Brian F Erling, Andrew D Perron, William J Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.004
Published in issue: March 2004
xEvaluation of the electrocardiogram (ECG) is a complex, subjective process with the potential for interobserver disagreement. The objective of this study was to determine the ECG patterns with discrepant interpretations, the rates of disagreement in the determination of both the presence of ST segment elevation (STE) and morphology. ECGs were reviewed in a retrospective fashion by attending EPs for STE and waveform morphology. Those ECGs that were interpreted in a discrepant fashion were then analyzed to detect patterns of disagreement.
Serge Reichlin, Thomas Dieterle, Can Camli, Bernd Leimenstoll, Ronald A Schoenenberger, Benedict Martina
DOI: http://dx.doi.org/10.1016/S0735-6757(03)00093-7
Published in issue: March 2004
xIt is not exactly known how ED physicians perform in evaluating cardiac systolic murmurs. In 203 consecutive medical ED patients with systolic murmur, we compared the initial clinical evaluation, including auscultation, with transthoracic echocardiography. Of the 203 patients, 132 (65%) had innocent murmurs and 71 patients (35%) had valvular heart disease. Sensitivity and specificity of the initial clinical routine evaluation in diagnosing echocardiographic valvular heart disease were 82% (70%–86%) and 69% (60%–76%), respectively.
Michelle Gill, Korbin Haycock, Steven M Green, Baruch Krauss
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.006
Published in issue: March 2004
xThe Bispectral Index Monitor (BIS) is validated as a measure of sedation depth during general anesthesia, but its value otherwise remains unclear. We hypothesized that BIS scores would correlate with standard subjective measures of assessing sedation in intubated adult ED patients and that BIS would predict inadequate sedation. Sedation was assessed by recording clinical features and by having treating physicians complete a visual analog scale (VAS; rated “not sedated” to “completely sedated”) at 10, 30, and 60 minutes after intubation.
Andrew D De Piero, Stephen J Teach, James M Chamberlain
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.007
Published in issue: March 2004
xThe objective of this study was to determine the rate of positive ED diagnostic evaluations and significant interventions during the hospitalization of infants after an apparent life-threatening event (ALTE). The study was performed at a single, tertiary care children’s hospital. Patients under 6 months of age were identified for a potential ALTE from the ED chief complaint log. The charts of patients meeting the definition of an ALTE were abstracted for data pertaining to the patient’s history, physical examination, ED diagnostic evaluation, and admission.
Armand G Sprecher, Robert L Muelleman, Michael C Wadman
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.005
Published in issue: March 2004
xThe objective of this study was to determine if a neural network model can identify victims of intimate partner violence (IPV). A custom neural network model was constructed and trained using the 1995 ED databases at Truman Medical Center of all female visits. The input vector developed was an array of 100 binary elements containing, in coded form, the patient’s age, day of week, primary diagnosis (excluding 995.81), disposition, race, time, and E-code. The trained network was then presented with a series of 19,830 female patients from the 1996 ED database to determine if it could discriminate cases from control subjects.
Rade B Vukmir, The Sodium Bicarbonate Study Group
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.008
Published in issue: March 2004
xThere are many variables that can have an effect on survival in cardiopulmonary arrest. This study examined the effect of urban, suburban, or rural location on the outcome of prehospital cardiac arrest as a secondary end point in a study evaluating the effect of bicarbonate on survival. The proportion of survivors within a type of EMS provider system as well as response times were compared. This prospective, randomized, double-blind clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered by prehospital urban, suburban, and rural regional EMS area.
Leslie S Zun, Douglas N Blume, Joseph Lester, Giles Simpson, Lavonne Downey
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.009
Published in issue: March 2004
xA large amount of EM information can be found on the Internet, but the accuracy of this information has not been determined. This study compares the “gold standards” of EM information on four common emergencies with top healthcare web sites. The study also examines the relationship of web sites’ credentials and certification on content. Checklists were developed for four emergency medical topics: influenza, febrile child, chest pain, and stroke from the “gold standards” promoted by the American Stroke Association, the American Heart Association, the National Heart, Lung and Blood Institute, and the American College of Emergency Physicians.
Scott E Mcintosh, Stephen Leffler
DOI: http://dx.doi.org/10.1016/S0735-6757(04)00015-4
Published in issue: March 2004
xPain is an important but understudied and often overlooked aspect of emergency medical care. This study examined the management of pain after discharged of patients from the emergency department (ED). We hypothesized that pain management after discharge would be adequate, and that patients would use their medications as prescribed. We surveyed 144 patients by telephone after they had been treated in the ED for common orthopedic complaints. We used a standardized questionnaire to assess prescription-filling practices, side effects of medications, interventions by other health-care professionals, and adequacy of pain relief.
Linda Rossman, Jeffrey S Jones, Chris Dunnuck, Barbara N Wynn, Michelle Bermingham
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.012
Published in issue: March 2004
xClinicians may not perform a medical-legal examination in cases in which a sexual assault was attempted but no penile-vaginal contact occurred. This retrospective study was conducted to document the frequency and type of genital injuries in women in whom forced digital penetration was the only reported type of assault. Study patients were consecutive female patients presenting to an urban sexual assault clinic during a 3-year study period. The clinic is associated with a university-affiliated urban hospital and is staffed by registered nurses trained to perform forensic examinations using colposcopy with nuclear staining.
Te-I Weng, Frank Fuh-Yuan Shih, Wen-Jone Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.011
Published in issue: March 2004
xPlasma ammonia measurement is a simple yet important screening in the ED for patients with unexplained stupor or delirium. Acute hyperammonemia is a medical emergency for which immediate steps must be taken to minimize permanent brain damage. Although the most common causes of hyperammonemia are severe abnormal liver function, the absence of liver disease in some cases has been observed. This brief report describes four hyperammonemia cases with normal liver function in the ED. On careful history and speculated examinations, ornithine carbamoyltransferase (OTC) deficiency, hematologic malignancy, and the side effects of valproic acid and 5-fluorouracil (5-FU) were considered.
Jay D Fisher, John J Reeves
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.001
Published in issue: March 2004
xUrolithiasis is not a frequent diagnosis in school-aged children. The clinical presentation can lack many of the clinical clues such as flank pain that are seen in older patients. We present four cases demonstrating this potential diagnostic dilemma.
Erik B Kulstad, Christine E Kulstad, Elise O Lovell
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.002
Published in issue: March 2004
xMany rapid d-dimer assays are commercially available with wide ranges of reported sensitivities, often based on small sample sizes. This has limited their intended use as rapid and inexpensive tests to evaluate pulmonary embolism in the low-risk patient. We sought to determine the sensitivity of the STA-Liatest D-Di d-dimer assay in our ED. We performed a retrospective analysis of 103 patients seen in our ED with the admitting diagnosis of known or suspected pulmonary embolism. These charts were assessed to establish if a d- dimer assay was performed within 24 hours.
Diana Pancu, Moira Davenport, Kevin Roth, Michael Heller
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.010
Published in issue: March 2004
xIt has been proposed that the workup of suspected subarachnoid hemorrhage should begin with lumbar puncture (LP) rather than computed tomography (CT) scan. We investigated whether EPs would in fact advocate this strategy in an index hypothetical case and in variations of the index case. An eight-question survey was distributed to EM physicians attending national continuing medical education meetings. Questions included whether the responders would advocate “LP first” in the following scenarios: (1) the index case in which the patient’s symptoms had been present for more than 12 hours, other diagnoses were very unlikely, the patient was fully insured, and CT scan was available immediately; (2) a case in which the patient is not insured; (3) a case in which the respondent is the patient; and (4) a case in which there is a delay in obtaining a CT scan.
Tighe Zimmers, Hemant Patel, Rick Stephani
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.022
Published in issue: March 2004
Francis M. Fesmire
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.003
Published in issue: March 2004
Dominique VanPee, Jean Bernard Gillet, Didier Schoevaerdts
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.013
Published in issue: March 2004
Paola Chiovenda
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.014
Published in issue: March 2004
Michael A. Miller, Vicky Martinez, Richard McCarthy, Manish M. Patel
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.015
Published in issue: March 2004
Kuang-Jui Chang, Wen-Jone Chen, Shey-Ying Chen, Kuang-Chau Tsai, Ang Yuan
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.016
Published in issue: March 2004
Rowland J. Elwell, Payman Darouian, George R. Bailie, George Eisele, M.Donald McGoldrick
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.017
Published in issue: March 2004
Sony Jacob, Hitender Jain, Mathew Mathew, Roy Gay, James B. Goldberg, Denis J. Dollard
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.018
Published in issue: March 2004
Brian Sloan, Geoffrey Somerville, Michael Olinger, Geoffrey Billows, David Brokaw
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.019
Published in issue: March 2004
Michael Rosenberg, Kevin Parsiak
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.020
Published in issue: March 2004
Ryan Kirkpatrick, Lisa Chan, Kevin Reilly
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.021
Published in issue: March 2004
Holly Cooper, Tamara Thomas
DOI: http://dx.doi.org/10.1016/j.ajem.2003.08.016
Published in issue: March 2004
Guy Sanders
DOI: http://dx.doi.org/10.1016/j.ajem.2003.09.015
Published in issue: March 2004
Graham E. Snyder, Howard J. Shaps, Matthew Nelson
DOI: http://dx.doi.org/10.1016/S0735-6757(03)00019-6
Published in issue: March 2004
DOI: http://dx.doi.org/10.1016/S0735-6757(04)00017-8
Published in issue: March 2004
DOI: http://dx.doi.org/10.1016/S0735-6757(04)00018-X
Published in issue: March 2004
DOI: http://dx.doi.org/10.1016/S0735-6757(04)00019-1
Published in issue: March 2004
