The American journal of emergency medicine
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Each year hundreds of thousands of children receive care in emergency departments after head injury. Minor head injuries account for a majority of these injuries. The prevalence, morbidity, and costs associated with pediatric minor head injuries make it an important topic. We review the management of pediatric minor head injury, emphasizing current areas of controversy, including criteria for neuroimaging, indications for hospitalization, the role of anticonvulsant therapy, and the long-term neurobehavioral sequelae of pediatric minor head injury.
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Seventy-seven percent of emergency physicians (EPs) work as either employees or independent contractors (ICs). In contrast, other hospital-based physicians such as radiologists and anesthesiologists have a much higher percentage of ownership in their medical practices. ⋯ This will inevitably result in less self-determination for their future. Combined with the great strides EM has achieved as a specialty, EPs' brightest future lies in being citizens of a broader, more expansive, all encompassing EM practice.
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Comparative Study
Delta CK-MB outperforms delta troponin I at 2 hours during the ED rule out of acute myocardial infarction.
It has been shown that a rise in creatine kinase MB bank (CK-MB) of > or = + 1.6 ng/mL in 2 hours is more sensitive and equally specific for detection of acute myocardial infarction (AMI) as compared with a 2-hour CK-MB > or = 6 ng/mL during the emergency department (ED) evaluation of chest pain. Because cardiac specific troponin I (cTnI) is thought to have similar early release kinetics as compared with CK-MB mass, we undertook a retrospective cohort study in 578 chest pain patients whose baseline CK-MB and cTnI was less than two times the hospital's upper limits of normal and who underwent a 2-hour CK-MB and cTnI to compare sensitivities and specificities of the 2-hour delta CK-MB (deltaCK-MB) and delta cTnI (delta cTnI) for AMI and 30-day Adverse Outcome (AO). Thirty day AO was defined as AMI, life-threatening complication, death, or percutaneous transluminal coronary angioplasty (PTCA)/coronary artery bypass graft (CABG) within 30 days of ED presentation. ⋯ There were no differences in specificities for AMI and 30-day AO. Combining the two tests (MBdelta > or = +1.5 ng/mL and/or a deltaTnI > or = +0.2 ng/mL) resulted in an incremental increase in sensitivity of 89.5% for AMI and 61.9% for AO (P < .005). Patients with either a rise in CK-MB of > or = +1.5 ng/mL or rise in cTnI of > or = +0.2 ng/mL in 2 hours should receive consideration for aggressive antiischemic therapy and further diagnostic testing before making an exclusionary diagnosis of nonischemic chest pain.
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In this article we seek to determine the duration of immobilization in patients presenting to the emergency department (ED). We conducted a 10-week prospective study of a convenience sample of patients transported to a level one trauma center immobilized with a backboard and cervical collar. Total backboard time (TBT) was measured from the time the ambulance left the scene to the time the patient was removed from the backboard, while total ED backboard time (TEDBT) was measured from the time of arrival at the ED to the time of backboard removal. ⋯ There were 102 patients for whom TEDBT was available and averaged 46.36 (+/-44.88) minutes. Dividing patients into those who were removed from the backboard prior to radiographs (n = 95), the TEDBT average was 37.6 minutes (+/-29.6), whereas the average for those who had radiographs prior to removal from the backboard (n = 7) was 165.3 minutes (+/-49.7). Patients are left on backboards for significant periods of time even when no radiographs are taken prior to backboard removal.