The American journal of emergency medicine
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Blunt traumatic rupture of the left ventricle of the heart is rarely diagnosed preoperatively and is usually fatal, with only a few survivors reported in the literature. This report describes a case of a 54-year-old woman who survived a left ventricular rupture from a motor vehicle accident. Her cardiac injury was not suspected because she was not hypotensive and had no signs of pericardial tamponade. She developed circulatory arrest 2 hours after her injury, during induction of anesthesia.
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A nonconcurrent prospective cohort study was conducted to evaluate if National Resident Matching Program (NRMP) rank developed using multivariate regression followed by consensus group activity is associated with perceived general performance during emergency medicine residency. All residents graduating from a university hospital-based residency program between 1990 to 1993 were ranked by university faculty, private attendings, charge nurses, and a clerk. Each evaluator was asked to order (from the strongest to the weakest) a deck of cards that contained only each graduate's name and picture. ⋯ There was moderately strong agreement among evaluators about the relative strength of the 20 residents (W = 0.67, P < .001). The association of perceived rank with NRMP rank was much greater than that expected by chance (r(s) = .35, P < .0001). Applicants with better NRMP ranks were perceived as stronger residents, which supports the strategy of using formal statistical modelling followed by consensus group activity as a method of generating NRMP rank lists.
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Pulmonary thromboembolism (PTE) is a common cause of morbidity and mortality in an emergency department patient population. The advent of ventilation/perfusion (V/Q) lung scanning and the more recent publication of well- controlled analysis of results, such as the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) data, have provided the clinician with effective diagnostic algorithms to use in suggestive cases. However, there are disorders other than PTE, such as bronchogenic carcinoma, that can cause characteristic abnormalities in V/Q scanning. One such case is described in this report.
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In suburban and rural counties, patient transport to specialized facilities such as trauma centers may result in prolonged transport times with the resultant loss of ambulance coverage in the primary service area. We evaluated the American College of Surgeons trauma triage criteria as modified by New York State to determine the ability of these criteria to predict the need for trauma center care in victims of blunt traumatic injury. Blunt trauma patients were retrospectively identified through review of patient care reports for the presence either of mechanism or of physiological criteria for transport to a trauma center. ⋯ Patients with physiologic criteria may benefit from transport directly to a trauma center. Because of the low need for operative intervention and ICU services, patients with no criteria or mechanism criteria at long distances from a trauma center may be initially evaluated at the closest hospital and transferred to a trauma center if hospitalization or ICU care is necessary. Further study to determine the predictive value of certain individual mechanism criteria is warranted.