Annals of emergency medicine
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Two widely used formulas for calculating the number of practicing emergency physicians (EPs) are based on the total number of US emergency departments and patient visits. In this study we hypothesized that the number of physicians now working in EDs is significantly greater than the estimates yielded by these formulas. Therefore we attempted to determine the accuracy of these methods for predicting the true number of practicing EPs. We also examined the training, board certification, and distribution of EPs. ⋯ Current staffing estimates regarding EPs working in Missouri greatly underestimate actual staffing needs. Board-certified EPs are in severe shortage and are unequally distributed in Missouri. Extrapolated nationally, these estimates may negatively affect funding and available residency positions for emergency medicine.
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Patient involvement in medical decisionmaking is accepted as an ethical and a legal imperative. Medical decisions are based in part on individuals' knowledge and acceptance of risk of adverse consequences. It is unclear whether actions taken to protect against low risk of poor outcome reflect patient or physician preferences. We sought to test the hypothesis that emergency department chest pain patients presented with a hypothetical situation involving a low risk of myocardial infarction are more willing than ED physicians to accept the risk associated with discharge from the hospital. ⋯ ED patients with chest pain appear to be more likely than physicians to accept a small risk of poor outcome in a hypothetical circumstance. Many patients cannot identify the risks associated with their decision.
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To assess the ability of patients to accurately estimate specific waiting times in the emergency department. ⋯ Patients are not very accurate in their estimation of actual waiting times. Although fewer than one fourth of the respondents overestimated the TWT spent in the ED, almost half the respondents overestimated the PWT.
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To assess the incidence of cardiac arrest among patients who use self-transport to seek medical care for chest pain. ⋯ The incidence of cardiac arrest among patients who attempted to reach the hospital by private transportation was very low compared with the incidence among those who chose the EMS system for transport. This suggests that patient self-selection occurs, with the more seriously ill patients more commonly calling 911 for transport.
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In two separate cases, pediatric patients exposed to Armor-All Quicksilver Wheel Cleaner exhibited systemic toxicity including mental status changes, marked hypocalcemia, and ventricular fibrillation. One child also demonstrated profound hypomagnesemia. These are the first pediatric reports of near-fatal outcomes after ingestion or inhalation of a hydrofluoric acid-like product, namely, ammonium bifluoride.