Abstract. Objective: To determine the safety and effectiveness of intravenous (IV) etomidate for the sedation of patients undergoing painful procedures in the emergency department (ED). Methods: A twopart feasibility study for ED patients receiving IV etomidate for painful ED procedures was undertaken. In the initial phase, a retrospective series of patients receiving etomidate for ED procedural sedation was considered. This phase served as the basis for a descriptive, prospective feasibility study of consecutive ED patients. During the second phase, patients were evaluated for complications related to IV etomidate sedation or the procedure performed. Immediately following the procedure, the physician was asked to complete a data collection sheet documenting the patient's etomidate dose, the number of doses required to complete the procedure, the analgesic used, the complications of the procedure, and the patient's procedural recall. Results: Intravenous etomidate was administered to nine patients during the initial study phase and 51 during the prospective, descriptive phase. Indications for sedation included dislocation reduction (25), cardioversion (7), fracture reduction (20), abscess incision and drainage (4), foreign body removal (3), and chest thoracostomy (1). Physicians used 0.1-mg/kg IV bolus etomidate. A mean of 1.6 doses of etomidate was used to complete procedures (range 1-3 doses). Of the 60 patients in both study groups, 59 (98%) achieved adequate sedation by physician's assessment. Procedural success was documented for 56 patients (93%). There were 12 complications reported: oxygen desaturation below 90% (5), myoclonus (4), vomiting (1), pain with injection (1), and a brief bradycardic episode (1). No patient required assistance with ventilation or endotracheal intubation. Conclusions: Intravenous etomidate can be administered safely and effectively to provide appropriate conscious sedation for short, painful ED procedures. Key words: etomidate; sedation; conscious sedation; emergency department procedures. ACA-DEMIC EMERGENCY MEDICINE 2001; 8:13-18 E TOMIDATE is an imidazole hypnotic agent commonly used for emergent intravenous (IV) induction preceding endotracheal intubation. Its use in this setting continues to gain favor among emergency physicians (EPs), who value its rapid onset of action, short duration of sedation, and minimal respiratory and hemodynamic effects. A recent survey evaluating intubation practices at U.S. academic emergency departments (EDs) documented etomidate as the preferred induction agent in 23% of surveyed EDs. Patients who undergo painful procedures in the ED often require sedation and muscle relaxation for short periods. The strengths that are cited for the use of etomidate as an induction agent would infer value as a sedative agent. However, to the best of our knowledge, etomidate has received little attention within the context of procedural sedation. [2][3][4][5][6] In the setting of emergent procedural sedation, the shorter duration of action of etomidate relat...

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An evolutionary proposal is outlined for Ellis' genetic postulate for irrational thinking in the human species. Evolutionary bases are explored for demanding and grandiose thought constructs (cognitive products) which are either learned and/or created during one's lifetime due to a genetic potential to think irrationally (cognitive processes). Demandingness and grandiosity are emphasized because they serve as primary cognitive tendencies in rational-emotive therapy (RET) which appear to drive most other irrational belief systems. The main postulate is that a genetic potential to think irrationally has evolved and is genetically coded in humans because it facilitated adaptive behavioral and emotional responses as a means of securing critical advantages in early childhood development, increased reproductive success, and basic survival. Sociobiological and Darwinian principles are applied to support this hypothesis.Throughout the past three decades of rational-emotive therapy (RET), Ellis has asserted that 1) most humans have a strong tendency to think irrationally and to behave in self-defeating ways, and 2) this tendency derives in part from a genetic potential which transcends environmental and cultural differences (Ellis, 1962(Ellis, , 1976(Ellis, , 1980(Ellis, , 1987. Often referred to as a biological basis or innate tendency, Ellis asserts that a genetic potential for irrational thinking exists in humans which serves as a major cause for behavioral and emotional disturbance and general life unhappiness. Basically stated, the postulate assumes that Journal of Rational-Emotive and Cognitive-Behavior Therapy humans have a natural (i.e., genetic) tendency to think rationally and irrationally, and that irrational cognitions are quite easily learned and/or created throughout one's entire life span. Thus, in order to lead a psychologically healthy and happy life, Ellis (1973, 1988) professes that most humans must exert vigorous and persistent effort in identifying, counterattacking, and modifying irrational beliefs and illogical thought constructs. However, in the RET literature, although there are numerous descriptions and accounts of what irrational tendencies are and how they manifest and operate, explanations as to why such tendencies may be genetically programed into the human species in the first place are virtually nonexistent. In agreement with Dryden (1990), Ellis' genetic postulate is a fundamental aspect of RET which has received sparse theoretical attention.The main purpose of the present paper is to explore the possibility that an evolutionary basis may exist for Ellis' genetic postulate for irrational thinking in humans. Specifically, this paper will explore the possibility that a genetic potential to think irrationally (as well as rationally) may have differing degrees of evolutionary rootedness and may thus be genetically based in the human species. Hypothesized evolutionary values (e.g., adaptive, reproductive, and survival advantages) are explored for certain types of irrational thinking...

Reviews of treatment strategies for students with emotional disturbance (ED) have noted that most studies (a) do not involve entire classes or groups of classes, (b) are not conducted in public schools, and (c) do not report data for an entire 10-month school year (September to June). This study applied goal setting (GS), responsibility training (RT), and fixed ratio reinforcement (FRR) to three classes of students with ED in a public elementary school from September to June. GS included daily, weekly, and monthly goals for behavior and work earnings mints). RT included a level system with different reinforcers and privileges for each level, and nonisolated time out with problem solving. FRR included reward contingencies for behavior and work earnings. Data for 10 months indicated that (a) goals were consistently earned at high levels, (b) the percentage of students attaining higher RT levels progressively increased, and (c) time-out levels progressively decreased, with yearend spikes below prior peak levels. Findings supported the use of GS, RT, and FRR for students with ED in public school to encourage appropriate behavior and work effort over 10 months. Method limitations and research implications are discussed.The author is grateful for the dedication and assistance of the BOCES staff involved in this project: Nancy

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The present investigation provided a projective assessment of the effects of Freudian symbolism in advertising. 48 male and 48 female undergraduates served as subjects. Liquor advertisements containing phallic and vaginal symbols and advertisements lacking such symbols were presented to the experimental and control groups, respectively. Subjects were then administered a standard Thematic Apperception Test (TAT). All subjects believed that they were participating in a study of memory and retrieval. Clark's scoring system for TAT sexuality content was used to assess the effects of both sets of advertisements. Analyses of variance indicated group differences for two of the three dependent TAT sexuality variables. Results supported the psychoanalytic assumption that genital symbols promote sexual arousal without an observer's conscious awareness. Specifically, the effects of the utilization of Freudian symbolism as a manipulative variable in advertising were demonstrated.

Freudian sexual symbolism theory and research are discussed and an empirical test of that theory is presented. Following up the 1985 findings of Ruth and Mosatche, an experimental investigation measured the effects of sexual symbolism in advertising on self-reported purchasing tendencies. A within-subjects design exposed 42 male and 57 female undergraduates to liquor advertisements containing genital symbolism and to liquor advertisements lacking such symbolism. Liquors presented in advertisements were matched on purchasing desirability prior to the experimental manipulation with a separate undergraduate sample to balance for actual preference for liquor. Dependent t tests consistently indicated stronger purchasing tendencies for symbolic than for nonsymbolic advertisements. Data from these undergraduates supported the psychoanalytic postulate that sexual symbolism unconsciously motivates an observer toward goal-directed behavior. Specifically, psychoanalytic theory would suggest that genital symbolism motivates consumers' behavior via the sexual arousal based on an unconscious recognition of the male and female genitalia and the act of sexual intercourse.

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