Background. There are currently 34 International Emergency Medicine (IEM) fellowship programs. Applicants and programs are increasing in number and diversity. Without a standardized application, applicants have a difficulty approaching programs in an informed and an organized method; a streamlined application system is necessary. Objectives. To measure fellows&#x2019; knowledge of their programs&#x2019; curricula prior to starting fellowship and to determine what percent of fellows and program directors would support a universal application system. Methods. A focus group of program directors, recent, and current fellows convened to determine the most important features of an IEM fellowship application process. A survey was administered electronically to a convenience sample of 78 participants from 34 programs. Respondents included fellowship directors, fellows, and recent graduates. Results. Most fellows (70&#x25;) did not know their program&#x2019;s curriculum prior to starting fellowship. The majority of program directors and fellows support a uniform application service (81&#x25; and 67&#x25;, resp.) and deadline (85&#x25; for both). A minority of program directors (35&#x25;) and fellows (30&#x25;) support a formal match. Conclusions. Program directors and fellows support a uniform application service and deadline, but not a formalized match. Forums for disseminating IEM fellowship information and for administering a uniform application service and deadline are currently in development to improve the process.

Gabrielle A. Jacquet

Jamil D. Bayram

William B. Ewen

Bhakti Hansoti

Steven Andescavage

David Price

Robert E. Suter

Alexander Vu

Improving Knowledge and Process for International Emergency Medicine Fellowship Applicants: A Call for a Uniform Application

Objectives. The optimal antidote for the treatment of ethylene glycol or methanol intoxication is not known. The objective of this systematic review is to describe all available data on the use of ethanol and fomepizole for methanol and ethylene glycol intoxication. Data Source. A systematic search of MEDLINE and EMBASE was conducted. 
Study Selection. Published studies involving the use of ethanol or fomepizole, or both, in adults who presented within 72 hours of toxic alcohol ingestion were included. Our search yielded a total of 145 studies for our analysis. There were no randomized controlled trials, and no head-to-head trials. Data Extraction. Variables were evaluated for all publications by one independent author using a standardized data collection form. Data Synthesis. 897 patients with toxic alcohol ingestion were identified. 720 (80.3&#x25;) were treated with ethanol (505 Me, 215 EG), 146 (16.3&#x25;) with fomepizole (81 Me, 65 EG), and 33 (3.7&#x25;) with both antidotes (18 Me, 15 EG). Mortality in patients treated with ethanol was 21.8&#x25; for Me and 18.1&#x25; for EG. In those administered fomepizole, mortality was 17.1&#x25; for Me and 4.1&#x25; for EG. Adverse events were uncommon. Conclusion. The data supporting the use of one antidote is inconclusive. Further investigation is warranted.

Lorri Beatty

Robert Green

Kirk Magee

Peter Zed

A Systematic Review of Ethanol and Fomepizole Use in Toxic Alcohol Ingestions

Mortality and morbidity from traumatic injury are twofold higher in rural compared to urban areas. Furthermore, the greater the distance a patient resides from an organized trauma system, the greater the likelihood of an adverse outcome. Delay in timely diagnosis and treatment contributes to this penalty, regardless of whether the inherent barriers are geographic, cultural, or socioeconomic. Since ultrasound is noninvasive, cost-effective, and portable, it is becoming increasingly useful for remote/underresourced (R/UR) settings to avoid lengthy patient travel to relatively inaccessible medical centers. Ultrasonography is a user-dependent, technical skill, and many, if not most, front-line care providers will not have this advanced training. This is particularly true if care is being provided by out-of-hospital, &#x201c;nontraditional&#x201d; providers. The human exploration of space has forced the utilization of information technology (IT) to allow remote experts to guide distant untrained care providers in point-of-care ultrasound to diagnose and manage both acute and chronic illness or injuries. This paradigm potentially brings advanced diagnostic imaging to any medical interaction in a setting with internet connectivity. This paper summarizes the current literature surrounding the development of teleultrasound as a transformational technology and its application to underresourced settings.

Linping Pian

Lawrence M. Gillman

Paul B. McBeth

Zhengwen Xiao

Chad G. Ball

Michael Blaivas

Douglas R. Hamilton

Andrew W. Kirkpatrick

Potential Use of Remote Telesonography as a Transformational Technology in Underresourced and/or Remote Settings

The aim of this study was to describe the characteristics of children and adolescents admitted to the psychiatric emergency department (ED) of a French public teaching hospital over a six-year study period (2001&#x2013;2006). Data for all episodes of care in the psychiatric ED from January 1, 2001, to December 31, 2006, delivered to adolescents aged less than 18 years were retrospectively analyzed. During the six-year study period, 335 episodes of care in the psychiatric ED were experienced by 264 different adolescents. They accounted for 2.0&#x25; of the 16,754 care episodes of the ED; 164 patients (62.1) were female and the average age was 16.5 (SD = 1.6). The neurotic, stress-related, and somatoform disorders were the most frequent (25.4&#x25;) and concerned mainly anxiety disorders (15.2&#x25;). The frequency of the absence of psychiatric diagnosis (22.7&#x25;) was high. A total of 48 children and adolescents (18.2&#x25;) benefited from more than one episode of care. Several factors were associated to a higher number of visits to the ED: substance use, schizophrenia, disorders of adult personality and behaviour, disorders occurring in childhood and adolescence, and dual diagnosis. In conclusion, mental health disorders in children and adolescents are a serious problem associated with several potentially modifiable factors.

Laurent Boyer

Jean-Marc Henry

Jean-Claude Samuelian

Raoul Belzeaux

Pascal Auquier

Christophe Lancon

David Da Fonseca

Mental Disorders among Children and Adolescents Admitted to a French Psychiatric Emergency Service

Background. Acromioclavicular (AC) joint dislocation is a common shoulder problem. However, information about the basic epidemiological features of this condition is scarce. The aim of this study is to analyze the epidemiology of isolated AC dislocation in an urban population. Materials and Methods. A retrospective database search was performed to identify all patients with an AC dislocation over a 5-year period. Gender, age, affected side and traumatic mechanism were taken into account. X-rays were reviewed by two of the authors and dislocations were classified according to the Rockwood&#x2019;s criteria. Results. A total of 108 patients, with a mean age of 37.5 years were diagnosed with AC dislocation. 105 (97.2&#x25;) had an isolated AC dislocation, and 3 (2.8&#x25;) were associated with a clavicle fracture. The estimated incidence was 1.8 per 10000 inhabitants per year and the male-female ratio was 8.5&#x2009;:&#x2009;1. 50.5&#x25; of all dislocations occurred in individuals between the ages of 20 and 39 years. The most common traumatic mechanism was sport injury and the most common type of dislocation was Rockwood type III. Conclusions. Age between 20 and 39 years and male sex represent significant demographic risk factors for AC dislocation.

Claudio Chillemi

Vincenzo Franceschini

Luca Dei Giudici

Ambra Alibardi

Francesco Salate Santone

Luis J. Ramos Alday

Marcello Osimani

Epidemiology of Isolated Acromioclavicular Joint Dislocation

Background. Vascular injuries often result in life threatening hemorrhage or limb loss. When they present with a single entry or exit wound, surgery is immediately indicated. With multiple injuries, however, imaging such as CTA is necessary for diagnosis and choice of treatment. Methods. For all combat-related vascular cases admitted to our medical center during the Lebanon wars in 1982 and 2006, we compiled and compared presenting signs and symptoms, means of diagnosis, treatments, and results. Results. 126 patients with vascular injuries were admitted (87 in 1982, 39 in 2006). 90&#x25; were male; mean age of 29 years (range 20&#x2013;53). All injuries were accompanied by insult to soft tissue, bones, and viscera. 75&#x25; presented with injury to arteries in the extremities. 75&#x25; of these patients presented with limb ischemia, and 25&#x25; sustained massive blood loss. Treatments included venous interposition graft, end-to-end anastomosis, venous patch, endovascular technique (only in 2006), and ligation/observation. Complications included thrombosis and wound infections. Mortality and amputations occurred only in 1982, and this may be attributed to the use of imaging, advanced technique, and shorter average time from injury to hospital (7 hours). Conclusions. We recommend CTA as the first line modality for diagnosis of vascular injuries, as its liberal use allowed for early and appropriate treatment. Treatment outcomes improved with fast and effective resuscitation, liberal use of tourniquets and fasciotomies, and meticulous treatment by a multidisciplinary team.

Samy S. Nitecki

Tony Karram

Amos Ofer

Ahuva Engel

Aaron Hoffman

Management of Combat Vascular Injuries Using Modern Imaging: Are We Getting Better?

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Emergency Medicine International publishes original research articles and&nbsp;review articles&nbsp;related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care and wound care

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Emergency Medicine International publishes original research articles and review articles related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care and wound care

Emergency Medicine International