Annals of emergency medicine
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To determine the incidence and causes of unexpected death in emergency department patients and its relationship to initial ED presentation. To determine if length of ED stay is directly related to unexpected death. ⋯ Unexpected ED death was uncommon, usually nontraumatic, and occurred in patients with evidence of significant illness. Although average length of stay in the ED increased, there was no increase in the incidence of unexpected ED death. If lengths of ED stay continue to increase, this situation will require further study.
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Prehospital medications for congestive heart failure should affect hospital outcomes (survival and length of stay). ⋯ Prehospital medications improve survival in congestive heart failure, especially in critical patients. More than one combination of medications seems effective, and early treatment is associated with improved survival. However, these medications appear to increase mortality in patients misdiagnosed in the field. Factors used in paramedica and medical command assessments require further study.
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To determine the extent of supervision necessary for emergency medicine residents practicing in the emergency department. ⋯ Supervision is required for all patients managed by second-year emergency medicine residents, regardless of complaints. This evaluation should include a direct patient interview and examination by the emergency medicine attending and should not be limited to a case discussion or ED record cosignature.
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Induction of paralysis before intubation is controversial in the aeromedical setting. We reviewed our experience using neuromuscular blockade with nurse/paramedic aeromedical teams to determine effectiveness and outcome. ⋯ Neuromuscular blockade can be used safely and effectively in the field by experienced nurse/paramedic teams. Although problematic intubation was not eliminated, the difficulties encountered were manageable and the overall risk/benefit ratio was acceptable.