Academic emergency medicine: past, present, and future trends

This plenary sessions reviews the historical evolution and present status of academic emergency medicine in the United States, with predictions for future developments in the specialty.     

Hand carried echocardiography in the critical care setting

Miniaturized echocardiography units known as hand carried ultrasound (HCU) now exist with features similar to those used for standard echocardiography. The small size and low cost of these units may lead to increased availability of echocardiography to be performed by all physicians taking care of critically ill patients. Use of HCU by critical care physicians may allow for improved bedside diagnosis with improved accuracy over physical examination. Studies comparing HCU with standard echocardiography in the critical care setting have reported that HCU is limited by decreased image quality and that it may miss important diagnoses even when used by experienced sonographers and echocardiographers. Despite its limitations, however, HCU can often answer important clinical questions in the critically ill. This review explores the current literature on the use of HCU in the critical care setting, discusses the limitations of HCU, and examines the costs of implementing this new technology.     

Effectiveness of a critical care nursing course: preparing students for practice in critical care

Experiences in critical care in an undergraduate program provide an opportunity for students to develop beginning knowledge and skills for practice in this setting, gain exposure to the role of the nurse in critical care, and acquire competencies essential for care of any acutely ill patient regardless of health problem and setting. The purposes of this study were to (1) examine the acquisition of basic critical care nursing knowledge after completion of an undergraduate course in critical care, (2) compare the differences in learning between students who completed only the theory component of the course and those who completed both theory and clinical practice in critical care, (3) examine learner perceptions toward critical care nursing, and (4) examine the impact of the course on selection by new graduates of critical care as their practice specialty. A quasi-experimental pretest-posttest design was used with two experimental groups: lecture only and lecture and clinical practice, and a randomized control group. Subjects were 85 senior nursing students in a baccalaureate program in a large metropolitan area in the Midwest. Data were collected by using a demographic data sheet, the Basic Knowledge Assessment Tool (BKAT), the Perceptions of Critical Care Nursing Questionnaire (PCCNQ), and follow-up interviews of graduates who completed the course. Both experimental groups demonstrated a statistically significant increase in learning from pretest and posttest, as measured by the BKAT. There were no significant differences in BKAT scores between the lecture and lecture-clinical practice groups. Mean scores on the BKAT at posttest for the experimental groups, who participated in the course, were significantly higher than the control.(ABSTRACT TRUNCATED AT 250 WORDS)     

Infection control in pulmonary and critical care medicine

During the routine care of patients, pulmonary and critical care specialist may have significant exposure to respiratory infections and potentially infectious body fluids such as blood and pleural fluid. Bronchoscopy and intensive care services often require close contact with patients and the use of sharp devices required for intravascular catheterization. Rendering such care places physicians at risk for acquiring agents such as human immunodeficiency virus (HIV), hepatitis viruses, and Mycobacterium tuberculosis. As of December 1998, 188 cases of occupational transmission of HIV to health care workers (HCWs) in the United States have been reported to the Centers for Disease Control. Most documented cases of seroconversion involve percutaneous injury involving blood, with the greatest risks being associated with injury from a hollow-bore needle that has been in an infected patient's vein or artery. Because thousands of HIV-infected persons are unaware of their infection, HCWs must consider all patients to be infected with HIV and improve work practices accordingly. Nevertheless, elimination of all exposures is impossible, and postexposure prophylaxis with combination antiretroviral therapy is recommended for persons deemed a high risk of contracting HIV. Pulmonary specialists are at high risk of exposure to tuberculosis; proper precautions include isolation of patients with suspected tuberculosis and the use of DMF-HEPA respirator masks, especially while performing procedures like bronchoscopy. Contaminated bronchoscopes have been implicated in transmission and "pseudoinfection" of tuberculosis and nontuberculous mycobacteria, underscoring the need for rigorous cleaning and disinfection practices.