Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Subarachnoid hemorrhage (SAH) is a diagnosis often considered in patients presenting to the ED with acute sudden headaches, but with normal physical examinations. Standard of care today is for these patients to be investigated by noncontrast CT scan followed by lumbar puncture (LP) for negative CTs. ⋯ Given reasonable assumptions, for every 100 patients investigated, the "LP-first" model would result in 79 to 83 fewer CT scans and only seven to 11 additional LPs, as compared with traditional strategies. Among ED headache patients meeting LASH criteria, the authors believe use of this model could result in more efficient use of resources, minimal additional morbidity, and equal diagnostic accuracy for SAH.
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In first-trimester patients with abdominal pain or vaginal bleeding, pelvic ultrasonography (US) is often performed to assess the status of the pregnancy. Identification of echogenic material within the endometrial cavity in the absence of a gestational sac has been attributed to the presence of either retained products of conception or clotted blood. However, to the authors' knowledge, no study has directly addressed whether this finding reliably excludes the diagnosis of a normal intrauterine pregnancy (IUP). ⋯ In symptomatic patients who have echogenic material but no gestational sac visualized within the endometrial cavity at US, the likelihood of a normal IUP is low.
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To evaluate the quality of life of survivors of in-hospital and out-of-hospital cardiac arrest, and to correlate quality of life with clinically important parameters. ⋯ Although overall survival was poor, most survivors had acceptable health-related quality of life. Therefore, concerns about poor quality of life are not a valid reason to abandon efforts to improve the health care system's response to victims of sudden cardiac arrest. Further research is necessary to identify effective strategies for improving both survival and quality of life after cardiac arrest.
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Interest in international emergency medicine (EM) has grown steadily over the last ten years. This growth has been fueled by increased demand for emergency services abroad and the proliferation of emergency physicians (EPs) working in international relief and development. ⋯ Therefore, a group of EPs interested in fellowship training convened for the purpose of developing goals and objectives for a postgraduate training program in international EM. To that end, this article proposes guidelines for a fellowship training program for international EM.
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The objective of this article is to identify and describe Chinese emergency medical services (EMS) components. Chinese EMS system development began in the 1980s with "importing" of EMS principles from other systems. China is now attempting to unify these principles. ⋯ No on-line radio communication between hospitals and ambulances typically takes place. China has assimilated both traditional and unique EMS components and is undergoing development. It remains unclear whether a systematized EMS structure will emerge.