Factors Influencing Analgesic Use for Skatepark-Related Musculoskeletal Injuries

Objective: This study was designed to determine the proportion of patients with skatepark-related musculoskeletal injuries who were administered analgesics in the emergency department (ED) or at discharge, and to determine if differences in use of pain medication varied by injury type, anatomic location, or patient age. Methods: This is a retrospective review of a cohort of consecutive patients with musculoskeletal injuries presenting to a large urban ED from a local skatepark over a 1-year period (1999- 2000). Patients with non-musculoskeletal injuries were excluded. The outcome measure was analgesic use either in the ED or at discharge. Data included demographics, activity during injury, disposition, injury type (fracture or non-fracture), and injury location (upper or lower body). Analgesic data was abstracted from the medical records. Multivariable logistic regression was used to identify independent predictors of receipt of analgesic medications. Results: 85 injured patients were enrolled. No differences in age, sex, activity, or disposition were found comparing those who received analgesics (n=68) to those who did not (n=17). Overall, analgesia was administered to 80% (95% CI = 70 to 88%) of patients; 67% (95% CI = 56 to 77%) in the ED and 64% (95% CI = 52 to 74%) at discharge. Fractures were more likely to receive analgesia (adjusted OR = 18.5; 95% CI = 4.0 to 86.1) than non-fracture injuries. Lower body injuries were more likely to receive analgesics compared to upper body injuries (adjusted OR = 9.2; 95% CI = 1.5 to 55.8). Age was not independently associated with analgesic use. Conclusions: A high proportion of skatepark-related musculoskeletal injuries were treated with pain medications either in the ED or at discharge. In this study analgesic medication use was influenced by injury type and location of the injury, but not age

Academic Career Selection in American Emergency Medicine Residents

Background:  The future of academic emergency medicine (EM) is based on the continued successful recruitment and cultivation of new faculty from EM residents. Little data exist as to the current rate of residents initially choosing an academic career path or which residency programs are best situated to result in new faculty. Objectives:  Our study was designed to initially describe the current career demographics of graduating residents and then through statistical analysis investigate likely programmatic factors that affect academic career selection. Methods:  Data were collected via an online survey sent to EM residency program directors. Responders were asked to describe their graduates and their program characteristics over the past 5 years. A total of 103 survey responses, with complete data from 65 (76 responses contained enough data for national career selection rates), were received. Relevant covariates were tested for association with academic career entry using t‐tests or analysis of variance. An adjusted multivariable linear regression analysis model was then fitted. Results:  Survey responses indicated that 26.1% of residents chose an academic career (community 57.1%, fellowship 13.5%, military/Veteran’s Administration [VA] 2.6%, other 0.6%) with an approximately normal distribution. There were no significant differences found between programs when presence of mentorship programs, career track programs, or city size were analyzed. Multivariable linear regression analysis demonstrated significantly greater academic career choice among programs located in the Northeast/Mid‐Atlantic and the Midwest, larger programs (>12 residents/year), and programs with increased resident academic productivity (presentations given, non–peer‐reviewed publications), but did not demonstrate a difference between 3‐ and 4‐year programs. Overall, the model fitted using the above variables accounted for approximately 30% of the variation seen between programs (adjusted R 2  = 0.295). Conclusions:  Our data indicate that program region, size, and research productivity were best associated with academic career selection. Program length was not found to be significantly associated with academic career selection by residents, in contrast to previous studies. While many of these factors are not changeable, academic productivity can be cultivated by decision‐makers wishing to increase their residents’ academic career selection as opposed to changing program length to extend training for an additional year. It is our belief that our model provides a good description of programmatic factors affecting career choice. Additional research is necessary to further validate these findings, as well to provide important context to their general applicability for policy‐makers and program directors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86832/1/j.1553-2712.2011.01181.x.pd

Retroperitoneal hematoma after coil embolization of cerebral aneurysm -A case report-

We present the case of a 57-year-old man who developed retroperitoneal hemorrhage due to unintentional arterial puncture during femoral artery cannulation for Guglielmi detachable coil embolization. On emergence from anesthesia, he developed severe hypotension. Computed tomographic angiogram of the abdomen showed retroperitoneal hematomas around the urinary bladder, liver, and spleen. Because femoral artery cannulation is a common procedure for intravascular embolization in neuroradiologic procedures, Clinicians should be aware of the development of severe hematomas as a consequence of femoral artery puncture