J Emerg Med
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A pilot study was conducted to enumerate the most common evaluations done in the emergency department (ED) of a community hospital in assessing patients presenting with a first episode of syncope and to determine the feasibility of defining a clinically useful set of investigations to identify the subset of syncopal patients that can be safely discharged from the ED. The study was conducted as a retrospective chart review of patients seen during an 8 week period. In the course of the study, 33 consecutive adult patients presenting to the ED with first episodes of syncope were identified. ⋯ In this small study, few patients presenting with new onset syncope required admission. The number and types of investigations performed on these patients was inconsistent. Further study is needed to determine whether syncopal patients requiring admission can be identified in the ED with a small number of standard inexpensive laboratory investigations.
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In complex dislocations of the metacarpophalangeal joint, the volar plate is separated from the proximal phalanx and the metacarpal head is entrapped within surrounding tissue structures. These complex dislocations must be managed by open surgical reduction to reduce the dislocation and realign the volar plate. A 58-year-old male presented to the emergency department with a complex dislocation of the metacarpophalangeal joint of the left little finger, which was successfully treated by open reduction in the operating room. The indications for open reduction of metacarpophalangeal joint dislocations are reviewed.
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This study was designed to evaluate patients presenting to a large urban university emergency department (ED) who were subsequently denied authorization for reimbursed care by their managed care provider and to characterize the denial as potentially safe or unsafe based on published triage criteria. A consecutive case surveillance was performed from October 1, 1994 to September 30, 1995 at a university-based ED (30,000 visits per year) for adult patients in inner-city Chicago. Cases were comprised of adult managed care participants whose providers refused by telephone to authorize payment for ED services and who then left the ED without treatment. ⋯ By previously established criteria, 115 (47.1%) were identified as potentially unstable, 61 (53%) due to abnormal vital signs and 54 (47%) with other high-risk indications such as severe pain, chest pain, or abdominal pain. These potentially high-risk patients may subsequently suffer adverse outcomes. Current guidelines used for telephone triage by managed care to divert patients from our ED do not meet previously published safe triage criteria.
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The purpose of this report is to describe another case of a molten metal burn to the foot of a foundry worker. The foundry in which he worked failed to comply with Occupational Safety and Health Administration regulations with regard to protective apparel. This injury could have been prevented with annual, unscheduled inspections by the Occupational Safety and Health Administration and with enforcement of additional regulations regarding protective apparel.