Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To examine presentations and prevalence of head injury among elder victims of blunt trauma and to estimate the prevalence of occult injuries associated with a normal level of consciousness, absence of neurologic deficit, and no evidence of significant skull fracture. ⋯ Elder patients with head trauma are at higher risk of developing a significant intracranial injury, including subdural and epidural hematoma. An occult presentation is also more common in elders.
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To determine whether performance decrements at night actually translate into worsened measures of quality of patient care in the emergency department (ED). Emergency physicians and healthcare workers are sleepier and less cognitively proficient at night than during the day. Despite a lack of data, medical errors have been attributed to these deficits, and pharmacologic solutions recently have been suggested. ⋯ Quality indicators used in this study do not demonstrate marked deficits in patient care occurring at night. A very small, but measurable, increase in early mortality was identified. Improved measures to counter circadian disruption warrant study but may result in minimal improvements in patient care.
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Comparative Study
Confirmation of endotracheal tube placement after intubation using the ultrasound sliding lung sign.
To evaluate the performance of the ultrasound (US) sliding lung sign as a predictor of endotracheal tube (ETT) placement. Many other tools and examination findings have been used to confirm ETT placement; erroneous placement of the ETT has even been confirmed by US. ⋯ These results show that US imaging of the sliding lung sign in a cadaver model is an accurate method for confirmation of ETT placement. Further, the technique may have some utility in differentiating RMS bronchus from main tracheal intubations.
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Emergency department (ED) overcrowding threatens quality of care by delaying the time to diagnosis and treatment of patients with time-sensitive diseases, such as acute stroke. ⋯ In the authors' institution, the presence of concurrent trauma evaluation does not delay CT imaging of patients with potential stroke.
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To define in centimeters what constitutes mild, moderate, and severe acute pain in children by using the Color Analogue Scale (CAS) for pain. ⋯ This study quantifies what constitutes mild, moderate, and severe pain on the CAS scale. This information should be used to properly triage children with painful conditions and to identify appropriate patients for enrollment in analgesic studies.