Annals of emergency medicine
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We anticipate that over the next few years, emergency physician use of emergency department ultrasound will become the standard of care. However, many EDs are hampered in their efforts to gain hospital approval for emergency physician use of ultrasound because of the lack of publicized information regarding the goals of such use, the scope of emergency physician ultrasound privileges, emergency physician ultrasound credentialing criteria, and ED ultrasound quality-improvement plans. In this article we address these issues and provide an example of a proposal used successfully to gain hospital approval for ED use of ultrasound by emergency physicians.
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To determine whether neutrophil adherence was altered in the presence of systemic inflammatory response syndrome (SIRS) and infection or severe sepsis. ⋯ Neutrophil adherence was significantly decreased in patients with SIRS and severe sepsis compared with that in normal controls. A larger study enrolling consecutive SIRS subject at risk for severe sepsis may demonstrate whether this assay could be useful in managing sepsis in the ED.
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We conducted a pilot study to assess the feasibility of ultrasonography in the detection of traumatic complications of CPR. ⋯ Traumatic complications of CPR are well known but typically difficult to assess. Ultrasonography may identify injuries, help guide procedures, and serve as a means to assess pharmacologic effects on cardiac performance during CPR. It is a readily available, noninvasive means to assess these critically ill patients.
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To determine the accuracy and application of pelvic ultrasound performed by emergency physicians in detecting ectopic pregnancy (EP) in complicated first-trimester pregnancies. ⋯ Pelvic ultrasonography performed by emergency physicians can be used to rule out EP and make an accurate diagnosis in most patients with complicated first-trimester pregnancies during the initial ED visit. The remaining patients at risk can be identified and a diagnosis made by means of follow-up ultrasound and serial hCG determinations.
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To determine the effects of early fluid resuscitation on the rate, volume, and duration of hemorrhage using a sheep model of uncontrolled pulmonary vascular hemorrhage. ⋯ In this sheep model of uncontrolled pulmonary vascular hemorrhage, immediate fluid resuscitation significantly increased the rate, volume, and duration of hemorrhage. The vigorous administration of fluids to patients with penetrating chest trauma has the potential to significantly increase blood loss.