Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine the level of agreement between emergency physicians (EPs) and psychiatrists regarding the need for acute psychiatric hospitalization and treatment for patients presenting with alleged psychiatric complaints. ⋯ Moderate agreement between EPs and psychiatrists in key impressions and admission decisions suggests that shared training in psychiatric decision making, especially during residency training, is desired in this setting.
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To determine the incremental benefit of individual American College of Surgeons (ACS) trauma triage criteria for prediction of severe injuries after consideration of concurrent physiologic, anatomic, mechanism, or "other" criteria. ⋯ Physiologic and anatomic trauma triage criteria predicted increased hospital resource utilization and severe injury. On the other hand, when used concurrently with physiologic, anatomic, and "other" criteria, some mechanism criteria worsen specificity with negligible improvement in sensitivity. In particular, crash speed > 20 mph and > or = 30-inch vehicle deformity had little predictive value for all outcomes.
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A simplified 4-step cricothyrotomy technique is described. The procedure can be completed in < 30 seconds without use of suction or additional light source. The only equipment needed is a #20 scalpel, a tracheal hook with a large radius, and a cuffed tracheostomy tube. ⋯ Because the operator's body position and hand movements (steps 3 and 4) are similar to those in orotracheal intubation, there is a feeling of familiarity that enhances retention of the procedure. The steps are illustrated and 4 cases using this technique are reported. Since the hands at each step are stabilized on the patient and no special equipment is needed, this technique also may be ideal for the out-of-hospital environment.
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To determine emergency physicians' (EPs') attitudes toward physician-assisted suicide (PAS), factors associated with those attitudes, current experiences with attempted suicides in terminally ill persons, and concerns about the impact of legalizing PAS on emergency medicine practice. ⋯ Although the majority of Oregon EPs favor the concept of legalization of PAS, most have concerns that safeguards in the Oregon initiative are inadequate to protect vulnerable patients. These physicians would consider not resuscitating terminally ill patients who have attempted suicide under the law's provisions, only in the setting of documentation of the patient's intent.
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Child sexual abuse is an increasingly common problem. This article reviews the current clinical and behavioral indicators that will aid the emergency physician when evaluating and managing this condition. The most common differential diagnoses are described and a general approach to this diagnosis is suggested. Adopting a multidisciplinary method when evaluating this problem will lessen the anxiety facing the examining physician and provide a better outcome for the child, parents, and community.