The American journal of emergency medicine
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Recent studies have shown that discharging to home an emergency department (ED) patient with croup if the patient is clinically stable 3 to 4 hours after being treated with nebulized racemic epinephrine (NRE) is safe and cost-effective. The objective of this study was to determine if EDs in our geographic area are using NRE cost-effectively in the management of croup. A survey was mailed to the ED medical directors of 23 hospitals in Ohio, Kentucky, and Indiana within a 150-mile radius of our teaching/referral children's hospital. ⋯ The medical directors were asked what their disposition would be once the NRE therapy has been completed: automatically admit, transfer, discharge immediately, or observe for 3 to 4 hours and if stable at that time discharge to home with follow-up. Seven (30%) indicated they would automatically admit, compared with 16 (70%) who indicated they would observe for 3 to 4 hours (P = .06). This article discusses potential reasons that 30% of the ED medical directors in our geographic area would automatically admit these patients rather than observe for signs of improvement that could lead to safe discharge and resultant cost savings.
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Changes to Federal regulations pertaining to waiver of informed consent for acute care research were debated by the research and regulatory communities for more than 2 years before being finalized in October of 1996. Input from the general public was limited. This survey investigated the opinions of emergency medicine patients concerning waiver of informed consent for acute care research. ⋯ While most emergency medicine patients would want to be enrolled in a study if they had a serious illness and were unable to give informed consent, a significant percentage of patients would not want to be enrolled regardless of the degree of risk or availability of a family member to speak on their behalf. Waiver of informed consent for emergency research is an ethical dilemma pitting individual rights against societal needs and physician parentalism. A better understanding of what patients consider appropriate may help in resolving this dilemma.
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The purpose of this study was to quantify the proportion of men and women seen in a university emergency department (ED) for treatment of injuries resulting from intimate partner violence (IPV) that require reports to law enforcement authorities. A total of 1,516 adult ED patients were asked to complete a written survey instrument; 1,003 patients (66.2%) completed the survey. Two percent of patients reported they presented to the ED for treatment of injuries resulting from IPV. ⋯ Six percent of respondents reported that they had ever been threatened with a gun or knife by a partner, 2% within the past year. Only the lifetime prevalence of IPV was significantly greater among female patients, 15% versus 6% (P < .001). Approximately 2% of our ED patients require law enforcement intervention for IPV.
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The purpose of the study was to determine the epidemiology and the etiology of cardiac arrests witnessed by emergency medical services (EMS) personnel and the survival from resuscitation according to the Utstein style. Consecutive prehospital cardiac arrests witnessed by EMS personnel in the Helsinki City EMS system between January 1, 1994 and December 31, 1995 were included in this prospective cohort study. A total of 809 cardiac arrests were registered during the study period, 108 (13.3%) of which were EMS-witnessed. ⋯ In multivariate analysis, initial rhythm of ventricular fibrillation and cardiac etiology remained independent factors of survival. These results indicate that overall survival rates in EMS-witnessed cardiac arrests have remained low but those who survive are discharged without major neurological sequelae. Noncardiac etiology accounts for 45% of cases and seems to be a major determinant of low overall survival rates.