JACEP
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Of 20 patients with blunt chest trauma who underwent cardiac scanning, serial electrocardiography and cardiac monitoring to rule out myocardial contusion, four had positive cardiac scans. All four had electrocardiographic abnormalities: three had nonspecific ST-T wave changes, and the fourth had electrocardiographic evidence of an acute subendocardial infarction. ⋯ On the basis of this data, electrocardiogram changes in the traumatized patient have various causes. Cardiac scanning appears to be a useful adjunct to electrocardiography in confirming the presence of myocardial contusion.
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The out-of-hospital reports of 2152 consecutive paramedic fire rescue responses were reviewed. Examination of emergency department records and outcome was conducted in all cardiopulmonary arrests (120), major trauma (59) or nontraumatic hemorrhage (9) and one half (95 of 199 patients) with chest pain or possible myocardial infarction. Predominant age was 50 to 70 (66%) and men outnumbered women by four to one. ⋯ All survivors had ventricular fibrillation. Evaluation of the trauma and nontraumatic blood loss victims indicated that, after the paramedic places an intravenous line, the paramedic role is less well defined. Mean transportation time was 36 (trauma) and 38 (hemorrhage) minutes to the hospital.
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This study was designed to assess the ability of trained individuals to screen calls for emergency medical services to allow for safer or more appropriate responses. The degree of urgency of calls, as judged by dispatchers and a panel of physicians, was compared to estimates of the severity of the patient's illness or injury. ⋯ The emergency medical technicians were better able to assess severity and degree of urgency than were physicians or dispatchers. A tentative conclusion is that rapid response by an emergency medical services system will be based upon the caller's description of the situation rather than medical assessment of patient condition.
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The emergency department records at the St. Louis County Hospital were reviewed for 1973, 1974, and 1975. The distribution of patients was considered by the day of the week and hour of the day. ⋯ An analysis of peak patient load showed the first peak was around 11:00 am and the second, a higher peak, around 7:00 pm. By day of the week, more patients were seen on Tuesday and Saturday. Using data from such an analysis, emergency department personnel can devise an appropriate staffing pattern for their own situation.