Canadian Medical Association journal
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The volume of medical services delivered within hospital emergency departments in the City of Saskatoon is increasing rapidly. These probably are not "new" medical services but rather represent a transfer of "old" services to the emergency departments from other sites where they were previously rendered. ⋯ This acute and non-programmable nature of the illness makes it difficult to deliver the service in a physician's office where the appointment system prevails and efficiently deals with the great majority of his patients. Data to determine whether or not this is a desirable development have not yet been obtained but it is clear that in its present usage the emergency department must be thought of as a facility which not only provides exceptional diagnostic and therapeutic equipment but as one which also provides a treatment facility without prior appointment available at any hour of the day or night.
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The mortality rate of shock complicating myocardial infarction is extremely high (80-100%) despite intensive medical management. Five patients with acute myocardial infarction and cardiogenic shock received an emergency aorto-coronary bypass graft, from three hours to five days after the onset of infarction and three to nine hours after the onset of shock. ⋯ Two cases with A-V dissociation and complete heart block reverted to normal sinus rhythm after the operation. This limited experience indicates that emergency aortocoronary bypass graft surgery can reduce mortality significantly in properly selected cases of cardiogenic shock.