A Formalized Three-Year Emergency Medicine Residency Musculoskeletal Emergencies Curriculum

Audience and type of curriculum: The Ohio State University Emergency Medicine Residency Program Musculoskeletal Emergencies Curriculum is a three-year curriculum for PGY-1 to PGY-3 learners. Introduction/Background: Musculoskeletal complaints/injuries compose a significant proportion of emergency department visits; in fact, many can result in significant morbidity. These conditions present in a vast array of acuities from minor to life/limb threatening. Emergency medicine physicians must be facile in diagnosing and managing various musculoskeletal conditions. We aim to present a three-year curriculum that incorporates clinical experience, self-directed learning, and small group-based didactics using the flipped classroom model to allow learners to master the diagnosis and management of musculoskeletal emergencies. This curriculum will provide progressive training in the diagnosis and management of musculoskeletal emergencies. Objectives: Resident learners will master the diagnosis and management of emergent musculoskeletal conditions including fractures/dislocations, soft tissue injuries, compartment syndrome, joint complaints, infections, and complex injuries. Methods: The educational strategies used in this curriculum include: independent, self-directed learning via textbook and medical literature reading, didactic sessions describing the diagnosis and management of musculoskeletal conditions, a four-week orthopedic surgery rotation, and an optional four-week rotation at a medical center-affiliated sports medicine practice. Residents are expected to actively participate in the care of patients with musculoskeletal conditions/injuries presenting to the emergency department during the course of their residency training. The time requirements, reading material, and diagnosis/management techniques taught vary depending on the year of training. Length of curriculum: The entirety of the curriculum is three years; however, each year of residency training has specific objectives and educational material

A Formalized Three-Year Emergency Medicine Residency Musculoskeletal Emergencies Curriculum

Audience and type of curriculum: The Ohio State University Emergency Medicine Residency Program Musculoskeletal Emergencies Curriculum is a three-year curriculum for PGY-1 to PGY-3 learners. Introduction/Background: Musculoskeletal complaints/injuries compose a significant proportion of emergency department visits; in fact, many can result in significant morbidity. These conditions present in a vast array of acuities from minor to life/limb threatening. Emergency medicine physicians must be facile in diagnosing and managing various musculoskeletal conditions. We aim to present a three-year curriculum that incorporates clinical experience, self-directed learning, and small group-based didactics using the flipped classroom model to allow learners to master the diagnosis and management of musculoskeletal emergencies. This curriculum will provide progressive training in the diagnosis and management of musculoskeletal emergencies. Objectives: Resident learners will master the diagnosis and management of emergent musculoskeletal conditions including fractures/dislocations, soft tissue injuries, compartment syndrome, joint complaints, infections, and complex injuries. Methods: The educational strategies used in this curriculum include: independent, self-directed learning via textbook and medical literature reading, didactic sessions describing the diagnosis and management of musculoskeletal conditions, a four-week orthopedic surgery rotation, and an optional four-week rotation at a medical center-affiliated sports medicine practice. Residents are expected to actively participate in the care of patients with musculoskeletal conditions/injuries presenting to the emergency department during the course of their residency training. The time requirements, reading material, and diagnosis/management techniques taught vary depending on the year of training. Length of curriculum: The entirety of the curriculum is three years; however, each year of residency training has specific objectives and educational material

Endogenous methyl palmitate modulates nicotinic receptor-mediated transmission in the superior cervical ganglion

Nitric oxide (NO) is identified as the endothelium-derived relaxing factor and a neurotransmitter with a superfusion bioassay cascade technique. By using a similar technique with rat superior cervical ganglion (SCG) as donor tissue and rabbit endothelium-denuded aortic ring as detector tissue, we report here that a vasodilator, which is more potent than NO, is released in the SCG upon field electrical stimulation (FES) or addition of nicotine. Release of this vasodilator was enhanced by arginine analogs, including Nω-nitro-l-arginine (a NO synthase inhibitor), suggesting that it is not NO. Analysis by gas chromatography/mass spectrometry identified 2 saturated fatty acids, palmitic acid methyl ester (PAME) and stearic acid methyl ester (SAME), being released from the SCG upon FES in the presence of arginine analogs. Exogenous PAME but not SAME induced significant aortic dilation (EC50 = 0.19 nM), indicating that PAME is the potent vasodilator. Release of PAME and SAME was significantly diminished in chronically decentralized SCG but not denervated SCG, suggesting the preganglionic origin. Furthermore, release of both fatty acids was calcium- and myosin light chain kinase-dependent, suggesting that both were released from axoplasmic vesicular stores. Electrophysiological studies further demonstrated that PAME but not SAME inhibited nicotine-induced inward currents in cultured SCG and the α7-nicotinic acetylcholine receptor-expressing Xenopus oocytes. Endogenous PAME appears to play a role in modulation of the autonomic ganglionic transmission and to complement the vasodilator effect of NO