The American journal of emergency medicine
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Currently, the American Heart Association (AHA) recommends that physicians be certified in cardiopulmonary resuscitation (CPR) every two years. This study was undertaken to determine the effects of time since training on retention of CPR skills of physicians and to identify at what point performance deteriorates to a level requiring retraining with supervised practice. The physicians' performance of CPR one year or less after training was compared with that of more than one year after training. ⋯ Deterioration of skills may reflect the fact that senior residents do not actually perform CPR, but become team leaders and thereby lose their skills, or that poor performance is not corrected in actual "code" situations. If a two-year certification standard is maintained, CPR skill testing at least every 12 months should be considered. If skills have deteriorated, hands-on-practice should be undertaken at that time.
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A five-year retrospective study of pediatric salicylate intoxications (serum level greater than 300 micrograms/ml) revealed that 2/20 patients developed salicylate induced pulmonary edema. These patients had significantly higher initial anion gaps (P less than 0.02) and serum salicylate determinations (P less than 0.001) and tended to be younger with lower initial serum potassium and arterial carbon dioxide measurements. ⋯ Unlike other reports, these data suggest that pulmonary edema is not rare in severe pediatric salicylate ingestion and correlates with high serum salicylate levels and anion gaps. Early, aggressive detoxification, supportive therapy, and hemodynamic monitoring would appear to be indicated in these patients.
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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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A dominant characteristic of critical-care medicine today is the emergence of powerful institutions functioning within a framework of a noncoherent set of values and philosophical perspectives. Anyone who would assign a significant role to the philosophy of medicine for today's era must not simply account for the quandaries of critical-care medicine, but also attend to the antecedent values, conflicts, and absurdities that form the ethical issues, as well as the models of ethical response (market ethos, professional ethos, etc.) that indicate which moral principles might be relevant. These considerations form the new agenda for the philosophy of critical-care medicine. This broad philosophical task is an urgent one, for critical-care medicine is rapidly molding the moral dimensions of all of 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.