Annals of emergency medicine
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Randomized Controlled Trial Clinical Trial
Use of portable ultrasound to assist urine collection by suprapubic aspiration.
To determine whether portable ultrasound can improve the success rate of suprapubic aspiration (SPA). ⋯ Portable ultrasound can significantly improve the success rate of SPA and limit nonproductive attempts at SPA.
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To evaluate whether the capillary refill test can correctly differentiate between hypovolemic and euvolemic emergency department patients. ⋯ Capillary refill does not appear to be a useful test for detecting mild-to-moderate hypovolemia in adults.
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To describe the clinical and ECG features of cocaine abusers evaluated in the emergency department and admitted to the medical coronary care unit with chest pain consistent with myocardial ischemia. ⋯ Our findings confirm a small but significant incidence of myocardial infarction in cocaine abusers presenting to the ED with chest pain. The chronicity of cocaine abuse, the persistence of ECG abnormalities, and the variable temporal relationship of chest pain to cocaine abuse suggest possible chronic myocardial changes as etiologies of ischemia.
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To examine the variability and define the normal ranges of orthostatic vital signs in an emergency department population. ⋯ The data from this study indicate that there is a wider than expected variation in orthostatic vital signs among presumed euvolemic ED patients.
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There are currently 20 autonomous departments of emergency medicine in United States medical schools. EDs seeking autonomous status should institute a faculty development program to channel faculty energy into worthwhile research projects; establish protected time for clinical faculty to increase research productivity; develop expertise to compete for extramural funding; initiate an intramural research program so that faculty can learn the basics of grantsmanship; teach health care issues in ambulatory medicine; become involved in interdisciplinary teaching programs and curriculum development; maintain the present faculty commitment to 24-hour attending coverage; and develop university-based programs that originate from the ED. Program directors should establish liaisons with the medical school dean to acquaint him with the advantages of an autonomous department of emergency medicine; attempt to assess other relationships within the medical school to determine support for emergency medicine and to uncover and address opposition to autonomous departmental status; attempt to serve on medical school committees to meet other faculty, solve problems with them and develop trusting relationships; and develop broad-based support for autonomous departmental status both within and outside of the university. By devising and following a deliberate approach to attaining departmental status, emergency medicine will be assured of continued growth in the important decade ahead.