Annals of emergency medicine
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Multicenter Study
Missed diagnoses of acute myocardial infarction in the emergency department: results from a multicenter study.
To determine the rate of missed acute myocardial infarction (AMI) in the emergency department and the factors related to missed diagnoses. ⋯ The rate of missed AMI in the ED was only 1.9%. However, 25% of these might have been prevented had ST-elevation not been missed, and another 25% might have been prevented had patients who were recognized to have ischemic heart disease by the physician in the ED been admitted.
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Comparative Study
Endotracheal tube selection in children: a comparison of four methods.
To determine the accuracy of four methods of endotracheal tube size selection in the pediatric population. ⋯ Neither fifth finger width nor fifth finger diameter accurately predicts proper endotracheal tube size in most children. A more accurate estimation can be made using the age-based formula, but when the child's age is unknown or when calculation is awkward or impossible, an accurate estimate can be made using the width of the fifth fingernail.
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Emergency physicians desire to provide their patients with care that is of the highest quality and is cost effective. Any tool that promotes these aims is good and should be used. ⋯ ACEP has initiated a process for the development and evaluation of selected clinical policies. We anxiously await information that sheds light on the value of policies in enhancing the clinical practice of emergency medicine.
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Interest in pediatric emergency medicine has grown steadily during the past decade among pediatricians and emergency physicians. With the rapid proliferation of pediatric emergency medicine programs for pediatricians has come extensive and valuable experience with this type of fellowship education. As a result, the structure and scope of these programs have become increasingly well established. ⋯ The recent establishment of guidelines for pediatric emergency medicine subspecialty certification by the American Board of Emergency Medicine and the American Board of Pediatrics brings new importance to fostering such standards for the training for emergency physicians. To this end, we present a proposed pediatric emergency medicine fellowship program developed during a retreat that included physicians from an emergency medicine program and two pediatric hospitals. We also review some of the significant events that have occurred in the evolution of pediatric emergency care.