J Emerg Med
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Comparative Study
Ottawa Knee Rule: a comparison of physician and triage-nurse utilization of a decision rule for knee injury radiography.
The Ottawa Knee Rule (OKR) is a clinical decision rule for the ordering of knee radiographs by physicians in patients with blunt knee injuries. However, in many Emergency Departments, radiographs are also ordered by nurses during triage. This study was designed to compare application of the OKR by triage nurses and physicians. ⋯ No fractures were missed by physicians or nurses. Triage nurses and EPs in this study had fair agreement in their application of the OKR. Triage nurses greatly overestimated knee injuries, while maintaining sensitivity, at the expense of specificity and cost savings.
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We report the case of a 63-year-old man who presented to the Emergency Department (ED) with a 1-week history of sore throat, hoarseness and dysphagia. During his ED workup, the patient experienced an acute delirium 25 min after being given 2 mg of Lorazepam. The patient's mentation returned to normal within 1-2 min of being given 1 mg of Flumazenil. We discuss the various behavioral side effects of benzodiazepines and the indications for the use of Flumazenil.
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The objective of this study was to derive a simple equation to convert distances between air miles traveled by a helicopter and ground miles traveled by an ambulance. We performed a retrospective analysis of a convenience sampling of 245 "lights and sirens" ground ambulance transports between 1993 and 1997. Ground distances were recorded from odometer miles for each transport. ⋯ The approximation equation yielded an answer within 1 mile of the regression equation for distances up to 40 air miles. It is concluded that in a mixed rural and urban EMS system, one may convert air and ground mileage estimates by using the simple relationship: Ground miles = 1.3 (air miles). This conversion coefficient may prove useful for EMS personnel in designing reasonable helicopter utilization policies, making accurate transport decisions and conducting research.
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Letter Case Reports
Spontaneous rupture of arteriovenous fistula in a chronic dialysis patient.
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Randomized Controlled Trial Clinical Trial
A randomized study of electronic mail versus telephone follow-up after emergency department visit.
This study was conducted to determine whether electronic mail (e-mail) increases contact rates after patients are discharged from the emergency department (ED). Following discharge, patients were randomized to be contacted by telephone or e-mail. The main outcome was success of contact. ⋯ The telephone was nearly two times better than e-mail. The median time of response was 48 h for e-mail and 18 h for telephone. It is concluded that the telephone is a better modality of contact than e-mail for patients discharged from the ED.