Articles: emergency-services.
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To assess the surveillance of alcohol intoxication by surgical house staff, we examined the charts of 346 motor vehicle accident patients who presented to the trauma center of an urban teaching hospital emergency department. Half of the charts were reviewed before and half were reviewed after June 1986, when Connecticut enacted PA86-345, a law changing court rules of evidence so that the analysis by a hospital of a patient's blood could be used to establish probable cause for driving while under the influence of an intoxicant. ⋯ Not one patient was referred for alcohol abuse evaluation or treatment. We recommend more vigorous attempts to evaluate, diagnose, and refer patients who abuse alcohol since they threaten the public health.
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Relatively few emergency physicians are aware of the spectrum of regional anesthesia and the advantages it has to offer in the day-to-day practice of the specialty. Understanding the types of block and the principles that apply to neural blockade are only a beginning in the appropriate use of blockade techniques. A detailed knowledge of anatomy is essential to successful and safe practice; however, only repeated performance of the blocks will lead to predictable success!
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The chest radiological findings and outcomes of 120 consecutive patients attending the Accident & Emergency Department with anterior chest pain were recorded prospectively to investigate the value of routine chest radiography in their management. Twenty-one patients (17.5%) were excluded because of incomplete information. Thirty-seven radiological abnormalities were identified in 33 (33%) of the remaining 99 chest X-rays. ⋯ The casualty officer's interpretation of 70 (70%) of the chest X-rays was correct, but 36 errors were made interpreting the other 29 chest X-rays. Of these errors, 19 were false negative errors, resulting in the mismanagement of two patients and 17 false positive errors, resulting in the mismanagement of four patients. It appears that a routine chest X-ray provides little information of practical value in the management of patients with anterior chest pain attending an Accident & Emergency Department, unless the training of medical students and junior doctors in the interpretation of chest X-rays is improved.