Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Multicenter study of creatine kinase-MB use: effect on chest pain clinical decision making.
To determine whether creatine kinase-MB isomer (CK-MB) levels affect initial physician decisions regarding patients with potential cardiac chest pain. ⋯ For a minority of the patients who had subsequently proven MI, the CK-MB result helped guide disposition decisions. The CK-MB availability did not adversely impact the disposition of the patients who had unstable or new-onset angina.
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To evaluate the response by families of incompetent, chronically debilitated, and/or terminally ill patients who were contacted for do-not-attempt-resuscitation (DNAR) status by an emergency physician (EP). ⋯ The EP can play an important role in assisting the decision making process of families of incompetent, chronically debilitated, and/or terminally ill patients regarding institution of DNAR orders in the ED. Improved communication regarding existing DNAR orders with chronic care facilities might minimize the rare complaints received from families with preestablished DNAR orders.
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To determine whether either bedside teaching alone (group A) or bedside teaching with written course materials (group B) improved written examination scores, satisfaction with the rotation, or clinical grades of rotating PGY1 residents. ⋯ Both instructional methods were associated with improved written test performance. Written course materials did not augment bedside teaching in terms of test scores, clinical grades, or satisfaction with the rotation. At a university-based, high-volume ED, bedside teaching offers educational benefit to rotating PGY1 residents that may not be augmented by written course materials.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral intubation using a lighted stylet vs direct laryngoscopy in older children with cervical immobilization.
To compare the tracheal intubation success rates of blind oral intubation using a lighted stylet vs standard of direct laryngoscopy in anesthetized pediatric patients wearing rigid cervical collars. ⋯ Blind oral intubation using a lighted stylet under controlled conditions took longer than direct laryngoscopy. However, among those successful on the first intubation attempt, the times to intubation were not significantly different between groups (44.5 vs 52.9 sec). The lighted stylet technique is a viable alternative technique for intubating children who have concurrent cervical spine immobilization.
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To determine: 1) the number of patients arriving at the ED who had executed an advance directive (AD), 2) how many of the patients who had an AD brought the AD with them, and 3) whether those patients who did not have an AD had ever discussed ADs with their primary care providers (PCPs) or had ever heard of an AD. ⋯ The majority of high-risk patients presenting to this ED do not have ADs. Among those high-risk patients who did have ADs, fewer than 25% brought the ADs with them. The development of ADs for high-risk patients and the availability of ADs in the ED are woefully inadequate. Emergency physicians need to collaborate with PCPs to remedy these deficiencies.