Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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This SAEM position paper clarifies the role of emergency medicine in health care delivery. It builds upon the working definition of emergency medicine developed by the American College of Emergency Physicians in 1994 by describing the health care role of emergency physicians (EPs). EPs are first-contact providers who care for all patients regardless of age, gender, time of presentation, or ability to pay. ⋯ The EP's role is in organizing and monitoring the emergency care delivery system. Part of this role is to better align the health care provider training and ability with the specific medical needs of a patient. The emergency health care system remains the essential medical safety net for all individuals needing care in this country.
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Comparative Study
Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose.
To determine whether naloxone administered i.v. to out-of-hospital patients with suspected opioid overdose would have a more rapid therapeutic onset than naloxone given subcutaneously (s.q.). ⋯ There was no clinical difference in the time interval to respiratory rate > or =10 breaths/min between naloxone 0.8 mg s.q. and naloxone 0.4 mg i.v. for the out-of-hospital management of patients with suspected opioid overdose. The slower rate of absorption via the s.q. route was offset by the delay in establishing an i.v.
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To describe the training and certification of physicians who staff small EDs in rural West Virginia. ⋯ The majority of physicians staffing small rural EDs in West Virginia are neither residency-trained nor board-certified in EM. Further studies are warranted to determine the most efficient and effective way to maximize the skills and availability of emergency care providers in rural settings.
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To determine the test performance of a single serum progesterone value <5.0 ng/mL for detecting ectopic pregnancy or other abnormal pregnancies in symptomatic ED patients with beta-hCG levels <1,000 mIU/mL. ⋯ A single progesterone value <5.0 ng/mL has high sensitivity and specificity in detecting abnormal pregnancy in symptomatic ED patients with beta-hCG values <1,000 mIU/mL.
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To examine the effect of emergency immobilization on neurologic outcome of patients who have blunt traumatic spinal injuries. ⋯ Out-of-hospital immobilization has little or no effect on neurologic outcome in patients with blunt spinal injuries.