J Emerg Med
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Multicenter Study
Primary care physician and patient factors that result in patients seeking emergency care in a hospital setting: the patient's perspective.
Much has been written about "abuse" and "overutilization" of Emergency Departments (EDs). We undertook to study, from the patient's perspective, physician and patient factors that influence the patient's decision to seek ED care. The study was designed as a convenience cohort, multi-centre survey, conducted in 13 hospitals in the Greater Toronto Area. ⋯ As many as 55% of patients presented to the ED because it was more convenient. Only a minority (23%) of patients felt their acuity of illness warranted an ED visit. Primary care physicians need to play a stronger role in educating their patients about the utilization of emergency care and the services offered in the office setting.
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Splenic rupture is a rare but potentially deadly complication of colonoscopy. We present the case of a 70-year-old male who presented with abdominal pain, initially stable, almost 2 days after colonoscopy. The patient's clinical status deteriorated shortly after abdominal CT scan identified splenic rupture.
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There are more than seven million firearms in Canada and approximately 1400 firearm-related deaths per year. These figures are far greater than those for most European countries, but far less than those for the United States. This article will discuss the different classes of firearm deaths and the associated costs. Public health issues will be explored, especially as they relate to the involvement of the Canadian Association of Emergency Physicians, as well as injury control recommendations.
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The authors appraised the effectiveness of an in-line traction technique developed to reduce posteriorly dislocated hips. We had found certain application difficulties with the Allis, or modified Allis, technique, and subsequently developed a method that was easier to implement for the physician. The dislocated hip is relocated using the physician's arm to raise and maneuver the affected leg as the physician's shoulder is raised. Patient data for the case series were collected from March 1994 to March 1998.
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Despite the use of protective gear, a 15-year-old hockey player died when he was struck in the chest by a puck. This is the fifth recorded hockey death related to so-called commotio cordis, that is, blunt chest injury without myocardial structural damage. ⋯ Physicians should be aware that commotio cordis represents a distinctive pathological condition, in the event of which immediate recognition, precordial thump, CPR, and defibrillation are potentially lifesaving. Appropriate medical supervision at amateur hockey games, 911 telephone access, and on-site automated external defibrillators are issues that deserve careful consideration.