and low viscosity, the passage of helium through the respiratory tract is smoother, more laminar, and less turbulent than either air or oxygen. These properties have prompted the use of helium and oxygen in patients with airway obstructions due to tumor, foreign body, edema, or bronchoconstriction. Helium-oxygen has been used to facilitate bronchoscopy through small diameter endotracheal tubes and to increase the effectiveness of high-frequency jet ventilation. Helium has been successful in the treatment of spinal cord decompression sickness seen in divers. Helium-oxygen mixtures are commercially available and may be useful in the emergency department to treat patients with airway obstruction. This article reviews literature concerning the use of helium-oxygen gas mixtures in the emergency department. Additional research conducted in the future may further define the use of this unique gas mixture in the emergency department.

The 2005 Model of the Clinical Practice of Emergency Medicine: The 2007 Update

2007 EM Model Review Task Force Harold A. Thomas, MD, Chair Michael S. Beeson, MD Louis S. Binder, MD Patrick H. Brunett, MD Merle A. Carter, MD Carey D. Chisholm, MD Douglas L. McGee, DO Debra G. Perina, MD Michael J. Tocci, MD From the American Board of Emergency Medicine, East Lansing, MI (Thomas, Perina); Council of Emergency Medicine Residency Directors, Lansing, MI (Brunett); Residency Review Committee for Emergency Medicine, Chicago, IL (Binder); Society for Academic Emergency Medicine, Lansing, MI (Chisholm, McGee); American College of Emergency Physicians, Dallas, TX (Beeson, Carter); and the Emergency Medicine Residents’ Association, Dallas, TX (Tocci).

The 2007 Model of the Clinical Practice of Emergency Medicine: The 2009 Update: 2009 EM Model Review Task Force

From the American Board of Emergency Medicine, East Lansing, MI (Perina, Counselman); Council of Emergency Medicine Residency Directors, Lansing, MI (Beeson); Residency Review Committee for Emergency Medicine, Chicago, IL (Keim); Society for Academic Emergency Medicine, Chicago, IL (McGee, Sokolove); American College of Emergency Physicians, Dallas, TX (Char, Rosen); and the Emergency Medicine Residents’ Association, Dallas, TX (Tantama).

Four-year review of cigarette ingestions in children

The objective of our study was to assess the demographics, incidence, types of symptoms, and outcomes of cigarette product ingestions in children. The study was a retrospective database review. Seven hundred children under six years of age ingesting cigarettes or cigarette butts reported to a Poison Control Center between 1988 and 1991. Among 143 patients (20.4%) with symptoms, vomiting was the only symptom in 138 (98.6%) and occurred in less than 20 minutes in 104 (74.3%). The five remaining patients (two with vomiting, three without) developed transient lethargy or irritability that completely resolved. Forty-four of 700 patients ingested potentially toxic amounts and were referred to the emergency department; three were lost to follow-up. Initially asymptomatic patients never developed symptoms. Symptomatic patients improved without sequelae. No patient developed seizures. We concluded that significant toxicity from the ingestion of cigarette products in children is rare. Vomiting within 20 minutes is the most common symptom. Its absence predicts a favorable outcome, even when large amounts are suspected to have been ingested.

The Future of Emergency Medicine

BACKGROUND The specialty of emergency medicine (EM) continues to experience a significant workforce shortage in the face of increasing demand for emergency care. SUMMARY In July 2009, representatives of the leading EM organizations met in Dallas for the Future of Emergency Medicine Summit. Attendees at the Future of Emergency Medicine Summit agreed on the following: 1) Emergency medical care is an essential community service that should be available to all; 2) An insufficient emergency physician workforce also represents a potential threat to patient safety; 3) Accreditation Council for Graduate Medical Education/American Osteopathic Association (AOA)-accredited EM residency training and American Board of Medical Specialties/AOA EM board certification is the recognized standard for physician providers currently entering a career in emergency care; 4) Physician supply shortages in all fields contribute to-and will continue to contribute to-a situation in which providers with other levels of training may be a necessary part of the workforce for the foreseeable future; 5) A maldistribution of EM residency-trained physicians persists, with few pursuing practice in small hospital or rural settings; 6) Assuring that the public receives high quality emergency care while continuing to produce highly skilled EM specialists through EM training programs is the challenge for EMs future; 7) It is important that all providers of emergency care receive continuing postgraduate education.

The future of emergency medicine.

Physician shortages are being projected for most medical specialties. The specialty of emergency medicine continues to experience a significant workforce shortage in the face of increasing demand for emergency care. The limited supply of emergency physicians, emergency nurses, and other resources is creating an urgent, untenable patient care problem. In July 2009, representatives of the leading emergency medicine organizations met in Dallas, TX, for the Future of Emergency Medicine Summit. This consensus document, agreed to and cowritten by all participating organizations, describes the substantive issues discussed and provides a foundation for the future of the specialty.

Dextrose is absorbed by rectum in hypoglycemic rats

The objective of this study was to determine the efficacy of the rectal administration of dextrose in raising the serum glucose in a hypoglycemic rat model. A randomized, prospective, controlled experimental study was performed using 18-h fasted, acutely anesthetized Harlan Sprague-Dawley rats made hypoglycemic by the intravenous infusion of insulin at 3 U/kg/h for 2 h. At 1 h into the infusion, study rats received 1, 2, or 3 g/kg of 50% dextrose solution infused into the rectum using a balloon tipped catheter. Control animals received an equivolume, equi-osmolar (as compared to the 3 g/kg dose) amount of polyethylene glycol (PEG)-400 by rectum. Blood glucose (BG) measurements were made using blood obtained from the portal vein and a femoral artery. Intravenous insulin administered at 3 U/kg/h consistently produced BG levels 60% of baseline at 60 min and 80% of baseline at 120 min. BG levels in portal and arterial circulation increased after rectal dextrose. In general, portal venous values were greater than arterial after rectal dextrose. The greatest increase was seen 30 min after dextrose by rectum in animals receiving 3 g/kg. A 50% dextrose administered by rectum in hypoglycemic rats is absorbed in quantities sufficient to raise BG in the arterial and portal circulation.

Signs & Symptoms in Emergency Medicine: Literature-Based Guide to Emergent Conditions

Find the secret to improve the quality of life by reading this signs and symptoms in emergency medicine literature based guide to emergent conditions. This is a kind of book that you need now. Besides, it can be your favorite book to read after having this book. Do you ask why? Well, this is a book that has different characteristic with others. You may not need to know who the author is, how well-known the work is. As wise word, never judge the words from who speaks, but make the words as your good value to your life.

Antiphospholipid antibody syndrome: An unusual cause of stroke in a 22-year-old female

A 22-year-old female presented to the Emergency Department after the acute onset of left hemiparesis. Marked prolongation of the partial thromboplastin time, mild thrombocytopenia, a history of syphilis, and recent spontaneous abortion suggested the diagnosis of antiphospholipid antibody syndrome, an unusual cause of ischemic stroke. This case illustrates the clinical and laboratory features of this uncommon disorder.