Annals of emergency medicine
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To determine the frequency with which patients with suspected tuberculosis (TB) or TB risk factors present to US emergency departments and to describe current ED TB infection-control facilities and practices. ⋯ Patients with TB or at risk for TB are often treated in US EDs, and the risk for transmission of TB in this setting appears to be increasing. Prolonged waiting times and lack of infection-control facilities in EDs may contribute to this problem. Consideration should be given to implementation of policies and facilities recommended by the CDC.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative trial of continuous nebulization versus metered-dose inhaler in the treatment of acute bronchospasm.
To compare continuous nebulization with the use of a metered-dose inhaler (MDI) with spacer device for delivery of albuterol in acute bronchospastic episodes in the emergency department. ⋯ On the basis of the findings of this study, we conclude that continuous nebulization is equally effective as MDI with spacer device for delivery of albuterol to treat acute bronchospastic episodes in the ED. Each method of delivery offers advantages. Each ED should decide which modality to use on the basis of its own resources.
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Comment Letter Comparative Study Clinical Trial Controlled Clinical Trial
Hyperbaric oxygen and carbon monoxide poisoning.
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To evaluate the ability of emergency health care providers and patients to demonstrate the proper use of metered-dose inhalers (MDIs). ⋯ These results suggest that many patients use MDIs improperly. Emergency physicians, house staff, and nurses responsible for instructing patients in optimal inhaler use may lack even rudimentary skills with these devices.
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At this writing, a collaborative partnership has been in place for 30 months between the Boston University Medical Center, the University of Massachusetts Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia, to improve emergency and trauma care in that city. Fifty-five individuals have traveled to and from the Emergency Hospital, the partner hospital. The collaboration has led to the creation of the Emergency Medical Services Institute (EMSI) at Emergency Hospital, an 800-bed facility that serves as a trauma center and as base for the Yerevan ambulance system. ⋯ To date, 45 nurses have graduated from a 400-hour training program. This partnership program chose an education initiative as the vehicle for interaction between the United States and the formerly Soviet-directed Armenian health care system. Officials of the partner hospital requested assistance in upgrading the skills of its abundant emergency care workforce, citing cardiovascular disease, trauma, and accidents as leading causes of death and disability in Armenia.(ABSTRACT TRUNCATED AT 250 WORDS)