Understanding ACGME Standards for Simulation: A Document Analysis of Institutional and Program Requirements.

Our institution has established priorities for graduate medical education (GME) simulation which include increasing adoption of, garnering additional financial support for, and creating a core simulation curriculum. Better understanding of the Accreditation Council for Graduate Medical Education (ACGME) simulation requirements will inform our efforts and serve as a guide for other institutions. The purpose of this study was to perform a structured review of ACGME simulation standards using a document analysis to guide GME simulation activities at an institutional level.

Clinical Images in Emergency Medicine: Cushing's Disease.

Case Presentation: A 22-year-old female presented to the emergency department with a two-month history of worsening fatigue, unintentional weight gain, and progressive facial swelling. Physical examination findings included hirsutism, moon facies, and abdominal striae. Subsequent brain magnetic resonance imaging revealed the presence of a 2.

A survey of handoff practices in emergency medicine.

This study aimed to assess practices in emergency department (ED) handoffs as perceived by emergency medicine (EM) residency program directors and other senior-level faculty and to determine if there are deficits in resident handoff training. This cross-sectional survey study was guided by the Kern model for medical curriculum development. A 12-member Council of Emergency Medicine Residency Directors (CORD) Transitions in Care task force of EM physicians performed these steps and constructed a survey.

An algorithm for transition of care in the emergency department.

Objectives: The objective of this study is to present an algorithm for improving the safety and effectiveness of transitions of care (ToC) in the emergency department (ED).

Methods: This project was undertaken by the Council of Emergency Medicine Residency Directors (CORD) Transitions of Care Task Force and guided by the six-step Kern model for curriculum development. A targeted needs assessment in survey form was designed using a modified Delphi method among the CORD ToC Task Force.

Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose.

We report the first case of sustained-release verapamil toxicity treated with Intralipid fat emulsion (IFE). Toxicity was confirmed by elevated serial serum verapamil and metabolite, norverapamil, levels. Most previously reported cases of IFE therapy involve local anaesthetic toxicity and cardiac arrest.

Role of hydroxocobalamin in acute cyanide poisoning.

Objective: To review the recently approved cyanide antidote, hydroxocobalamin, and describe its role in therapy.

Data Sources: Relevant publications were identified through a systematic search of PubMed using the MeSH terms and key words hydroxocobalamin and cyanide. This search was then limited to human studies published since 2000.

Ethylene glycol ingestion treated only with fomepizole.

Introduction: Ethylene glycol is a widely used chemical that is capable of causing significant injury if ingested. Treatment for ethylene glycol poisoning typically includes basic supportive care, alcohol dehydrogenase inhibition, and hemodialysis. Recent data have suggested that hemodialysis may not be necessary for cases of ethylene glycol poisoning that can be treated with fomepizole as blocking therapy before acidosis or renal dysfunction develops.

Recurrent life-threatening ventricular dysrhythmias associated with acute hydrofluoric acid ingestion: observations in one case and implications for mechanism of toxicity.

Introduction: Hydrofluoric acid (HF) is a weak inorganic acid used for etching and as rust remover. Systemic toxicity is manifested as ventricular dysrhythmias. The mechanisms for these dysrhythmias are not well elucidated.

Systemic toxicity after an ocular exposure to xylazine hydrochloride.

There are limited reports of human overdose with the animal tranquilizer, xylazine hydrochloride. The reported effects include hypotension, bradycardia, and respiratory depression. Ocular exposures to xylazine have not been previously reported.

Intentional bupropion overdoses.

Bupropion is an antidepressant that has recently seen increased usage in smoking cessation. This increased usage, along with its potential for causing seizures, has renewed interest among clinicians about the effects of this drug. The purpose of this study is to describe the clinical course of intentional bupropion overdoses in adults and adolescents.

Unintentional intravenous infusion of Golytely in a 4-year-old girl.

Objective: To report an accidental intravenous infusion of Golytely (polyethylene glycol and electrolyte solution; PEG-ELS) in a pediatric patient that did not result in systemic toxicity.

Case Summary: A 4-year-old Hispanic girl presented to the emergency department after ingestion of approximately 24 tablets of 6-mercaptopurine (6-MP) 2 hours earlier. She vomited twice after receiving syrup of ipecac at home.

Delayed salicylate toxicity at 35 hours without early manifestations following a single salicylate ingestion.

Objective: To report a case of delayed toxicity following a single ingestion of aspirin, where the initial concentrations were nearly undetectable and the patient was completely asymptomatic for the first 35 hours.

Case Summary: A 14-year-old white female was evaluated after a single ingestion of 120 tablets of aspirin 81 mg/tablet hours before arrival to the emergency department. She denied nausea, abdominal pain, tinnitus, or shortness of breath.

Language preferences among callers to a regional Poison Center.

Providing service to non-English speaking populations is a common challenge facing Poison Centers (PC). Previous studies have identified that people who do not speak functional English are unlikely to call a PC. We developed a survey to determine the language preferences of poison center callers and to identify if we were failing to offer services in languages other than English to callers who felt they needed them.

Serotonin syndrome with elevated paroxetine concentrations.

Objective: To describe a case of serotonin syndrome due to paroxetine and ethanol.

Case Summary: A 57-year-old white man was brought to the emergency department one day after ingesting paroxetine 3600 mg and a pint of hard liquor. He denied the use of any other drug or herbal products and regular use of alcohol.

Death by quinine.

We report a case of a man with a 9.75 g ingestion of quinine. The patient presented with recurrent pulseless wide complex tachycardia for which he received sodium bicarbonate, defibrillation and overdrive mechanical pacing.

Inhalational methanol toxicity in pregnancy treated twice with fomepizole.

We describe a pregnant patient with a long history of inhalant abuse who came to our hospital twice during her pregnancy. In both admissions, she was treated with fomepizol (4-MP), a newly available alcohol dehydrogenase antagonist for treatment of ethylene glycol poisoning.

Opisthotonic posturing with neuromuscular irritability attributable to 4-aminopyridine ingestion by a healthy pediatric patient.

Introduction: 4-Aminopyridine (4-AP) is a potassium channel blocker used to increase muscle strength in the treatment of demyelinating diseases such as multiple sclerosis. We describe a case of ingestion by an 8-month-old child that resulted in severe but transient symptoms.

Case Report: An 8-month-old boy was found with greenish saliva, and a capsule with green 4-AP powder was missing.

Elemental mercury poisoning in a family of seven.

Mercury poisoning in children is rare but may have devastating health consequences when exposure is unrecognized. Mercury occurs in three forms: elemental, inorganic, and organic. Elemental mercury (Hg(0)) vapor may become volatile following an accidental spill and may be readily absorbed from the lungs.