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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A healthy 4-year-old boy presented to the pediatric emergency department after inserting a black-eyed pea into his right external ear canal. Initial attempts at removal of this foreign body were unsuccessful, resulting in patient agitation. ⋯ Spontaneous respirations resumed after 40 seconds, and the child recovered with no apparent ill effects. This case illustrates the need for adequate monitoring and preparation for emergency airway management when using ketamine for sedation in the ED.
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To determine the relative importance of variables correlated with patient satisfaction with emergency department care and service. ⋯ The total time patients spend in the ED and patients' perceptions of their wait time for an ED bed are not as important to patient satisfaction as is receiving prompt and caring service. The above service variables are key areas that may be targeted to improve ED services.