Annals of emergency medicine
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To identify patients presenting with hypotension due to blunt trauma who should undergo computed tomography (CT) of the head before urgent chest or abdominal operation. ⋯ CT scan of the head before general surgical operation appears to be safe in patients who respond to initial resuscitation. The likelihood of craniotomy in patients with Glasgow Coma Scale scores of 13 or less is comparable to the likelihood of general surgical operation. Physicians should be encouraged to make CT of the head a high priority in this group.
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The National Highway Traffic Safety Administration developed the EMS (emergency medical services) Technical Assessment Program to assist states in developing and improving their EMS systems. The main goals of this evaluation were to document the level of improvement in EMS system development following completion of the Technical Assessment Program and to identify necessary program improvements at the National Highway Traffic Safety Administration. ⋯ Program evaluation revealed that significant recommendation-based changes occurred in all components of EMS systems. The Technical Assessment Program is one tool that states can use to promote EMS system improvements.
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To determine the prevalence of abnormal computed tomography (CT) scans and define high-risk clinical variables in patients with mild head injury. ⋯ Abnormalities on CT scans in patients with mild head trauma are fairly common, although the need for neurosurgical intervention is rare. Clinical decision rules can be used to identify those patients with more serious intracranial pathology. Such strategies should be validated prospectively in various ED settings.
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To describe a population of patients who arrived in a pediatric emergency department with pulse and respirations but then sustained cardiopulmonary or respiratory arrest while in the ED. ⋯ Cardiopulmonary or respiratory arrest in the pediatric emergency department is rare. The rate of survival of such an arrest is superior to that in outpatient arrests but inferior to that in inpatient arrests.
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To assess the prognostic value of initial end-tidal CO2 pressures (PETCO2) during CPR in patients with out-of-hospital cardiac arrest (OHCA). ⋯ In this observation study of 27 patients, initial PETCO2 during CPR with automated ventilation was prognostic for ROSC in patients with OHCA. Patients with ROSC have higher PETCO2 values after 1 and 2 minutes than do patients without ROSC.