Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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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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To determine the rate of termination of resuscitative efforts for out-of-hospital cardiac arrest patients and whether variability exists among different base hospitals providing online medical control (OLMC). ⋯ There is significant variability in Los Angeles, depending on the particular base hospital that provides OLMC, in pronouncement of death and termination of resuscitative efforts for medical cardiac arrest in the field. Given potential ethical, logistical, and economic concerns, efforts to assure consistency in the practice of discontinuing resuscitative efforts in the field is warranted.
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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
Identification of out-of-hospital cardiac arrest clusters using a geographic information system.
To locate all out-of-hospital cardiac arrests (OHCAs) in Rochester, New York, and identify clusters of OHCAs, as well as clusters of patients who did not receive bystander cardiopulmonary resuscitation (CPR), in order to identify locations that may benefit from prevention efforts. ⋯ Out-of-hospital cardiac arrest can be plotted by geographic location. Clusters of OHCAs can be identified, which could be used to guide resource allocation. Clusters of OHCAs in which the patients did not receive bystander CPR can also be identified and could be used to direct educational programs. Census data can be superimposed on this information to identify characteristics of cluster locations and were used to demonstrate that the identified clusters were not simply the result of population density.
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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.