Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine the short-term medical outcome of hypoglycemic insulin-dependent diabetic patients who refuse transport after out-of-hospital therapy and return to baseline mental status. ⋯ The practice of treating and releasing most hypoglycemic insulin-dependent diabetic patients who return to normal mental status after D50W administration appears in general to be safe. Patients should be advised of the risks of recurrent hypoglycemia.
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An important argument for emergency physician use of ultrasonography is that it results in more rapid patient disposition, but there are few articles to support this position. This study sought to demonstrate a significant decrease in the time spent in the ED when emergency physicians performed transvaginal ultrasonography (TVUS), as compared with when TVUS was performed by consultants, in the evaluation of first-trimester pelvic pain or vaginal bleeding. ⋯ This study demonstrates a more rapid ED transit time when TVUS was performed at the bedside by emergency physicians as compared with when pelvic ultrasonography required consultation. Additionally, fewer calls to consultants were required.
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Jehovah's Witnesses are members of a Christian group that does not allow blood transfusion. It is a general practice for adult Witnesses to carry on their person a wallet-sized advance directive card refusing blood. The blood refusal card directs that no blood is to be given to the owner under any circumstance, even if physicians believe transfusion will be lifesaving. ⋯ Advance directives regarding life and death decisions should be subject to scrutiny and not be automatically accepted at face value. A goodfaith decision to transfuse the unconscious adult Jehovah's Witness, in emergent need of blood, is justified if the patient does not have a blood refusal advance directive that is informed and otherwise survives a high level of scrutiny. The ethical and medicolegal considerations upon which this thesis is based are discussed.
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To examine the population and geographic patterns, patient characteristics, and clinical presentations and outcomes of alcohol-related ED visits at a national level. ⋯ Alcohol abuse poses a major burden on the emergency medical care system. The age, gender, and geographic characteristics of alcohol-related ED visits are consistent with drinking patterns in the general population.
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Jehovah's Witnesses refuse blood transfusions out of obedience to the Bible's command to all Christians to abstain from blood. The Witnesses take this scriptural injunction seriously and, of their own initiative, execute advance medical directive cards to communicate their refusal to medical personnel in the event of their incapacity. ⋯ Further, not only does Migden and Braen's analysis subordinate patient values to professional preference in all cases, but the heightened scrutiny protocol they propose is useless because it cannot possibly be implemented in the hypothetical they posit. Finally, their legal analysis is not well founded and practitioners who choose to follow it will do so at their peril.