J Emerg Med
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Belarus is a small eastern European nation between Poland and Russia. Except for the lingering effects of Chernobyl radiation contamination, its system of health care and, in particular, emergency care has received little attention in the world literature. Emergency medical care is organized similarly to that provided in Russia and other European countries. ⋯ EDs, many patients have a minimal evaluation after admission to the actual ward or hospital ICU. Emergency Medicine has not been officially organized as a specialty. Opportunities exist for interchange and discussion on the delivery of emergency care.
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Emergency Medical Services (EMS) rely on batteries to power external cardiac defibrillators. While maintenance protocols should be followed to ensure that batteries possess adequate capacity to power their defibrillator, they are not often applied to new batteries. This study examines the effects of prolonged storage on sealed lead acid (SLA) batteries, the number of batteries that are affected by lead sulfate, and the ability of a protocol to restore the capacity in SLA batteries. ⋯ After discharge, there was an average of 17% improvement in the measured capacity, with no differences in the final capacity readings in each battery type. In conclusion, sealed lead acid batteries are affected by prolonged storage. The loss of capacity created by accumulation of lead sulfate can be reversed if battery maintenance protocols are used as part of EMS quality assurance programs.
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Cardiogenic shock is one of the most dramatic presentations in Emergency Medicine and requires rapid and accurate assessment, evaluation, and treatment. The cardiovascular disasters that present with shock include acute myocardial infarction with pump failure, aortic dissection, massive pulmonary emboli, and cardiac tamponade. We report a patient who presented to our Emergency Department (ED) in cardiogenic shock 10 days after insertion of a permanent cardiac pacemaker. ⋯ In reviewing the literature, we found many reports relating to complications of pacemakers and even more information regarding the various etiologies of cardiac tamponade, but cardiac tamponade as a consequence of pacemaker insertion rarely has been reported. Cardiac tamponade can occur secondary to perforation of the right ventricle during pacemaker electrode insertion and manipulation. Perforation is generally believed to be benign and self-limiting and only rarely causes tamponade and hemodynamic compromise; however, that was not the case for our patient.
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This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. The U. S. ⋯ Causes of ED use by the elderly do not vary meaningfully by location. Most ED visits by this group are for conditions that seem appropriate for this setting. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.
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Comparative Study
Scene disposition and mode of transport following rural trauma: a prospective cohort study comparing patient costs.
This prospective cohort study was performed from 1994 to 1996 to compare the impact of scene disposition on prehospital and hospital costs incurred by rural trauma patients transported to a trauma center by helicopter or ground ambulance. The study included all rural adult injury victims who arrived at the tertiary trauma center by ambulance within 24 h of injury. Inclusion criteria consisted of inpatient admission or death in the emergency department, and any traumatic injury except burns. ⋯ Many severely injured patients were initially transported to a rural hospital rather than directly to the trauma center. At both the scene and rural hospital, consistent use of triage criteria appeared to be lacking in determining the severity of injury, appropriate destination, and mode of transport for trauma patients. Since no significant difference in prehospital helicopter and ground transport costs was demonstrated, the decision on mode of transport should be in the best interest of patient care.