Articles: emergency-medicine.
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Clinical Trial Controlled Clinical Trial
Missed myocardial ischaemia in the accident & emergency department: E.C.G. a need for audit?
Accident & Emergency Department Senior House Officers rely heavily on their ECG interpretation skills in the diagnosis and management of patients with chest pain. This prospective double-blind study was designed to test the accuracy with which Accident & Emergency Senior House Officers interpret ECGs, by comparing their interpretation with that of a Consultant Cardiologist. ECGs from 279 of 314 consecutive patients with chest pain were analysed. ⋯ Despite the inaccurate interpretation of 43% of abnormal ECGs, 96.5% of the patients in the study were considered to have been managed correctly. Audit of all ECGs recorded in the Accident & Emergency Department should be undertaken by someone with experience of ECG interpretation. New A&E staff should receive training in the interpretation of ECGs.
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The beginnings of organized emergency care can be traced through military history dating back to the Middle Ages. In 1769, the first civilian rescue society was established to look after shipwrecked persons. Sociological and technical requirements of the late 19th century led to the formation of different rescue associations and to writing of regulations for rescue and ambulance services. ⋯ Today the rescue service functions to bring a physician, often an anesthesiologist, to the victim as quickly as possible. Modern rescue laws fix a lead time of 5 to 15 minutes for a professional rescue service to reach the scene. The medical equipment and qualifications of personnel treating life-threatening trauma and diseases have improved, and in this context, the role of the anesthesiologist is important.
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This article is the first of two parts outlining the objectives for a resident rotating in the intensive care unit (ICU). It is part of a larger continuing series on the goals and objectives to direct the training of emergency medicine residents on off-service rotations. ⋯ Critical care is a logical continuum for the sick and injured patient as he moves from the prehospital and emergency department (ED) settings to the ICU. These objectives are designed to focus the resident's reading and study during a critical care rotation.