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In this model of FPI and uncontrolled hemorrhage, early aggressive resuscitation, which is currently recommended, resulted in increased hemorrhage and failure to optimize cerebrovascular parameters. In addition, a 60-minute period of moderate hypotension (MAP = 60 mm Hg) was well tolerated and did not compromise cerebrovascular hemodynamics, as evidenced by physiological parameters that remained within the limits of cerebral autoregulation.

Abstract. Objective: To evaluate the impact of environmental factors on emergency medicine (EM) resident career choice. Methods: Program directors of all U.S. EM residencies were surveyed in November 1997. A 22-item questionnaire assessed resources allocated to research, fellowship availability, academic productivity of faculty and residents, and career choices of residency graduates. Results: The response rate was 83%. The program director (mean Ϯ SD) estimates of resident career choice were as follows: 27.8 Ϯ 19.1% pursued academic positions with emphasis on teaching, 5.4 Ϯ 9.8% pursued academic positions with emphasis on research, and 66.8 Ϯ 23.1%, pursued private practice positions. In addition, 5.70 Ϯ 6.13% of the residency graduates were estimated to seek fellowship training. Univariate analyses demonstrated that increasing departmental funding for research, having substantial resource availability (defined as having at least two of the following: dedicated laboratory space; support for a laboratory research technician/assistant, a clinical research nurse or study coordinator, a statistician, or an assistant with a PhD degree), a greater number of peer-reviewed publications by residents (r = 0.22; p = 0.08), and a greater number of peer-reviewed publications by faculty (r = 0.26; p = 0.04) positively correlated with the percentage of graduates who pursue academic research careers. Using multiple regression, however, increasing intramural funding and the presence of substantial resource availability were the only variables predictive of resident pursuit of an academic research career. Conclusion: Modification of the EM training environment may influence the career choices of graduates. Specifically, greater commitment of departmental funds and support of resources for research may enhance the likelihood of a trainee's choosing an academic research career. Key words: academic emergency medicine; career choice; environmental factors; residents. ACADEMIC EMERGENCY MEDICINE 1999; 6:262 -270 T HE DRAMATIC growth of the specialty of emergency medicine (EM) during the past 25 years is a result of the widely recognized need for improved care of ED patients. Thus, the specialty has developed with a strong clinical orientation and a proportionately smaller focus on academics and research. This has generally been the case even at those institutions that have supported EM residency programs. A 1994 study by Gallagher et al.1 demonstrated that only 30% of EM residency programs were closely affiliated with an academic If EM is to fully develop its academic potential, it will be necessary to shift from a predominantly clinical focus to a balance between clinical and academic missions. There is evidence that this process has already begun. In the past six years, 32 new academic departments and 36 new residency programs have been established in EM. Thirtyeight percent of the newly established departments and 30% of the newly established residency programs are at research-intensive academic medical centers as defined by t...

In this model of TBI, acute EtOH intoxication in the presence of HS potentiates the physiological and metabolic alterations that may contribute to secondary brain injury.

Drugs contributing to overdose deaths are listed on death certificates, but their validity is rarely studied. To assess the accuracy of "morphine" and "codeine" listings on death certificates for unintentional overdose deaths in Allegheny County, PA, investigative and laboratory reports were reviewed. Deaths were reclassified as heroin-related if documentation showed 6-monoacetylmorphine in blood or urine, "stamp bags" or drug paraphernalia at scene, history of heroin use, or track marks. Deaths were considered morphine-related if notes indicated morphine use, prescription, or morphine at scene, or codeine-related if the codeine blood level exceeded morphine. Of 112 deaths with morphine but not heroin listed on the death certificate, 74 met heroin criteria and 21 morphine criteria. Of 20 deaths with both morphine and heroin listed, only one met morphine criteria. Of 34 deaths with codeine listed, only five were attributed to codeine. Consideration of patient history, death scene evidence, and expanded toxicology testing may improve the accuracy of death certificate drug listings.