Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The authors sought to validate a clinical decision rule that young adult (younger than 40 years) chest pain patients without known cardiac disease who had either no cardiac risk factors and/or a normal electrocardiogram (ECG) are at low risk (<1%) for acute coronary syndromes (ACS) and 30-day adverse cardiovascular (CV) events. ⋯ A modified clinical decision rule described a group of patients with a 0.14% risk of ACS that was free from 30-day adverse CV events.
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Comparative Study
A novel method of evaluating the impact of secondary brain insults on functional outcomes in traumatic brain-injured patients.
Prior studies suggest that the emergency department (ED) occurrence of secondary brain insults (SBIs), such as systemic hypotension and hypoxia, worsens outcome in patients with traumatic brain injury. However, previous methods of assessing SBIs have been relatively crude, generally only determining the incidence and duration of events. The authors hypothesized that a new method that accounts for the cumulative depth and duration of SBIs would provide a more informative measure that better correlates with outcome. ⋯ New methods of measuring SBIs that take into account depth and duration of episodes may more accurately reflect the influence of these events on outcome after head trauma.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Propofol versus midazolam/fentanyl for reduction of anterior shoulder dislocation.
The authors aimed to compare propofol and midazolam/fentanyl for reduction of anterior shoulder dislocations using the modified Kocher's maneuver. ⋯ Propofol appears to be as effective as midazolam/fentanyl for reduction of anterior shoulder dislocation using the modified Kocher's maneuver. However, the advantage of shorter wakening times associated with propofol should be weighed against the possibility of adverse events, particularly respiratory depression and vomiting.
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Multicenter Study Comparative Study
Attitudes and judgment of emergency physicians in the management of patients with acute headache.
There is little evidence guiding physicians in the evaluation of acute headache to rule out nontraumatic subarachnoid hemorrhage (SAH). The authors assessed emergency physicians in: 1) their pretest accuracy for predicting SAH, 2) their comfort with not ordering either head computed tomography (CT) or lumbar puncture (LP) in patients with acute headache, and 3) their comfort with not ordering head CT before performing LP in patients with acute headache. ⋯ Physicians were able to moderately discriminate SAH from other causes of headache before diagnostic testing.
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Comparative Study
An emergency department guideline for the diagnosis of pulmonary embolism: an outcome study.
To assess the clinical outcome of patients suspected of pulmonary embolism (PE) following implementation of an emergency department (ED) diagnostic guideline. ⋯ Implementation of a PE diagnostic guideline in a community ED setting is safe and has improved the specificity of the enzyme-linked immunosorbent assay D-dimer test when compared with previous studies.