Annals of emergency medicine
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Numerous clinical guidelines have been promoted to help improve the management of acute injury and illness. In November 1997, the National Asthma Education and Prevention Program released the final version of its comprehensive second Expert Panel Report, designed to distill scientific advances in asthma care and provide a set of practical tools to help guide clinician and patient decisions. The panel's recommendations for acute asthma care stress the use of the objective measures of pulmonary function to assess severity, aggressive inhaled beta 2-agonist therapy, early systemic corticosteroid administration, and early disposition decisions. This article provides a focused overview of the 146-page document and highlights aspects of the new guidelines of particular importance to emergency physicians.
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Emergency medicine has progressed significantly since its initial recognition as a medical specialty. Relatively little factual information is known, however, regarding who or how many physicians practice emergency medicine. The purpose of this study is to determine the total number of physicians practicing clinical emergency medicine during a specified period, to describe certain characteristics of those individuals, and to estimate the total number of full-time equivalents (FTEs), as well as the total number of individuals needed to staff those FTEs. ⋯ Given that there are 4,945 hospitals with EDs and given that the data indicate there are 4.96 FTEs per ED, the total number of FTEs is projected to be 24,548 (standard error = 437). Given further that the data indicate a physician/FTE ratio of 1.51:1, we conclude that there are 36,990 persons (standard error = 683) needed to staff those FTEs. When adjusted for persons working at more than one ED, that number is reduced to 32,026.
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To determine the test performance characteristics of serum cardiac troponin T (cTnT) measurement for diagnosis of acute myocardial infarction (AMI), and to determine the ability of cTnT to stratify emergency department patients with chest pain into high- and low-risk groups for cardiac complications. ⋯ Measurement of cTnT will accurately identify myocardial necrosis in patients presenting to the ED with possible AICS. Elevated cTnT values identify patients at increased risk of cardiac complications.
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Distal placement of the endotracheal tube tip in the glottic opening is rarely discussed in most emergency medicine, surgery, and prehospital medicine texts. We report three cases of glottic intubation recognized after the patients were thought to have been successfully intubated. ⋯ Recognition of this complication is aided by the use of radiographic findings, inappropriate endotracheal tube depth, and the presence of inadequate ventilatory volumes. Potential complications of glottic intubation include dislodgement of the endotracheal tube, kinking of the tube, and inadequate protection of the airway.