Annals of emergency medicine
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Early electrical therapy for patients with ventricular fibrillation and ventricular tachycardia can result in a significant increase of lives saved from sudden cardiac death. Rapid defibrillation has become a goal of prehospital and emergency department cardiac care, and the use of automatic external defibrillators can aid in reaching this objective. The history, mechanics, and implications of automatic external defibrillators are presented.
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An unusual case of acute extra-articular patellar dislocation is described in which the patella dislocated laterally, rotated 90 degrees about its vertical axis, and wedged against the lateral femoral condyle. Closed reduction in the emergency department failed and operative intervention was required.
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The emergency department is the focal point for many social ills, not the least of which is substance abuse. We conducted a study to determine to what degree substance abuse education is taught in emergency medicine residency training programs. A set of educational objectives was developed by a task force composed of representatives of the American College of Emergency Physicians, the Society of Teachers of Emergency Medicine, and the University Association for Emergency Medicine. ⋯ The data revealed that such topics as narcotic prescription law, patterns of risk, and issues pertaining to substance abuse by physicians were covered by fewer than half of the programs responding. Respondents were generally satisfied with the adequacy of training of residents and faculty in the area of substance abuse; however, they were dissatisfied with the adequacy of available training materials. Recommendations for changes in graduate curriculum as well as avenues for further research are provided.
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Initial therapy in acutely ill septic patients is necessarily empiric. Although a specific etiologic infectious diagnosis is rarely made in an acute situation, a treatment decision must be made and must be developed from history, physical examination, and minimal laboratory and roentgen studies. Three life-threatening syndromes are discussed: febrile-neutropenic patients with cancer, immunosuppressed patients with fever and lung infiltrates, and patients with acute community-acquired meningitis.
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Emergency physicians often encounter clinical situations in which medical resuscitation may not coincide with patient expectations. These situations present complicated medical, legal, and ethical dilemmas. The history of the patient's right to refuse treatment as it applies to resuscitative medical care is reviewed. Medical recognition of patient autonomy and legal precedents affirming it are discussed, as are the various types of advance directives, including the living will and durable power of attorney and their clinical uses.