Articles: emergency-medicine.
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In this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. ⋯ Four hundred and fifty-six ultrasound examinations were videotaped and entered into the study; 408 (89%) of the studies performed were determined to be "acceptable." The diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of these studies were as follows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); transabdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis, or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in intrauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0). The 48 "technically limited studies" included: 39 transabdominal (33 gallbladder, 1 abdominal aortic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ultrasound. This study suggests that emergency physicians with a minimal amount of training display acceptable technical skill and interpretive acumen in their approach to emergency ultrasonography.
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A postal survey was conducted to gain an overview of current opinion and practice relating to intraosseous infusion in adult resuscitation in accident and emergency (A&E) departments in the UK and to use the results to generate debate in light of published and personal experience. ⋯ Numerous references appear in the literature relating to intraosseous infusion in adult resuscitation and represent a wealth of experience. The technique is taught and used in our department in contrast with the results of this survey, which demonstrate that it is infrequently taught and used in UK A&E departments. The more widespread teaching of this technique for adult use is recommended.
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Emergency Medicine (EM) physicians frequently see patients with alcohol abuse or dependence (AA/AD). Brief interventions delivered in the Emergency Department (ED) have been advocated for these patients, however, little is known regarding EM physician willingness to support such interventions. We conducted a study to determine EM physicians' attitudes toward the use of interventions for AA/AD in the ED. ⋯ Of the 257 respondents (45.9%), a total of 76% agreed that AA/AD is a treatable illness and only 15% would not agree to support of ED interventions. Both supporters and non-supporters thought that the lack of sufficient time was an impediment to treating AA/AD in the ED. Our study suggests that the majority of ED physicians would support the implementation of brief intervention for AA/AD in the ED.
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Ann Fr Anesth Reanim · Jan 2000
Comparative Study[The effect of "seniorization" on the prescription of biological tests in an admissions and emergency service].
This prospective study compared the prescriptions of biological tests (PBT) for patients admitted to an Emergency medical service (EMS) of a University hospital, according as to whether the staff consisted either of medical residents only (study period P1) or of residents trained in emergency medicine and continuously supervised by a senior specialist (study period P2). During the one-month study periods, a total of 5,948 patients were admitted (2,781 during P1 and 3,167 during P2 respectively). Between P1 and P2 the rate of PBT decreased by 38.8% (P < 0.0001), the mean expenses for PBT per patient by 13.8% (P < 0.0001) and the total expenses by 53.4%. Teaching and training of residents in emergency medicine and supervision by a senior specialist improve the quality of care and decrease health care cost.