J Emerg Med
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We designed a prospective observational study to attempt to validate two recently described clinical decision rules for knee radiography. Consecutive patients aged > or = 15 yr with acute knee injuries occurring less than 1 wk prior to presentation were included for study. Patients with distracting conditions, open knee injuries, or previous surgery were excluded. ⋯ Use of the Stiell rule would have led to radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 49.8%). We conclude that neither clinical decision rule is 100% sensitive. Further refinement will be necessary to identify all patients with knee fractures.
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Hospital emergency departments were surveyed to estimate the number of patients treated for carbon monoxide (CO) poisoning after a severe winter storm disrupted electrical service in western Washington State. At least 81 persons were treated. The two main sources of CO were charcoal briquettes (54% of cases) and gasoline-powered electrical generators (40% of cases). ⋯ All persons affected by CO from generators were non-Hispanic Whites. This was the largest epidemic of storm-related CO poisoning reported in the United States. This epidemic demonstrated the need to anticipate CO poisoning as a possible consequence of winter storms in cold climates and to make preventive messages understandable to the entire population at risk, including those persons who do not understand written or spoken English.
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Our study objective was to determine whether simple clinical criteria can be used to safely reduce the number of patients who require cranial computed tomography (CT) scan after sustaining minor head trauma. Awake patients (Glascow Coma Scale = 15) who presented to the emergency department with acute head injury associated with a loss of consciousness were evaluated for clinical predictors of head injury prior to CT scan. The studied risk factors included severe headache, nausea, vomiting, and depressed skull fracture on physical examination. ⋯ The use of four simple clinical criteria in minor head trauma patients would allow a 61% reduction in the number of head CT scans performed and still identify all patients who require neurosurgical intervention and the majority of patients with an abnormal CT scan. This method could lead to a large savings in patient charges nationwide. Further studies may be helpful in confirming these findings.
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Biography Historical Article
Edlich drive: a metaphor for the Edlich tradition.
Richard F. Edlich, MD, the Raymond F. Morgan Professor of Plastic Surgery and Professor of Biomedical Engineering, has been honored with the naming of a new road at North Fork Business Park: Edlich Drive. ⋯ Edlich's unparalleled contributions to his community include the establishment of the Emergency Department at the University of Virginia, the implementation of a regional emergency medical system, and the development of the Pegasus Emergency Flight Operations. Other accomplishments include the founding of the Ira DeCamp Regional Burn Center and the Department of Rehabilitation Medicine. "Drive" aptly characterizes Dr. Edlich's unfailing commitment to his many roles as physician, research scientist, community leader, and mentor for medical students and residents.
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The study objective was to assess Canadian emergency physicians for their management preferences and their compliance with recently developed guidelines for treatment of acute asthma in adults. The design was a cross-sectional survey sent to members of the Canadian Association of Emergency Physicians (CAEP) and to the emergency department (ED) directors of all Canadian hospitals with more than 25 beds in November 1992. ED directors who had not responded were sent a second survey in January 1993. ⋯ Physicians with more training were more likely to assess and treat patients according to current asthma treatment guidelines. The survey shows that many Canadian emergency physicians did not follow published recommendations for the care of patients with acute asthma. This finding was especially so with regard to objective evaluation of airflow, aggressive use of beta-agonists, the use of corticosteroids, and in making appropriate arrangements for patient discharge and follow-up.