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Background: Graduates of Emergency Medicine (EM) residency training programs are expected to be proficient in ultrasound. However, best practices for teaching residents ultrasonography has yet to be determined., Study Objectives: To determine if a dedicated Emergency Department (ED) ultrasound rotation objectively improves residents' EM ultrasound knowledge, interpretation accuracy, and clinical decision-making based on ultrasound findings., Methods: EM residents completing a required ED-based ultrasound rotation were prospectively studied. Before the start of the rotation, each resident completed a 20-question pre-test. At the end of the rotation, residents completed a 20-question post-test. Both tests covered physics, trauma (focused assessment with sonography for trauma), first-trimester pregnancy, aorta, biliary, echocardiography, and vascular sonography, using a multiple-choice format. In both tests, ultrasound images were included in 11 of the 20 questions. The questions were divided into three categories: knowledge-based (8 questions), interpretation (9 questions), and clinical decision-making (3 questions), for both tests. Scores on pre-tests and post-tests were compared using a Wilcoxon signed-rank test., Results: During the 2-year study period, 21 residents completed the rotation. The median pre-test score was 16 (interquartile range [IQR] 14.5-17), compared to a median post-test score of 19 (IQR 18-20), p < 0.001., Conclusions: A dedicated ED ultrasound rotation improves residents' EM ultrasound knowledge and interpretation accuracy based on ultrasound findings, as measured by improvement on ultrasound test scores., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Few studies have evaluated the effect of Emergency Department (ED) overcrowding on resident education., Objectives: To determine the impact of ED overcrowding on Emergency Medicine (EM) resident education., Materials and Methods: A prospective cross-sectional study was performed from March to May 2009. Second- and third-year EM residents, blinded to the research objective, completed a questionnaire at the end of each shift. Residents were asked to evaluate the educational quality of each shift using a 10-point Likert scale. Number of patients seen and procedures completed were recorded. Responses were divided into ED overcrowding (group O) and non-ED overcrowding (group N) groups. ED overcrowding was defined as >2 h of ambulance diversion per shift. Questionnaire responses were compared using Mann-Whitney U tests. Number of patients and procedures were compared using unpaired T-tests., Results: During the study period, 125 questionnaires were completed; 54 in group O and 71 in group N. For group O, the median educational value score was 8 (interquartile range [IQR] 7-10), compared to 8 (IQR 8-10) for group N (p = 0.24). Mean number of patients seen in group O was 12.3 (95% confidence interval [CI] 11.4-13.2), compared to 13.9 (95% CI 12.7-15) in group N (p = 0.034). In group O, mean number of procedures was 0.9 (95% CI 0.6-1.2), compared to 1.3 (95% CI 1-1.6) in group N (p = 0.047)., Conclusions: During overcrowding, EM residents saw fewer patients and performed fewer procedures. However, there was no significant difference in resident perception of educational value during times of overcrowding vs. non-overcrowding., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Alcohol use increases injury risk and severity. However, few studies have evaluated the ability of emergency physicians (EPs) to accurately determine sobriety., Objectives: To determine the predictive value of clinical sobriety assessment by EPs in blunt trauma patients with acute alcohol use., Materials and Methods: Blunt trauma patients, aged 18-65 years with suspected acute alcohol use, were prospectively enrolled in the study. EPs assessed study subjects before sample collection for blood alcohol level (BAL) and urine drug screen measurement. Alcohol exposure was considered significant if BAL was ≥ 80 mg/dL. Sobriety (non-significant alcohol exposure) was defined as a BAL < 80 mg/dL. EP sobriety assessment was compared to measured BAL and predictive values were calculated. Agreement on significance of alcohol exposure occurred if EP-estimated BAL > 80 mg/dL agreed with measured BAL > 80 mg/dL, or estimated BAL < 80 mg/dL agreed with measured BAL < 80 mg/dL. Chi-squared analysis was used to compare the proportion of correct physician assessments among patients with sobriety and those with significant alcohol exposure., Results: Of 158 enrolled subjects, 153 completed clinical assessment. EP assessment had a predictive value of 83% (95% confidence interval [CI] 77-90%) for significant alcohol exposure and 69% (95% CI 60-78%) for sobriety. Agreement on the significance of alcohol exposure was 82% (125/153; 95% CI 76-88%). EPs identified 32% (11/34; 95% CI 17-48%) of sober patients, but identified 96% (114/119; 95% CI 92-99%) of patients with significant alcohol exposure. EP assessment was significantly less accurate in identifying sober patients (p < 0.01)., Conclusions: Emergency physicians identified significant recent alcohol exposure in blunt trauma patients 96% of the time. However, clinical assessment by EPs in blunt trauma patients with recent alcohol use had only moderate predictive value for significant alcohol exposure. Sober patients were frequently misidentified as having significant alcohol exposure., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: The utility of ultrasound-guided peripheral intravenous access (USGPIV) has been well described. However, few studies have investigated USGPIV techniques., Objectives: To describe a modified Seldinger technique for USGPIV., Methods: Emergency Department patients with difficult i.v. access (three or more failed landmark attempts) were prospectively enrolled. USGPIV was attempted using modified Seldinger technique. A 20-gauge, 3.81-cm catheter with integral wire was used for all procedures. The basilic vein was identified using a high-frequency linear probe (5-10 MHz). The needle was inserted into the vein with dynamic guidance in short axis, and the cannula was advanced over a wire. Time from skin puncture to catheter insertion, number of needle sticks, and overall procedure time were recorded., Results: Twenty-five patients were enrolled and underwent USGPIV; success rate was 96% (24/25). The mean number of needle sticks was 1.32 (95% confidence interval 1.12-1.52). Median time from skin to catheter insertion was 68 s (+/- SD 70.5 s). Median total procedure time was 7 min (420 s) (+/- SD 5.23 min)., Conclusions: Modified Seldinger technique is an effective method of USGPIV and is worthy of a prospective comparison with non-Seldinger technique., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Emergency Medicine (EM) residency program web sites are an important tool that programs use to attract applicants. However, there are only a few studies examining the aspects of a program's web site that are most important to EM applicants. We conducted a cross-sectional study of 142 prospective residency applicants interviewing for an EM position at one of three EM residency programs for the 2003 match. The survey demonstrated that almost all applicants researched EM programs online. The majority (71%) identified geographic location as the most important factor in applying to a specific program. Approximately 40% considered an easily navigated web site as very/moderately important to their application decision-making process. Rotation schedule was also important in applicant decision-making. The Internet is a significant source of information to the majority of applicants in EM. Online information from programs' web sites, although not as significant as geography, influences an applicant's choice of where to apply for a residency position. An easily navigated, complete web site may improve the recruitment of candidates to EM residency programs.

Bedside ultrasound has become an important diagnostic tool for emergency physicians. Clinical investigators have demonstrated that evaluating soft tissue infections with ultrasound is useful for the detection of subcutaneous abscesses. Bedside ultrasound of a preputial cavity abscess in the Emergency Department has not been previously described in the English medical literature. A preputial cavity abscess, a rare complication of balanoposthitis, is a collection of pus between the foreskin and the distal penis. This case report describes the use of ultrasound to diagnose a penile abscess and reviews the related literature.