J Emerg Med
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Comparative Study
A survey of prehospital care paramedic/physician communication for Multnomah County (Portland), Oregon.
All field paramedic/patient encounters requiring advanced life support management in Multnomah County, Oregon, required radio/telephone communications with the emergency department physicians of the county's single medical resource hospital for a period of 6 months. A survey of these communications (compliance estimated to be 75% to 80%) demonstrated that paramedics established contact during management or transport in one-half of instances and after transport in the remainder. Consultation was estimated to be helpful in 12% to 17% of cases and of critical importance rarely. Additional benefits were seen in hospital notification, education, and as an adjunct to the medical record; and the concept of a single centralized resource hospital was established in this community.
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Codeine often causes gastrointestinal cramping and pain. Treatment for such symptoms is usually symptomatic and supportive. ⋯ The authors present four cases in which naloxone (Narcan) was used with success in relieving gastrointestinal side effects that were apparently due to codeine. It is suggested that patients with gastrointestinal symptoms and a history that strongly implicates codeine as the etiology be treated with naloxone.
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Case Reports
Free intraperitoneal cholelithiasis--a sign of traumatic perforation of the gallbladder.
Traumatic perforation of the gallbladder is relatively infrequent and is rare as an isolated lesion. The unique aspect of this case is the diagnosis of traumatic gallbladder perforation based on plain abdominal roentgenographic evidence of free intraperitoneal cholelithiasis.
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One of the major questions confronting prehospital care services today concerns determining the appropriate level of training for EMS personnel that will provide the most cost effective systems. Unfortunately there are no studies which assess this problem. Various communities have modified or expanded the roles of prehospital personnel beyond the traditional training of EMTs and paramedics. Continuing education and skills maintenance are ongoing problems faced by all EMS systems, which have been addressed in various ways by individual locales.