The American journal of emergency medicine
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Rotating residents (RRs) were surveyed to determine their impressions of an emergency department (ED) run by career emergency physicians (EPs), in the hope of generating insights into controversies that occur between the ED and other hospital departments. A questionnaire was distributed to RRs at Taipei Veterans General Hospital in September 1993. The questionnaire inquired about basic data, workload, and ED training and teaching, and also asked respondents for their overall evaluation of emergency medicine and EPs. ⋯ Fear of malpractice suits and difficult interaction with patients and patients' families were also cited as stressful factors. All RRs considered ED training important; self-learning and the accumulation of ED experience, as well as the conference on emergency pitfalls, were the two aspects of training most favored, garnering approval by 92% and 80%, respectively. The overall impression of the RRs on emergency medicine and the performance of EPs was favorable.(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical Trial Controlled Clinical Trial
Appearance scales to measure cosmetic outcomes of healed lacerations.
To develop an appearance scale that will allow the objective and scientific comparison of the cosmetic results of healed lacerations, 33 photographs of healed lacerations and incisions with variable cosmetic results were shown to four plastic surgeons. These plastic surgeons were asked to independently rate the photographs on two separate occasions using two scales, a Visual Analogue Scale and a Categorical Scale. Interobserver and intraobserver agreement were determined for each scale. ⋯ The agreement of the categorical scale was also good with a kappa coefficient for interobserver agreement of 0.53. The kappa coefficient for intraobserver agreement ranged from 0.48 to 0.72. Because the visual analogue scale and categorical scale showed good interobserver and intraobserver agreement, both may be considered good measurement tools in the comparison of alternate methods of laceration care.
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Alternative techniques and equipment for intubation may be particularly useful in settings such as air-medical transport, prehospital on-scene care, mass casualty incidents, or incidents in which there may be a lack of medications or equipment. Once traditional techniques of endotracheal intubation and tube verification have been mastered, emergency medicine residents and other intubators should be encouraged to learn alternative techniques, such as these, that may be of use in some special situations, even within the ED. Neither of these two techniques of BAAM-assisted blind oral intubation can be considered essential, nor should it be contended that these techniques supplant learning of more conventional methods of endotracheal intubation and tube placement verification. ⋯ Use of a BAAM to assist in blind oral intubation of a spontaneously breathing patient may allow for oral intubation of awake patients without the additional use of paralytic medications. Use of the BAAM with a digital technique during external cardiac massage may facilitate intubation by the digital technique and help to verify endotracheal tube position. These two additional uses for the BAAM should be noted and these two additional methods of airway control be recognized as backup methodologies in the armamentarium for situations in which they may be needed.
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Previous research at the Division of Air Medical Services at East Carolina University School of Medicine has demonstrated impairment of chest compression efficacy in the setting of an airborne BO-105 helicopter. This study was undertaken to determine whether in-flight compression efficacy could be improved with utilization of a pressure-sensing monitor providing real-time feedback during cardiopulmonary resuscitation (CPR). ⋯ The mean proportion of correct compressions (95.7 +/- 3.2%) achieved with utilization of the pressure-sensing monitor was significantly higher (P < .01) than the corresponding proportion for the control group (33.4 +/- 12.1%). This study demonstrated that the difficulties of performing effective in-flight chest compressions are largely overcome with utilization of a pressure-sensing device providing real-time feedback on compression efficacy.
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The sooner a person who is experiencing symptoms and signs of an acute myocardial infarction (AMI) (including out-of-hospital cardiac arrest) receives medical treatment, the greater his or her chances of survival and limitation of infarct size. A universal 9-1-1 emergency telephone system makes it possible for AMI patients or those around them to easily and quickly call for help and for emergency medical services (EMS) personnel to rapidly and accurately locate the patient. This article by the Access to Care Subcommittee of the National Heart Attack Alert Program (NHAAP) Coordinating Committee describes the history of 9-1-1, its key elements, its current implementation status, and existing State legislation and standards. ⋯ Approximately 195 United States cities with a population of greater than 100,000 people have access to enhanced 9-1-1. It is the contention of the NHAAP that 9-1-1 services should be universally available to all Americans to ensure seamless access to EMS and, potentially, early detection, evaluation, and treatment for AMI. This article reports several key recommendations for achieving this goal.