Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine whether clinical parameters and neurologic scores can be used to guide the decision to obtain computed tomography (CT) head scans for ethanol- intoxicated patients with presumed-minor head injuries. ⋯ The prevalence of intracerebral injury in CT scans of ethanol-intoxicated patients with minor head injuries was 8.4%. Commonly used clinical parameters and neurologic scores at presentation and one hour later were unable to predict which patients would have intracerebral injuries and evidenced by CT scans. Our low (1.9%) neurosurgical intervention rate supports the need to develop a selective approach to CT scanning in this population.
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Comparative Study
Positive-outcome bias: comparison of emergency medicine and general medicine literatures.
The existence of positive-outcome bias in the medical literature is well established. Positive-outcome bias in two emergency medicine journals was compared with that found in two general medicine journals. ⋯ There was no significant difference in the proportions of positive-outcome studies published in this sample of the emergency medicine literature compared with the general medicine literature. The potential impact of positive-outcome bias and methods of dealing with the problem are reviewed.
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To determine if stress levels of emergency medical services (EMS) personnel can be reduced by adjusting work schedules to personnel preferences. ⋯ Stress in EMS personnel increased despite a new schedule pattern designed to accommodate the preferences of EMS personnel.
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Recovery from severe cyclic antidepressant overdose with hypertonic saline/dextran in a swine model.
To determine the effect of a hypertonic saline and dextran (HSD) solution on blood pressure and QS duration during severe cyclic antidepressant (CA) toxicity in swine. ⋯ In this swine model of severe CA toxicity, a solution of 7.5% saline/6% dextran significantly reversed hypotension and QRS prolongation. HSD also improved survival to 60 minutes.
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For educational purposes, the Residency Review Committee for Emergency Medicine requires that emergency medicine residencies "provide a mechanism for each resident to obtain information on outcomes of patients the resident has evaluated in the emergency department." The authors analyzed the current patient follow-up systems of emergency medicine residencies and, based upon survey results propose a comprehensive organized system of follow-up. ⋯ Most emergency residency-affiliated hospitals in our survey had follow-up systems in place. Of existing systems, only a minority were rated by residency directors as effective or satisfactory. A model for a comprehensive system of patient follow-up is proposed.