Annals of emergency medicine
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Comparative Study
Emergency department interpretation of electrocardiograms.
To determine the concordance of emergency physicians' and cardiologists' interpretations of abnormal ECGs. ⋯ Although the overall discordance was more than 50%, most ED misinterpretations were determined unlikely to have clinical significance. Additional studies are needed to identify variables that contribute to ED ECG misinterpretation and to develop methods to resolve these difficulties.
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Multicenter Study Clinical Trial
Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: serial CK-MB sampling in the emergency department. The Emergency Medicine Cardiac Research Group.
This study tested the hypothesis that serial creatine phosphokinase (CK)-MB sampling in the emergency department can identify acute myocardial infarction (AMI) in patients presenting to the ED with chest pain and nondiagnostic ECGs. ⋯ Serial CK-MB determination in the ED can help identify AMI patients with initial nondiagnostic ECGs. Use of serial CK-MB analysis may facilitate optimal in-hospital disposition and help guide therapeutic interventions in patients with suspected AMI despite a nondiagnostic ECG.
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Multicenter Study Clinical Trial
Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device.
To evaluate continuous, semiquantitative end-tidal carbon dioxide (ETCO2) monitoring in the prehospital and emergency department setting for confirming proper endotracheal tube placement and assessing prognosis and blood flow during CPR. ⋯ The colorimetric ETCO2 device is highly accurate for confirming endotracheal tube position in nonarrest patients. In cardiac arrest patients, a reading signifying more than 0.5% ETCO2 confirms correct endotracheal tube placement, while a value signifying less than 0.5% ETCO2 during resuscitation suggests that something is wrong (eg. esophageal intubation, inadequate circulatory flow, prolonged down-time interval, hypothermia, or significant ventilation/perfusion mismatch).
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Randomized Controlled Trial Clinical Trial
Preformatted charts improve documentation in the emergency department.
To determine if the use of programmed charts with complaint-specific entry criteria results in improved documentation of patient encounters and better clinical outcome. ⋯ Programmed charts improve documentation by facilitation of the documentation process and allow more time for patient-physician interaction. Quality of documentation alone, however, is not a reliable indicator of patient outcome or of the quality of care received.
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Clinical Trial
Conscious sedation in the emergency department: the value of capnography and pulse oximetry.
The purpose of this observational study was to describe the use of nasal capnography and pulse oximetry in monitoring heavily sedated emergency department patients. ⋯ The use of pulse oximetry is recommended for the detection of unrecognized hypoxemia during conscious sedation. Capnography by nasal cannula appears to be a useful modality in monitoring during conscious sedation, but further research and clinical experience are required before routine use can be recommended.