Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine whether out-of-hospital care charts selectively report trauma triage criteria, and the impact of such documentation on triage guideline development. ⋯ In the authors' EMS system, standard EMS report documentation underreports ACS trauma triage mechanism criteria. This underreporting appears to bias outcome analysis in the direction of a worse outcome and more resource utilization. Reporting of mechanism-of-injury criteria improves with use of a structured data instrument.
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Comparative Study Clinical Trial Controlled Clinical Trial
Subcutaneous lidocaine does not affect the success rate of intravenous access in children less than 24 months of age.
To determine whether subcutaneous lidocaine (SQL), when used to decrease the pain of IV catheter insertion, adversely affects IV access in children < 24 months of age. ⋯ SQL use prior to an IV attempt in children < 2 years of age does not impact vascular access. A secondary finding was that vascular access with and without SQL in infants and small children generally can be accomplished in 1 attempt.
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To determine the level of agreement between emergency physicians (EPs) and psychiatrists regarding the need for acute psychiatric hospitalization and treatment for patients presenting with alleged psychiatric complaints. ⋯ Moderate agreement between EPs and psychiatrists in key impressions and admission decisions suggests that shared training in psychiatric decision making, especially during residency training, is desired in this setting.
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To determine the accuracy of CT of the chest in diagnosing the presence of cardiac injury in stable patients with penetrating chest injuries. ⋯ Chest CT may be a useful test for diagnosing the presence of hemopericardium in the setting of penetrating thoracic injury. With the caveat that the patient must be removed from a closely monitored environment, the authors the use of CT in stable patients with penetrating chest wounds whenever echocardiography is unavailable.
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To determine whether the shock index (SI), defined as the ratio of heart rate (HR) to systolic blood pressure (SBP), is a useful marker for significant injury in trauma patients. ⋯ The optimal SI threshold performed similarly to the optimal threshold HR or SBP for prediction of injury severity.