Annals of emergency medicine
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To evaluate a combined cardiac marker approach with adjunct two-dimensional echocardiography in diagnosing acute myocardial infarction (AMI) in the emergency department. ⋯ Serum myoglobin shows greater sensitivity but is less specific than CK-MB in the early detection of AMI. Use of a combination of both rapid assays during a 3-hour time period in the ED appears to be superior to use of either enzyme assay alone. Two-dimensional echocardiography does not appear to be helpful in diagnosing AMI in the ED.
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Case Reports
Use of the scapular manipulation method to reduce an anterior shoulder dislocation in the supine position.
We report the successful use of the scapular manipulation method to reduce an anterior shoulder dislocation in a multiply traumatized patient in the supine position. We discuss the treatment options for multiply traumatized patients with anterior shoulder dislocations in whom cervical spine injury is a possibility. Although larger patient studies are necessary for confirmation, we show that in this particular case the scapular manipulation technique was safely employed. To our knowledge, this is the first reported case of use of the scapular manipulation method with the patient in the supine position.
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We examined the percentage of outpatient clinic appointments kept after referral from the emergency department. Several factors (age, sex, and specialty) were examined, to determine their effect on patient compliance. ⋯ The compliance rate at VGH is higher than any found in studies of similar American hospitals. We determined two main explanations for this phenomenon: (1) the ED clerk makes the outpatient clinic appointment before the patient leaves the ED and gives the patient a computer printout of the date and time of the appointment and a map with the location of the appointment circled, and (2) patients do not have to pay for outpatient clinic visits.