Annals of emergency medicine
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The publication of comprehensive evidence-based guidelines for the management of non-ST-segment elevation acute coronary syndrome by the American College of Cardiology and the American Heart Association in September 2000 marked a sentinel event in the evolution of managing this challenging patient population. Many of the recommendations included in the guidelines have relevance to the emergency department care of patients with non-ST-segment elevation acute coronary syndrome and were summarized in Annals of Emergency Medicine in September 2001. ⋯ Several of the modified and new recommendations again potentially affect ED management. These are presented and discussed here.
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The rapid 4-step technique for cricothyrotomy was originally described as making use of a single traction hook on the cricoid ring. However, it is possible that such hook placement could lead to damage of the cricoid ring. As an alternative, a double-hook device was developed to augment the rapid 4-step technique by dispersing forces applied to the cricoid ring. The objectives of this study were to compare the requisite forces for intubation and the structural tolerances of the cricoid ring between the single- and double-hook techniques. ⋯ When applying the rapid 4-step technique for cricothyrotomy, the force required to intubate with either the single- or double-hook technique is small. The cricoid ring, however, tolerates significantly more force without breakage when the double-hook technique is used.
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Clinical Trial
The effects of consecutive night shifts on neuropsychological performance of interns in the emergency department: a pilot study.
We obtain preliminary information on the neuropsychological performance of house officers at the beginning and end of a shift while they worked consecutive night shifts in the emergency department. ⋯ Interns working nights demonstrated a significant reduction in visual memory capacity across the night shift. Research involving neuropsychological performance during night shifts in the ED is important. It might provide valuable insights into ways to improve our performance during night shifts.