BET 2: Does topical lidocaine improve oral intake in children with painful mouth ulcers?

A shortcut review was carried out to establish whether topical lidocaine was effective at reducing pain and improving oral intake in children with painful oral lesions. 34 papers were found using the reported searches, of which two presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these two papers are tabulated.

BET 1: Does inhaled tranexamic acid reduce morbidity in adults with haemoptysis?

A short cut review was carried out to establish whether inhaled tranexamic acid is more effective than placebo at controlling bleeding in patients with haemoptysis. Thirty-four papers were found using the reported searches, of which one presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper is tabulated.

BET 2: Usefulness of IV lidocaine in the treatment of renal colic.

A shortcut review was carried out to establish whether intravenous lidocaine is effective in the management of renal colic. Two studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these studies are tabulated.

BET 1: Trimethoprim-sulfamethoxazole in uncomplicated skin abscess.

A short cut review was carried out to establish whether incision and drainage followed by treatment with oral trimethoprim-sulfamethoxazole is better than incision and drainage alone at treating patients with uncomplicated skin abscesses. One hundred and ninety-seven papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated.

Have First-Year Emergency Medicine Residents Achieved Level 1 on Care-Based Milestones?

Background: Residents in Accreditation Council for Graduate Medical Education accredited emergency medicine (EM) residencies were assessed on 23 educational milestones to capture their progression from medical student level (Level 1) to that of an EM attending physician (Level 5). Level 1 was conceptualized to be at the level of an incoming postgraduate year (PGY)-1 resident; however, this has not been confirmed.

Objectives: Our primary objective in this study was to assess incoming PGY-1 residents to determine what percentage achieved Level 1 for the 8 emergency department (ED) patient care-based milestones (PC 1-8), as assessed by faculty.

How Do Emergency Medicine Residency Programs Structure Their Clinical Competency Committees? A Survey.

Background: The Accreditation Council for Graduate Medical Education (ACGME) recently has mandated the formation of a clinical competency committee (CCC) to evaluate residents across the newly defined milestone continuum. The ACGME has been nonproscriptive of how these CCCs are to be structured in order to provide flexibility to the programs.

Objectives: No best practices for the formation of CCCs currently exist.

Spontaneous spinal epidural abscess in a 21-month-old child.

Spontaneous epidural abscess formation is a rare finding in all populations and even more so in the pediatric population. Its rarity and varied presentations often lead to misdiagnosis. We present a pediatric case in which the diagnosis of spontaneous spinal epidural abscess was missed upon initial presentation and subsequently identified at a later visit to the emergency department.

Emergency pharmacist impact on health care-associated pneumonia empiric therapy.

Purpose: Health care-associated pneumonia (HCAP) is a serious infection dependent on proper treatment that often presents in the emergency department (ED) and deviation from treatment guidelines appears to be high. This study was conducted to evaluate the impact of emergency medicine pharmacists (EPhs) on adherence of empiric antibiotic therapy to guideline recommendations.

Methods: A retrospective chart review of adult patients with HCAP who presented to an academic medical center ED from September 1, 2008 to June 30, 2010 was conducted.

Paramedic electrocardiogram and rhythm identification: a convenient training device.

Introduction: A common reason for utilizing local paramedics and the emergency medical services is for the recognition and immediate treatment of chest pain, a complaint that has multiple possible etiologies. While many of those complaining of disease processes responsible for chest pain are benign, some will be life-threatening and will require immediate identification and treatment. The ability of paramedics to not only perform field electrocardiograms (ECGs), but to accurately diagnose various unstable cardiac rhythms has shown significant reduction in time to specific treatments.

Resolution of delayed altered mental status associated with hydrogen peroxide ingestion following hyperbaric oxygen therapy.

An 82-year-old women presented with altered mental status, seizure, and apnea after an accidental ingestion of concentrated hydrogen peroxide. Ingestion of concentrated peroxide can result in gas embolism of the cerebral vasculature. After hyperbaric treatment, the patient had prompt and full neurologic recovery.