J Emerg Med
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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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This is the 34th article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Abdominal and gastrointestinal complaints are common problems in the emergency department and often lead to consultation with a surgeon. Because an understanding of the principles of surgical diagnosis and treatment is an essential component of the practice of emergency medicine, residents rotating on surgical services require specific goals and objectives to emphasize early patient assessment, identification of the possible need for surgery, and a basic understanding of definitive management.
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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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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.
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Case Reports
Use of the laryngeal mask prior to definitive intubation in a difficult airway: a case report.
The laryngeal mask, a relatively new airway adjunct, consists of a large tube with an inflatable shallow mask at its distal end which forms a seal around the glottic opening. We describe a case of a difficult intubation in the emergency department of an obese patient with microagnathia, a short bull neck, and a nasopharyngeal hemorrhage in which a laryngeal mask was used to temporarily manage the airway prior to definitive intubation. In difficult airway cases where it is impossible to ventilate the patient by face mask or intubate the trachea, ventilation with the laryngeal mask may be an alternative to transtracheal jet ventilation or cricothyrotomy. The laryngeal mask may be useful in managing the difficult airway provided that the risks of an inadequate seal, obstruction, coughing and laryngospasm, and lack of protection from aspiration are recognized.