Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine the short-term outcome of patients with a known seizure disorder who have a seizure, are evaluated by out-of-hospital care providers, and refuse transport. ⋯ Most patients (94.2%) who were evaluated by out-of-hospital care providers for a seizure and refused transport had no further seizure activity in the subsequent 72 hours. However, because there is a risk of recurrence, out-of-hospital care providers and medical command physicians should ensure that patients understand the risks of refusal.
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To describe a novel endotracheal intubation technique, magnetically guided intubation (MGI), and its rate of success in inexperienced medical students and interns using an airway mannequin model. ⋯ A novel method of orotracheal intubation using magnetic guidance is described as achieving a high rate of successful intubations when performed by inexperienced intubators.
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After a pilot study suggested that African American patients enrolled in managed care organizations (MCOs) were more likely than whites to be denied authorization for emergency department (ED) care through gatekeeping, the authors sought to determine the association between ethnicity and denial of authorization in a second, larger study at another hospital. ⋯ African Americans were more likely than whites to be denied authorization for ED visits. The observational study design raises the possibility that incomplete control of confounding contributed to or accounted for the association between ethnicity and gatekeeping decisions. Nevertheless, the questions that these findings raise about equity of gatekeeping indicate a need for additional research in this area.
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Case Reports
Ethics seminars: Consent and refusal in an urban American emergency department: two case studies.
Patients in the emergency department frequently voice refusals of care or are unable or unwilling to consent to care. While general principles surrounding consent and refusal can be articulated in theory, it is often far more complicated in the real setting. Further, it is impossible to contemplate in advance every possible situation that might arise. ⋯ Emergency physicians face such complex decisions on a routine basis. Ethical reasoning skills are obviously a core competence in emergency medicine, even if easy answers are elusive. Two cases are presented that illustrate this complexity, and routes to resolution are discussed.
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To implement a new five-level emergency department (ED) triage algorithm, the Emergency Severity Index (ESI), into nursing practice, and validate the instrument with a population-based cohort using hospitalization and ED length of stay as outcome measures. ⋯ Triage nurses at these two hospitals successfully implemented the ESI algorithm and provided useful feedback for further refinement of the instrument. Emergency Severity Index triage reproducibly stratifies patients into five groups with distinct clinical outcomes.