Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Hypertension is common after intracranial hemorrhage (ICH) and may be associated with higher mortality and adverse neurologic outcome. The American Heart Association recommends that blood pressure be maintained at a mean arterial pressure (MAP) less than 130 mm Hg to prevent secondary brain injury. ⋯ Hypertension after acute ICH is associated with adverse neurologic outcome. The dose of hypertension may more accurately identify patients at risk for adverse outcomes than the American Heart Association guidelines and may lead to better outcomes if treated when identified in this manner.
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To describe the evaluation and outcomes of elder patients with suspected acute coronary syndromes (ACS) presenting to the emergency department (ED). ⋯ Elder patients who present to the ED with suspected ACS represent a population at high risk for ACS and 30-day mortality. Elders are more likely to be admitted to the hospital, but despite an increased risk for adverse events, they have similar odds of receiving a diagnostic test, such as stress cardiac imaging or cardiac catheterization, compared with nonelder patients. Different clinical variables are associated with ACS, and clinical prediction rules utilizing presenting symptoms should consider the effect modification of age.
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Tracking medical student clinical encounters is now an accreditation requirement of medical schools. The use of handheld computers for electronic logging is emerging as a strategy to achieve this. ⋯ Electronic logging by medical students during their emergency medicine clerkship has many potential benefits as a method to document clinical encounters and procedures performed. However, this study demonstrated poor compliance and dissatisfaction with the process. In order for electronic logging using handheld computers to be a beneficial educational tool for both learners and educators, obstacles to effective implementation need to be addressed.
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Randomized Controlled Trial Comparative Study
Can untrained laypersons use a defibrillator with dispatcher assistance?
Automated external defibrillators (AEDs) provide an opportunity to improve survival in out-of-hospital cardiac arrest by enabling laypersons not trained in rhythm recognition to deliver lifesaving therapy. This study was performed to examine whether untrained laypersons could safely and effectively use these AEDs with telephone-guided instructions and if this action would compromise the performance of cardiopulmonary resuscitation (CPR) during a simulated ventricular fibrillation out-of-hospital cardiac arrest. ⋯ The quality of dispatcher-assisted CPR is poor. Dispatcher assistance in defibrillation by a layperson not trained to use an AED seems feasible and does not compromise the performance of CPR.