Platelet count

An estimate of the platelet count is usually given as part of the complete blood count (CBC). It should not be neglected when reviewing CBC results as it is a fair screening test and satisfactory for most purposes in the emergency department. It is a quantitative study, and the functional status of the platelet must always be considered in interpretation of clinical significance. Patients presenting with abnormal bleeding histories, particularly women with mucosal origin bleeding, should have an evaluation of platelet quantity by an accurate method and functional quality by a bleeding time. Though rarely used, the emergency physician should be familiar with the indication and mechanics of platelet transfusions. The laboratory charge for the platelet count is $17.00 to 18.00, whether it is automated or hand counted.

Coagulation studies: prothrombin time, partial thromboplastin time, bleeding time

Three coagulation tests available in the emergency department are described in this article. Methods, results, and implications in the bleeding patient are reviewed.

Hemoglobin/hematocrit and other erythrocyte parameters

The authors review erythrocyte physiology, blood collection, and laboratory methodology for enumerating blood cells. The clinical interpretation of abnormal erythrocyte parameters is discussed, and the emergency department approach to anemia and polycythemia is detailed.

The Cincinnati DC-9 experience: lessons in aircraft and airport safety

Twenty-three passengers died on June 2, 1983, when a McDonnell Douglas DC-9 experienced an inflight rear lavatory fire near Cincinnati, OH. Evidence of toxic fume inhalation was developed by investigators, demonstrating lethal levels of carbon monoxide and cyanide in the victims' blood. An analysis of the inflight progression of fire and smoke, and the subsequent extension of this following the emergency landing at Greater Cincinnati Airport has been accomplished. This data is augmented by other data from previous accidents of this type. Data from interviews with survivors was collected, including inflight experiences, emergency escape processes and airport disaster management during the emergency. Several practical means of respiratory protection both inflight and during emergency evacuation are documented. Onboard preventive measures in regard to this type of emergency have been identified. Emergency evacuation and modern airport disaster management techniques are codified and described. This recent accident provides information for future adoption by the responsible authorities so that inflight and postflight fires do not continue to cause significant numbers of fatalities. Modified lightweight passenger breathing apparatus, upgraded flight attendant and aircrew portable breathing apparatus, floor level guidance to exits, less flammable and toxic interior materials, improved passenger evacuation information, tailored airport emergency response procedures, and upgraded toilet smoke detector equipment are examples.

A course in anatomy for emergency medicine residents

The understanding of human anatomy is a critical component of the practice of medicine. A specialty with the breadth of emergency medicine is best approached with a sound basis in anatomy and pathophysiology which leads to a better understanding and differential diagnosis of the disease process. It was the authors' opinion that a specialty with the surgical emphasis found in emergency medicine should have a correlating emphasis in the anatomical sciences. Subsequent testing of PGY-II residents demonstrated a fair to poor understanding of anatomy when gauged by a standard freshman anatomy examination tailored to clinical circumstances. This paper reports on a 3-year experience in giving a 1-week 40-hour anatomy course which included didactic presentations by the anatomy and surgery departments. The impact of this course on clinical practice, problems in its preparation, and outcome of a shared experience with residents from general surgery are discussed. The course is felt to be a successful addition to the training of emergency medicine specialists.

Single-dose antibiotic therapy of urinary tract infection: is it appropriate in the emergency department?

Accurate diagnosis of urinary tract infection (UTI) is possible in the emergency department. Clinical differentiation of upper tract infection (pyelonephritis) from lower tract infection (cystitis) is difficult. The consequences of untreated UTI justify treatment by the emergency physician. Many treatment schemes are available. Single-dose antibiotic therapy is the preferred treatment method for uncomplicated UTI. It reduces compliance problems, effectively cures lower UTI, and provides for early identification of patients with more complex infection. The complications of this therapy are minimal.

Electrical interventions in cardiopulmonary resuscitation: pacing

The techniques of cardiac pacing, the types of pacing electrodes, technologic advances and new devices, and the future of pacing in CPR are discussed.

Electrical interventions in cardiopulmonary resuscitation: defibrillation

The general concepts of defibrillation are reviewed. Research continues in the area of implanted defibrillators, new circuiting, and more effective current transfer.

Nontraumatic suppurative mediastinitis presenting as acute mediastinal widening

A case of acute nontraumatic suppurative mediastinitis in a 56-year-old man is presented. The patient was admitted with signs and symptoms of a left lower lobe pneumonia and acutely developed mediastinal widening on chest radiograph. A mediastinal abscess was drained by posterior mediastinotomy after a complicated hospital course. Mediastinitis is a rare complication of pneumonia. It is a serious condition, requiring prompt diagnosis and aggressive therapy, and should be considered in the differential diagnosis of acute mediastinal widening.

Electrical interventions in cardiopulmonary resuscitation: cardioversion

Although there are complications associated with cardioversion, they are relatively infrequent and usually of small magnitude compared with the primary disease. Cardioversion is an invaluable part of the emergency physician's armamentarium.

A new library for emergency medicine

The publication of textbooks that are relevant to emergency medicine has increased rapidly during the past decade. This increase has created confusion in the selection of appropriate texts for both emergency medicine residency and hospital emergency department libraries. A critical review of 703 pre-selected texts was performed. From this review, a recommended list of 165 books for the resident library and 27 books for the emergency department library is suggested. The cost of these libraries is $6,433.05 and $1,230.05, respectively. The libraries are designed to assist emergency physicians and librarians in attaining maximum value in the expensive process of textbook selection.

Adaptation of the emergency medicine core content to a three-year residency core curriculum

An outline of a didactic curriculum from the Core Content in Emergency Medicine is presented. The 430 hours of lecture are distributed over three years. Three new categories have been added to the Core Content as previously defined by the Graduate/Undergraduate Education Committee of the American College of Emergency Physicians: drugs of emergency medicine, laboratory/radiology use in emergency medicine, and resident evaluation series. The benefits of this core curriculum are improved organization in educational format, better defined curricular guidelines for developing residencies, and standardized guidelines for individual topic assessment and review.