Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients.
To determine if midazolam is superior to lorazepam or haloperidol in the management of violent and severely agitated patients in the emergency department. Superiority would be determined if midazolam resulted in a significantly shorter time to sedation and shorter time to arousal. ⋯ Midazolam has a significantly shorter time to onset of sedation and a more rapid time to arousal than lorazepam or haloperidol. The efficacies of all three drugs appear to be similar.
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In May 2004, the Society for Academic Emergency Medicine (SAEM) National Affairs Committee was tasked with evaluation of graduate medical education (GME) funding in the face of declining Medicare reimbursement and support, and its implications for emergency medicine. This article was developed to educate the SAEM membership on the current status and climate of funding for GME and to serve as the basis of a position statement from SAEM on this topic. The paper presents the history and background on GME financing followed by currently known changes from the recently signed Medicare Act of 2003.
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Clinical Trial
Derivation of clinical prediction rules to identify children with fractures after twisting injuries of the ankle.
The authors sought to derive maximally sensitive prediction rules for identifying children with significant fractures after acute twisting injuries to the ankle. ⋯ A set of sensitive prediction rules was developed to identify children with significant fractures after twisting injuries to the ankle. External validation and refinement of the rules will be needed before recommendation of widespread use.
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Clinical Trial
Noninvasive intracranial cerebral flow velocity evaluation in the emergency department by emergency physicians.
Transcranial Doppler (TCD) is an accepted modality for the evaluation of cerebral blood flow velocities. ⋯ Noninvasive blood flow velocity monitoring of the middle cerebral artery using TCD is feasible in the ED when performed at the bedside on intubated patients with traumatic brain injury and others during tracheal intubation and resuscitation.
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During a widespread North American blackout in August 2003, the authors identified a cluster of patients presenting to their northern Manhattan emergency department (ED) with complaints related to medical device failure. The characteristics of this group with respect to presenting complaint, type of device failure, time spent in the ED, and disposition are described in an effort to better understand the resource needs of this population. ⋯ Patients using electrical medical devices seek care in the ED when power failure occurs, and they require significant ED and hospital resources. Effective disaster planning should anticipate the needs of this population.