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Postpartum haemorrhage is an infrequent but potentially life-threatening obstetrical emergency amenable to simulation. An educational programme consisting of a lecture and high-fidelity simulation exercise was given to incoming obstetrics and gynaecology (OB) and family medicine (FM) residents. Residents reported pre- and post-intervention confidence scores on a 1-5 Likert scale and a subset completed a postpartum haemorrhage knowledge assessment. Residents reported significant improvements in confidence in parameters involved in diagnosis and management of postpartum haemorrhage. The postpartum haemorrhage test mean scores significantly increased (57.4 ± 9.6% vs 77.1 ± 7.9%, p < 0.01) and were significantly correlated to confidence scores (Spearman's coefficient of 0.651, p < 0.001). In conclusion, an education programme that incorporates high-fidelity simulation of postpartum haemorrhage improves the confidence and knowledge of incoming residents and appears to be an effective educational approach.

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This article approaches the subject of closed head trauma from the time-sensitive vantage point of the emergency physician. As the clinical scenario unfolds, he or she constantly evaluates the need for diagnostic tests as information is received from paramedics, nurses, and the history and physical examination. This article provides a synopsis and a critique of original clinical trials to aid the emergency physician in making an evidence based decision.

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OBJECTIVE: To identify bicycle-riding circumstances associated with bicycle-related injury among school-aged children. DESIGN: Case-control. SETTING: One metropolitan emergency department and 3 suburban emergency departments. SUBJECTS: Consecutive sample of children aged 7 through 18 years who experienced bicycle-related trauma and control children seen for non-bicycle-related trauma (matched for age within 1 year, sex, and area of residence [urban vs suburban]). METHODS: Parents and case children were interviewed by telephone about the bicycle ride resulting in their visit to the emergency department. Parents and control children were interviewed about their most recent bicycle ride. The survey instrument addressed the following potential risk factors: helmet use, bicycle speed, road conditions, riding location, bicycle condition, an adult presence, riding destination, bicycle style, and stunt riding. RESULTS: Interviews were completed with 47 (73%) of 64 eligible case children and 42 (69%) of 61 control children with the following age distribution: 27 (30%) of the interviews were completed with children aged 7 to 9 years, 40 (45%) of the interviews were completed with children aged 10 to 14 years, and 22 (25%) of the interviews were completed with children aged 15 to 18 years. Fourteen children (16%) were wearing helmets. There was a high degree of agreement between parent and child responses, higher for case children than for control children. In univariate analyses, injury was associated with riding with other children (vs riding alone or with adults), riding fast or slow (vs normal speed), riding a BMX-style (motocross) bicycle (vs another standard or multispeed style bicycle), playing on the bicycle (vs going to school or other purposeful or nonpurposeful trip), and riding only on the sidewalk (vs in the street). More case children than control children were farther than 3/4 mile (> 1.2 km) from home (38% vs 19%, P = .05). Multiple logistic regression identified' slow riding speed (odds ratio, 10.3;95% confidence interval, 1.6-66.8), distance from home farther than 3/4 mile (> 1.2 km) (odds ratio, 3.7;95% confidence interval, 1.1-12.5), and riding on the sidewalk (odds ratio, 6.1;95% confidence interval, 1.8-20.5) as independent risk factors for injury. CONCLUSIONS: This study identifies 3 counterintuitive but apparently strong behavioral risk factors for bicycle injuries treated in an emergency department in children aged 7 through 18 years in the Chicago (III) area. These findings will need to be confirmed in larger samples from a wider range of locales. In addition to stressing the importance of wearing a helmet when riding a bicycle, it may be desirable to include the findings of this study in anticipatory guidance discussions with school-aged children.

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When to intervene and control the airway is the critical decision the physician must make. The technical expertise and confidence of each physician determine the particular airway modality chosen. The medications used depend on each clinical setting and can significantly impact the outcome of airway management. To control the airway and breathing and move on to circulation requires a broad knowledge of alternative airway management techniques and the challenging task of placing each into the appropriate clinical setting.

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Frequent and varied injuries are sustained during the operation of power lawn mowers in the United States. A description of one such injury leading to cardiac trauma is presented. The clinical signs of injury were initially unclear, and obtaining accurate historical data was vital in the diagnosis of this patient.

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Acute renal failure secondary to nonsteroidal anti-inflammatory agents is an uncommon occurrence, but may have serious or even lethal consequences. We present one such reaction resulting in cardiac arrest in a 59-year-old diabetic treated with indomethacin. Since presenting symptoms may be vague and unimpressive, one must consider this potential complication to make an early diagnosis and intervene appropriately. In addition when prescribing anti-inflammatory drugs such as indomethacin, one should be cautious in patients who are predisposed to the development of acute renal failure. Risk factors that should be considered are preexistent hepatorenal dysfunction, extracellular fluid volume contraction, and concomitant use of nephrotoxic drugs.

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A method for the production of thin axial transverse sections, coronal views, and sagittal views from overlapped thick computed tomography (CT) scans has been developed. Thin slices are produced by spatially filtering the overlapped CT data using a filter that is a combination of square waves in the spatial domain. Resolution recovery and noise properties have been examined in phantomas and patients for a selection of filter parameters. Sample results of these studies are presented. The method has been applied to data from several hundred patient studies. Several of these cases are shown to illustrate the method.

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