Annals of emergency medicine
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While health care has become one of the leading policy concerns of the American public, cost containment has emerged as the most prominent underlying factor. Components of health care cost escalation include societal problems, consumer demand, an aging population, the technology explosion, administrative inefficiencies, the malpractice crisis, fraud and abuse, the lack of health promotion and disease prevention, the rising number of uninsured, and regulatory issues. The three major categories of health reform proposals, with characteristic cost containment features, are discussed. A comprehensive listing of available cost containment interventions is summarized in ten categories.
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Case Reports
Pacemaker-twiddler's syndrome: a rare cause of lead displacement and pacemaker malfunction.
Pacemaker-twiddler's syndrome is characterized by spontaneous, subconscious, inadvertent, or deliberate rotation of the pulse generator by the patient resulting in lead dislodgement and pacemaker malfunction. We present a case of pacemaker-twiddler's syndrome that involved an atrioventricular sequential pacemaker. It resulted in failure of atrial lead capture and phrenic nerve stimulation but without loss of ventricular lead capture. A search of the literature revealed only ten previous cases reported; none were in the emergency medicine literature, and none involved an atrioventricular sequential pacemaker.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neuromuscular blockade-assisted oral intubation versus nasotracheal intubation in the prehospital care of injured patients.
To compare nasotracheal intubation (NTI) to neuromuscular blockade-assisted oral intubation (NMB-assisted oral intubation) in the prehospital care of injured patients. ⋯ In the prehospital management of severely injured patients, there is no significant difference between NMB-assisted oral intubation and NTI in the rate at which endotracheal intubation is achieved. However, practitioners may prefer NTI because it requires significantly less time to perform than NMB-assisted oral intubation.
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The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community.
To determine whether an advanced cardiac life support (ACLS) course in a rural hospital will improve resuscitation success from cardiac arrest. ⋯ The institution of an ACLS-provider course in a rural community hospital was associated with improvement in initial resuscitation for patients with ventricular fibrillation/tachycardia and out-of-hospital arrest.
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To study the prevalence, risk factors, and consequences of ambulance diversion. ⋯ Ambulance diversion is a common and increasing event that delays emergency medical care.