Emergency neurological care of strokes and bleeds

Ischemic stroke and brain hemorrhage are common and challenging problems faced by emergency physicians. In this article, important details in the diagnosis and clinical management of these neurological emergencies are presented with the following goals: 1) To provide a more comprehensive understanding of the approach to the identification and management of patients who have sustained ischemic and hemorrhagic strokes; 2) to explain the importance and application of commonly used national stroke scoring and outcome scales; 3) to improve the ability to recognize important aspects in the approach and comprehensive treatment of ruptured and unruptured intracranial aneurysms; and 4) to demonstrate the difficulties in the neurological, neurosurgical, and endovascular treatment of these catastrophic diseases.

Imaging in acute stroke

Imaging in the acute setting of suspected stroke is an important topic to all emergency physicians, neurologists, neurosurgeons and neuroradiologist. When it comes to imaging, the American College of Radiology (ACR) continually updates its guidelines for imaging pathways through the ACR Appropriateness Criteria.1,2 This article is a general review of the imaging modalities currently used to assess and help guide the treatment of strokes.

Medical students' occupational exposures to potentially infectious agents

PURPOSE

To describe the epidemiology of occupational exposures sustained by third-year medical students at a state university medical school, and identify associated factors that may be modified to decrease exposure risk.

METHOD

The cohort consisted of all third-year students after completion of each third-year clerkship rotation. At the end of each clinical rotation (a total of six for each student during the year), questionnaires were distributed to the 119 students. Demographic information, type of exposure, rotation, circumstances, compliance with CDC universal precaution recommendations, and post-exposure prophylaxis (PEP) were assessed. Inferential statistics were used to describe the results.

RESULTS

Of a total of 714 questionnaires, 644 (90.2%) were returned. Of the 644, there were 60 reports (9.3%) of one or more exposures to blood or body fluids. The incidence of exposure varied with clerkship: 23 on surgery, 18 on obstetrics-gynecology, eight on outpatient medicine, four on psychiatry, four on pediatrics, and three on internal medicine. Thirty-six (60%) were skin or mucous membrane exposures to blood, body fluid, or respiratory secretions, and 24 (40%) were percutaneous exposure by instrument. Ten (17%) of the exposures resulted in official incident reports and seven accepted PEP recommendations.

CONCLUSION

Medical students are often exposed to body fluids during their initial clerkship year, primarily in their surgical rotations. Additional education on these rotations may be useful in reducing exposure risk.