Annals of emergency medicine
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The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. In prior work (EMSOP I), discomfort had the highest weighted score among outcome categories for the top 3 adult conditions (ie, minor trauma, respiratory distress, chest pain) and the first and third highest rankings for children's conditions (ie, minor trauma, respiratory distress). ⋯ The Oucher Scale, combining a visual analog scale with pictures, seems most promising for out-of-hospital use among younger children. Future research in out-of-hospital care should be conducted to determine the utility and feasibility of these measures, as well as the effectiveness of interventions for pain relief.
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Meta Analysis
The accuracy of the enzyme-linked immunosorbent assay D-dimer test in the diagnosis of pulmonary embolism: a meta-analysis.
We sought to determine the sensitivity and specificity of the enzyme-linked immunosorbent assay (ELISA) D -dimer test in the diagnosis of pulmonary embolism (PE) in the adult emergency department population. ⋯ The ELISA D -dimer test is highly sensitive but nonspecific for the detection of PE in the clinical setting. This test might help clinicians safely rule out PE, especially in the face of low and low-to-moderate pretest probabilities.
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Induced hypothermia to treat various neurologic emergencies, which had initially been introduced into clinical practice in the 1940s and 1950s, had become obsolete by the 1980s. In the early 1990s, however, it made a comeback in the treatment of severe traumatic brain injury. The success of mild hypothermia led to the broadening of its application to many other neurologic emergencies. ⋯ Mild hypothermia has been applied with varying degrees of success in many neurologic emergencies, including traumatic brain injury, spinal cord injury, ischemic stroke, subarachnoid hemorrhage, out-of-hospital cardiopulmonary arrest, hepatic encephalopathy, perinatal asphyxia (hypoxic-anoxic encephalopathy), and infantile viral encephalopathy. At present, the efficacy and safety of mild hypothermia remain unproved. Although the preliminary clinical studies have shown that mild hypothermia can be a feasible and relatively safe treatment, multicenter randomized, controlled trials are warranted to define the indications for induced hypothermia in an evidence-based fashion.
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We evaluate the ability of paramedic rapid sequence intubation (RSI) to facilitate intubation of patients with severe head injuries in an urban out-of-hospital system. ⋯ Paramedics can use RSI protocols that include neuromuscular blocking and sedative agents to facilitate intubation of patients with head injuries.
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Emergency departments frequently receive telephone calls from the general public. Callers sometimes request detailed instruction or medical advice. ⋯ Case law indicates that the expectations for the medical outcomes of those receiving telephone-based medical advice will not be significantly less than those for on-site ED triage. This American College of Emergency Physicians Policy Resource and Education Paper (PREP) explores these issues.