Annals of emergency medicine
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Patients generally have the right to refuse medical care, a right based on certain legal precedents. Its application in the emergency department leads to difficult decisions for the emergency physician. ⋯ These include psychiatric patients, narcotics abusers, alcoholics, "street people," and some patients with migraine headaches. They represent some of our most difficult decisions because the treatment required for the patient is often clear and the patient refuses care or demands inappropriate care.
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Patients presenting to the emergency department with chest discomfort are a difficult problem for emergency physicians. Nearly 50% of patients with acute myocardial infarction (AMI) will initially have nondiagnostic ECGs on ED presentation. The purpose of this study was to determine if patients with AMI having nondiagnostic ECGs could be identified using new immunochemical assays for serial CK-MB sampling in the ED. ⋯ Immunochemical CK-MB methods allowed rapid, sensitive detection of AMI in the ED. Early detection of AMI offers many potential advantages to the emergency physician. Early detection of AMI, while the patient is in the ED, could direct disposition of this potentially unstable patient to an intensive care setting. Such information may prevent the ED discharge of patients with AMI having nondiagnostic ECGs. The diagnosis of AMI within a six-hour period after symptom onset may allow thrombolytic therapy to be given to patients with AMI not having diagnostic ECGs. This study served as a pilot trial for a multicenter study of the Emergency Medicine Cardiac Research Group, which is currently ongoing.
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To analyze prognostic indicators and the outcome of resuscitation in submersion victims (drowning and near drowning). ⋯ This study shows that no indicator at the rescue site and in the hospital is absolutely reliable with respect to death or survival.
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To determine whether the Injury Severity Score (ISS) correlates with the resource requirements of severely injured patients by studying the association of the ISS with three major interventions (fluid resuscitation, invasive central nervous system monitoring, and acute operative repair) trauma centers routinely provide severely injured patients. ⋯ The ISS may not be completely correlated with the resource requirements of injured patients and should not be used as the sole means by which to define major injury.
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Randomized Controlled Trial Comparative Study Clinical Trial
Buffered versus plain lidocaine as a local anesthetic for simple laceration repair.
Buffered lidocaine was compared with plain lidocaine as a local anesthetic for simple lacerations. ⋯ Buffered lidocaine is preferable to plain lidocaine as a local anesthetic agent for the repair of simple lacerations.