Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine the incremental benefit of individual American College of Surgeons (ACS) trauma triage criteria for prediction of severe injuries after consideration of concurrent physiologic, anatomic, mechanism, or "other" criteria. ⋯ Physiologic and anatomic trauma triage criteria predicted increased hospital resource utilization and severe injury. On the other hand, when used concurrently with physiologic, anatomic, and "other" criteria, some mechanism criteria worsen specificity with negligible improvement in sensitivity. In particular, crash speed > 20 mph and > or = 30-inch vehicle deformity had little predictive value for all outcomes.
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A simplified 4-step cricothyrotomy technique is described. The procedure can be completed in < 30 seconds without use of suction or additional light source. The only equipment needed is a #20 scalpel, a tracheal hook with a large radius, and a cuffed tracheostomy tube. ⋯ Because the operator's body position and hand movements (steps 3 and 4) are similar to those in orotracheal intubation, there is a feeling of familiarity that enhances retention of the procedure. The steps are illustrated and 4 cases using this technique are reported. Since the hands at each step are stabilized on the patient and no special equipment is needed, this technique also may be ideal for the out-of-hospital environment.
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Randomized Controlled Trial Clinical Trial
Topical tetracaine attenuates the pain of infiltration of buffered lidocaine.
To determine whether topical tetracaine attenuates the pain of buffered lidocaine infiltration. ⋯ Topical tetracaine attenuates the pain of infiltration of buffered lidocaine.
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Multicenter Study
A multisite survey of factors contributing to medically unnecessary ambulance transports.
To determine the social and demographic factors associated with medically unnecessary ambulance utilization, and to determine the willingness of patients to use alternate modes of transportation to the ED. ⋯ Patient age < 40 years and Medicaid coverage were associated with medically unnecessary ambulance use. Those patients for whom ambulance use was considered medically unnecessary commonly had no alternate means of transportation. Providing alternate means of unscheduled transportation may reduce the incidence of unnecessary ambulance use.