Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Editorial Comparative Study
Level 1 cardiac arrest centers: learning from the trauma surgeons.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Propofol versus midazolam/fentanyl for reduction of anterior shoulder dislocation.
The authors aimed to compare propofol and midazolam/fentanyl for reduction of anterior shoulder dislocations using the modified Kocher's maneuver. ⋯ Propofol appears to be as effective as midazolam/fentanyl for reduction of anterior shoulder dislocation using the modified Kocher's maneuver. However, the advantage of shorter wakening times associated with propofol should be weighed against the possibility of adverse events, particularly respiratory depression and vomiting.
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Comparative Study
Identification of out-of-hospital cardiac arrest clusters using a geographic information system.
To locate all out-of-hospital cardiac arrests (OHCAs) in Rochester, New York, and identify clusters of OHCAs, as well as clusters of patients who did not receive bystander cardiopulmonary resuscitation (CPR), in order to identify locations that may benefit from prevention efforts. ⋯ Out-of-hospital cardiac arrest can be plotted by geographic location. Clusters of OHCAs can be identified, which could be used to guide resource allocation. Clusters of OHCAs in which the patients did not receive bystander CPR can also be identified and could be used to direct educational programs. Census data can be superimposed on this information to identify characteristics of cluster locations and were used to demonstrate that the identified clusters were not simply the result of population density.
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The authors sought to validate a clinical decision rule that young adult (younger than 40 years) chest pain patients without known cardiac disease who had either no cardiac risk factors and/or a normal electrocardiogram (ECG) are at low risk (<1%) for acute coronary syndromes (ACS) and 30-day adverse cardiovascular (CV) events. ⋯ A modified clinical decision rule described a group of patients with a 0.14% risk of ACS that was free from 30-day adverse CV events.
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Multicenter Study Comparative Study
Attitudes and judgment of emergency physicians in the management of patients with acute headache.
There is little evidence guiding physicians in the evaluation of acute headache to rule out nontraumatic subarachnoid hemorrhage (SAH). The authors assessed emergency physicians in: 1) their pretest accuracy for predicting SAH, 2) their comfort with not ordering either head computed tomography (CT) or lumbar puncture (LP) in patients with acute headache, and 3) their comfort with not ordering head CT before performing LP in patients with acute headache. ⋯ Physicians were able to moderately discriminate SAH from other causes of headache before diagnostic testing.