J Emerg Med
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Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in children. In addition to these more typical features, the 13-month-old boy reported here developed clinical, radiographic, and echocardiographic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shortening fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up echocardiography as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salicylate-induced pulmonary edema.
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Rapid sequence intubation (RSI) has recently gained wide acceptance among emergency physicians (EP). The debate regarding the safety of neuromuscular blocking (NMB) agents in the hands of EPs nonetheless remains open, as objective studies are few, and all data available so far come from tertiary care centers. This retrospective study was done to review our experience with RSI and assess the related morbidity and mortality. ⋯ All patients were successfully intubated. No mortality was attributed to the use of muscle relaxants. Our results support the safety and effectiveness of RSI in the hands of emergency physicians.
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The objective of this study was to determine the degree of association of self-estimated scholastic standing (self-rank) with an independent evaluation of the dean's letter (dean's letter score). Applicants to our emergency medicine residency program were asked to estimate their scholastic standing on the application form. A blinded independent review of the dean's letter for each applicant was performed, and the letter was scored. ⋯ There was also an appreciable relationship between self-rank and final rank in the NRMP Match. Self-rank of scholastic standing by applicants to an emergency medicine residency is strongly associated with dean's letter information. Self-rank may be useful during early screening of applications before dean's letters are available.
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We constructed a clinical decision rule to optimize the use of radiography in patients with acute knee injuries. A prospective observational study at a university hospital ED was conducted over 10 months. Patients 15 years of age and older with acute knee injuries who underwent radiography were included. ⋯ Limiting knee radiography to patients with these criteria would have reduced radiography by 39% without missing a fracture. In conclusion, a clinical decision rule for knee radiography that requires the presence of either an inability to bear weight, an effusion, or an ecchymosis was shown to reduce the need for radiography by 39% while still identifying all fractures. Prospective validation of this model is required.
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How will emergency department utilization and costs be affected by universal coverage provisions? Proponents of health care reform predict that the number of ED visits will decline when currently uninsured Americans become eligible for primary physicians' care. However, economic concepts indicate the contrary: that ED volume and costs will actually escalate upon implementation of health care reform initiatives. These basic concepts include: 1) the insulation of most consumers from the true cost of health care, fostering higher demands for that care; 2) the financial benefits afforded physicians and health maintenance organizations by ED's ability, and legal responsibility, to assess and treat any patient at any time; and 3) access to ED personnel and material by individuals with urgent and nonurgent conditions, which generates fixed costs, regardless of patient volume. These effects of health care reform on EDs must be anticipated by hospital administrators to avoid compromise of patient care quality and consumer satisfaction.