Annals of emergency medicine
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Comparative Study
Light reflection rheography as a noninvasive screening test for deep venous thrombosis.
To determine if light reflection rheography is a useful screening tool for the diagnosis of proximal leg deep venous thrombosis. ⋯ Light reflection rheography proved to be an excellent screening tool for emergency patients with the clinical suspicion for an acute proximal leg deep venous thrombosis. A normal light reflection rheography examination was 97.5% accurate as a negative predictor. That is, a normal light reflection rheography excluded the diagnosis of proximal leg deep venous thrombosis when compared with duplex ultrasonography and/or contrast venography when the duplex ultrasonography and/or contrast venography showed no evidence of proximal leg deep venous thrombosis. An abnormal light reflection rheography does not equate to an acute leg deep venous thrombosis as the specificity was only 68.4%. An abnormal light reflection rheography mandates further diagnostic studies such as duplex ultrasonography and/or contrast venography to confirm a diagnosis of proximal leg deep venous thrombosis.
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Case Reports
Lightning strikes: nature of neurological damage in patients evaluated in hospital emergency departments.
Emergency physicians and staff are usually the first to evaluate and manage victims of lightning strikes. Damage to the nervous system is often the most devastating consequence of lightning strikes. Contrary to most articles in the literature in which neurological disorders are said to be either transient or delayed, we report the cases of six patients with severe, immediate, and in at least three, permanent clinical problems. Patients with signs of spinal cord lesions are most likely to have permanent disabilities.
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To determine whether the test ordering of physicians working in a teaching hospital emergency department could be influenced by modification of automated laboratory order sets. ⋯ Modification of ED "standard orders" can result in reduction of laboratory use without an adverse effect on patient care.
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Fishhook injuries rarely pose a true emergency, and only a few cases of posterior ocular injury from fishhooks have been described. We present a case of penetrating ocular, orbital, and cranial trauma produced by a broken fishhook. The morbidity and mortality as well as the initial emergency evaluation of penetrating foreign objects in the orbital-cranial region are discussed.
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To assess the impact of the introduction of an emergency medicine residency program on the quality of care in an urban community hospital emergency department. ⋯ As measured by a process evaluation, documentation of the medical record, the introduction of an emergency medicine residency significantly improved the quality of care in this urban community hospital ED.