Neuronal nicotinic acetylcholine receptors (nAChRs) are the primary binding sites for nicotine within the brain. Using alpha(α)2 nAChR subunit-null mutant mice, the current study evaluates whether the absence of this gene product during mecamylamine-precipitated nicotine withdrawal eliminates neuronal activity within selective midbrain and limbic brain regions, as determined by the expression of the immediate early gene, cfos. Our results demonstrate that nicotine withdrawal enhances neuronal activity within the interpeduncular nucleus and dorsal hippocampus, which is absent in mice null for α2-containing nAChRs. In contrast, we observe that α2-null mutant mice exhibit a suppression of neuronal activity in the dentate gyrus in mice undergoing nicotine withdrawal. Interestingly, α2-null mutant mice display potentiated neuronal activity specifically within the stratum lacunosum moleculare layer of the hippocampus, independent of nicotine withdrawal. Overall, our findings demonstrate that α2-null mutant mice have altered cfos expression in distinct populations of neurons within selective midbrain and limbic brain structures that mediate baseline and nicotine withdrawal-induced neuronal activity.

The use of bedside ultrasound in the emergency setting has rapidly become the standard of care for detecting various pathologies. It has become essential for Emergency physicians to be proficient in the clinical application of bedside ultrasonography (US). Challenger's EM Ultrasound is a CD-ROM course designed to teach the basic techniques, capabilities, and interpretations of emergency US to emergency and acute care physicians. Author John Kendall, md, facep, is currently the Director of Emergency Ultrasound at Denver Health Medical Center. Dr. Kendall and co-authors Stahmer and Deutchman effectively use clear audio, video, and still US imagery, multimedia, and three-dimensional animations to teach the emergency US examinations. The third edition of Challenger EM Ultrasound covers many valuable topics using over 500 informative screens. This CD-ROM course is well-organized into 10 chapters that average about 50 screens each, with additional images and case studies that lead to many more optional screens. Chapters cover topics such as right upper quadrant, aorta, renal, and cardiac examinations. In this edition, chapters on “Lower Extremity Venous Exam” and “Sonographic Guidance of Procedures” were added along with significant enhancements to the “Trauma Exam” and “Pelvic Exam” chapters. Specific examples of topics covered include abdominal trauma, cardiac tamponade, and the use of color Doppler. Each provides up-to-date sonographic instruction in real time on key concepts essential to examinations in the acute setting. Each chapter is well taught with ample clear images—allowing for inexperienced physicians to confidently acquire skills while simultaneously providing information in depth enough to serve as a review for more experienced sonographers. Users of this program will gain understanding of the physics and mechanics of generating quality images and interpreting patient pathology. A user-friendly interface facilitates learning in diverse manners. The logically arranged search engine and other navigational tools allow you to quickly browse, review, highlight, or annotate individual screens. High-quality sonographic videos and images have zoom capabilities and concise labeling that enhance audio descriptions. Additionally, a variety of sonographic pathologies are shown in galleries that allow for learning at your own pace. Slides are designed to allow users to customize and prepare their own course-based presentations. An added bonus is the ability to earn up to 20.0 American Medical Association Category 1 Continuing Medical Education credits free by taking a 100-question quiz at the end of the course and mailing your results to Challenger. The overall material is consistently well organized, with abundant examples and interactive media. This course is a valuable learning tool for all physicians desiring to use US effectively in the acute setting. Physicians and residents will enhance their armamentarium through the use of this course.

Isolated angioedema of the uvula, or Quincke's disease, is a rare condition that can cause respiratory compromise. Although typically self-limiting, episodes of angioedema may require prompt therapy to prevent obstruction of the proximal airway. In this case report we review the appropriate steps for initial evaluation of patients with suspected angioedema, primary etiologies, and appropriate initial therapy.

This article discusses the benefits of integrating point-of-care diagnostic ultrasound into the four-year medical school curriculum. Handheld ultrasound devices have been used to teach medical students at the University of California (UC), Irvine, since August 2010, and the article explains how the use of this inexpensive, safe, and noninvasive tool enhances the ability of a physician conducting a standard physical exam to confirm suspected findings and uncover other suspected pathology at a reasonable cost. The authors describe the ultrasound curriculum at UC Irvine and the process of its implementation. In the appendix to the article, the authors describe the specific diagnostic benefits of using a handheld ultrasound device for each element of the Stanford 25 physical exam. Their ultrasound-enhanced approach to the physical exam is referred to as the "UCI 30." They make recommendations for how and when to integrate ultrasound into the physical exam. The article points out that early training of medical students in the use of ultrasound can avoid the diagnostic problems of ultrasound by maximizing students' comfort and ability to obtain accurate ultrasound images for diagnostic and procedural purposes.

Background: Differences in productivity between off-service residents rotating in the emergency department (ED) and their emergency medicine (EM) resident counterparts have never been directly quantified. Objectives: We sought to quantify the difference between off-service residents rotating in the ED and their EM resident counterparts.We also sought to find whether shift cards could be used to increase the productivity of off-service residents rotating in the ED. Methods: This is a prospective cohort study conducted at an urban, tertiary, Level I trauma center.We implemented the use of shift cards for off-service residents during their EM rotation. Completion of the shift card involved recording patients seen and their dispositions, procedures done, and documenting a learned bedside teaching point from their shift that day. Productivity was measured in terms of patients seen per hour (PPH) and relative value units per hour (RVU/h). Results: Off-service residents showed a productivity of 0.529 PPH (95% confidence interval [CI] 0.493-0.566) and 1.40 RVU/h (95% CI 1.28-1.53) prior to implementation of shift cards. With the introduction of shift cards, productivity increased to 0.623 PPH (95% CI 0.584-0.663, p = 0.001) and 1.77 RVU/ h (95% CI 1.64-1.91, p = 0.001). In comparison, first year EM resident productivity was 0.970 PPH (95% CI 0.918- 1.02) and 3.01 RVU/h (95% CI 2.83-3.19). Conclusions: Shift cards can be used to foster motivation for off-service residents rotating in the ED, and is a simple and costeffective method to improve system-based practices and utilization of resources.