Annals of emergency medicine
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A method is presented for reviewing the taped radio-telemetry records of paramedic calls managed by hospital-based emergency medicine residents. All paramedic calls to the LAC/USC base station are reviewed by an emergency medicine resident using a special tape review form which focuses on communication skills, initial paramedic field assessment, sense of urgency of the case, and the completeness of the filed report. ⋯ Tapes demonstrating particular skills or pitfalls in prehospital management are selected for monthly tape review conferences. Such conferences provide a method by which each side of the prehospital care team can perceive the position of the other, encouraging physicians and paramedics to enhance their respective roles in providing effective prehospital emergency care.
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Specific criteria have been proposed for the cessation of cardiopulmonary resuscitation (CPR) in the emergency department. Using these criteria and others, we developed a survey which was completed by 78 physicians practicing emergency medicine. ⋯ In this survey, the type of residency training, the size of city in which the physician practiced, and the number of years an individual had practiced emergency medicine significantly correlated with how he made the decision to cease CPR. Based on a review of the current literature, and due to the fact that considerable and variable ethical and psychological factors weigh in each clinical circumstance, the authors recommend that no criteria be followed for ceasing CPR.
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A survey was conducted to measure the knowledge, attitudes, and practices concerning emergency medical services (EMS) of physicians practicing in a suburban-rural county on Long Island, New York. Two hundred fifty-four physicians responded to a questionnaire formulated to determine the following: knowledge of the existing system; perceived changes in system components; opinions about factors affecting emergency department visits; physician recommendations to patients in hypothetical situations; reasons for choosing a particular hospital for emergency patients; interest in involvement in the county EMS training program; and physician socio-demographic characteristics. Such information is valuable in the planning of EMS programs.
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The Medical Information Center at The Hospital for Sick Children in Toronto began in March 1977 to improve triage, provide an improved poison information center, improve response to telephone callers seeking medical advice, and establish a telephone consultation service for physicians. It employs specially trained nursing staff and integrates functionally related services. To determine program effectiveness we studied the records of patients triaged, telephone calls to the poison information center, and calls for other medical information, for periods both before and after the center's opening. ⋯ The Medical Information Center telephone service ensures that more children are managed at home rather than (unnecessarily) treated in the emergency department. Most parents express satisfaction with this service. Few physicians have used the telephone consultation service.
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Lidocaine is recognized as a first line drug for ventricular arrhythmias and has recently been used in acute myocardial infarction as prophylaxis against ventricular fibrillation. A 68-year-old man was erroneously given 2 gm of lidocaine by intravenous push and sustained a cardiac arrest. He was treated supportively and had complete recovery. We discuss complications of therapeutic and excessive doses of lidocaine and outline measures for treatment of massive lidocaine overdose.