Annals of emergency medicine
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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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To evaluate a standardized training program in intraosseous (IO) infusion for prehospital providers. ⋯ A one-hour standardized training session was successfully used to train prehospital providers in the procedure of IO infusion. IO infusion then was implemented into their clinical practice with a satisfactory success rate and few complications.
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To determine retrospectively the diagnostic accuracy of various ECG ST segment elevation criteria for the prehospital ECG diagnosis of acute myocardial infarction. ⋯ Fifty-one percent of patients whose prehospital 12-lead ECG met 1 mm or more ST segment elevation criteria had non-myocardial infarction diagnoses. ST segment elevation alone lacks the positive predictive value necessary for reliable prehospital myocardial infarction diagnosis. Inclusion of reciprocal changes in prehospital ECG myocardial infarction criteria improved the positive predictive value to more than 90% and included a significant majority (62% to 86%) of acute myocardial infarction patients with ST segment elevation who received thrombolytic therapy within five hours after hospital arrival. ST segment elevation criteria that include reciprocal changes identify patients who stand to benefit most from early interventional strategies.
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To assess the frequency of institutional review board (IRB) review and informed consent in emergency medical services (EMS) research. ⋯ IRB review is often omitted by EMS investigators. This raises ethical concerns about EMS research. Investigators should document their consent method or approval to use an informed consent waiver in their manuscripts. A consent method should be specified for volunteers.
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Inferential and descriptive statistics continue to be used incorrectly when analyzing biomedical data. Glasgow Coma Score (GCS) and Revised Trauma Score (RTS) data have recently been described and analyzed using parametric statistical methods in several studies despite the ordinal nature of these data scales. The objective of this study was to determine whether GCS and RTS data are normally distributed, despite their ordinal nature. ⋯ Parametric statistical descriptors and inferential methods are inappropriate for use with GCS and RTS data. Ordinal data should be tested for normality before statistical analysis with parametric statistical methods.