The American journal of emergency medicine
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We examined the statistical resources within emergency medicine residency programs, and the attitudes of emergency medicine physician researchers toward activities wherein collaboration with a statistician is useful. Anonymous surveys were mailed to 104 emergency medicine physician researchers (1/program). Sixty-four (62%) responses were analyzed. ⋯ One-quarter of programs employed a full-time statistician. Collaboration among researchers and statisticians was considered sometimes or always useful for protocol development (aims 84%, design 99%, outcomes 99%, procedures 73%, sampling 97%, inclusion criteria 93%, number of subjects 100%); data entry 73%; statistical analysis 100%; and manuscript preparation 86%. Although most emergency medicine residencies lacked statistical resources within their program, physician researchers expressed positive attitudes toward collaboration with a statistician for all aspects of research.
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Case Reports
Painless limited dissection of the ascending aorta presenting with aortic valve regurgitation.
Aortic dissection is a medical emergency carrying high morbidity and mortality. Prompt diagnosis is sometimes difficult because of its varying presentations, but it is critical to the achievement of good clinical outcomes. ⋯ In both, the dissection was limited to the ascending aorta just distal to the aortic valve. These dissections were diagnosed by transthoracic and transesophageal echocardiography.
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Succinylcholine has long been the favored neuromuscular blocking agent for emergent airway management because of its rapid onset, dependable effect, and short duration. However, it has a plethora of undesirable side effects, ranging from the inconsequential to the catastrophic. When patients requiring tracheal intubation present with potential contraindications to succinylcholine use, the emergency physician will need to substitute a rapid-onset nondepolarizing neuromuscular blocking agent, such as rocuronium or mivacurium. An understanding of the pharmacology of these agents is essential.
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The purpose of this study was to investigate the therapeutic response to atropine of patients experiencing hemodynamically compromising bradyarrhythmia related to acute myocardial infarction (AMI) in the prehospital (PH) setting and the therapeutic impact of the PH response to atropine on further Emergency Department (ED) care. In addition, the prevalence of AMI in patients presenting with atrioventricular block (AVB) is noted. Retrospective review of PH, emergency department (ED), and hospital records. ⋯ Hemodynamically unstable (by ACLS criterion) AVB presenting in the PH setting is associated with a hospital diagnosis of AMI in most (55.6%) patients in this study. AMI patients with hemodynamically unstable AVB or bradycardia are no more likely to respond to atropine therapy in the PH setting than patients with non-AMI hospital diagnoses. Finally, although there is no difference in the treatment of compromising AVB or bradycardia received by AMI versus non-AMI patients in the PH or ED setting, AMI patients are more likely to achieve a normal sinus rhythm over the t
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The purpose of this study was to document prior emergency department (ED) use and injuries presented by victims of domestic violence (DV) homicides. We identified all female DV homicide cases investigated by Kansas City, Missouri, Police Department (KCPD) officials over 5 years. Medical Records from 12 hospitals were searched to determine how many homicide victims were in the ED within the 2 years preceding their homicide. ⋯ Because nearly half of all women who were victims of a DV-related homicide had been in the ED within 2 years before their deaths, the ED could play an important role in prevention. Approximately one half had documentation at least suggestive of battering. These results suggest the potential for universal screening, and documented safety assessments.