The American journal of emergency medicine
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Comparative Study
Emergency department utilization during a doctors' strike.
Emergency department (ED) patient volume at Jerusalem's Shaare Zedek Hospital was 33% higher during the 1983 doctors' strike as compared with the same period in 1982. Excess visits were recorded for both sexes (P less than 0.0001), but there were many more excess visits by females than males. ⋯ In contrast to excess ED visits, which were higher during the strike for both sexes, excess hospital admissions via the ED were recorded only among females (P = 0.007). The number of ED visits during the strike was increased on all three hospital work shifts (P less than 0.0001), with the greatest number of excess visits occurring between 7 AM and 3 PM.
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A prospective observation of cardiopulmonary resuscitation was made at an active municipal pediatric emergency department. Pediatric cardiorespiratory arrest, documented in only 26 patients over a 12-month period, was unusual. Fifteen were less than 1 year old, and four children survived to discharge. ⋯ Congenital abnormalities were present in 23% of patients; however, these accounted for 50% of the survivors. The overall survival rate was 15.4%. Suggestions for termination of resuscitation are given.
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The telephone number 911 is designated for public use in requesting emergency assistance. It is thought to reduce response time by reducing the interval between the decision to call for assistance and the notification of an agency that can dispatch the appropriate services. The experience of the Twin Cities metropolitan area of Minneapolis-St. ⋯ Compliance (use of an appropriate emergency number for the first call) was demonstrated by 139 of 347 callers (40%) in the pre-911 phase, and 225 of 305 callers (74%) in the post-911 phase (P less than 0.001). Rapid activation of the EMS system was rarely achieved by calling a hospital or physician first. Overall, 911 was found to be a more efficient means of activating the EMS system.
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In order to determine whether paramedics could be effectively trained in the skill of orotracheal intubation, 11 paramedics were entered into a pilot study. All paramedics received the same limited didactic, cadaver, and in vivo clinical preparation. ⋯ Subsequently, training has been expanded to a large number of paramedics, and the experience with intubation now includes a total of 128 patients and an overall success rate of 86%. It is concluded that paramedics can safely and effectively perform orotracheal intubation in a variety of adverse field conditions.
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We report a case of a 78-year-old woman, previously in good health, who was endotracheally intubated and brought to the emergency department following sudden cardiac arrest. Physical examination revealed absent breath sounds over the right hemithorax, and a portable chest radiograph demonstrated left mainstem bronchus intubation. Although right mainstem bronchus intubation is a common complication of endotracheal intubation, left mainstem bronchus intubation is rare.