Annals of emergency medicine
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Emergency medical services (EMS) systems in 25 midsized cities (population, 400,000 to 900,000) are described. Information describing EMS system configuration and performance was collected by written and telephone surveys with follow-ups. Responding cities provide either one- or two-tier systems. ⋯ Overall, the code 3 response time for all cities is an average of 6.6 minutes. The average response time of two-tier systems is 5.9 minutes versus 7.0 minutes for one-tier systems (.05 less than P less than .1). These data suggest that the two-tiered system B allows for a given number of ALS units to serve a much larger population while maintaining a rapid code 3 response time.
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A survey of the membership of the American College of Emergency Physicians (ACEP) was undertaken to identify members with special interest or expertise in pediatric emergency medicine. A questionnaire was published in the August 1988 issue of ACEP News, which was distributed to 12,079 members. One hundred seventy-one responses were returned, revealing a subset of the membership (1.42%) with a special interest or expertise in pediatric emergency care. ⋯ The majority of the respondents favored subspecialty board certification. Continuing education needs are generally being met, but there is a need for better geographical distribution of courses. Minifellowships and more pediatric rotations for emergency medicine residents were suggested.
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The accuracy of two methods of rapidly estimating total body weight in children was assessed. The first method correlated patient length to known total body weight, and the second correlated the weight of both legs weighted together to known total body weight. One hundred children undergoing general anesthesia in the operating rooms of Childrens Hospital of Los Angeles were entered into the study. ⋯ There was excellent linear correlation between hanging leg weight and total body weight (correlation coefficient [r2], 0.95) for all patients, and good linear correlation between supine length and total body weight, r2, 0.86). Range restriction analysis for both techniques showed poor correlation for total body weights of less than 10 kg and poor correlation for the supine length technique when total body weight was more than 25 kg. The hanging leg weight of an inert child has excellent correlation to total body weight for children weighing more than 10 kg.
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Randomized Controlled Trial Comparative Study Clinical Trial
Local anesthesia in pediatric patients: topical TAC versus lidocaine.
Lacerations requiring sutures are a common surgical emergency in children. Traditional anesthesia prior to suturing has been intradermal lidocaine. TAC (0.5% tetracaine, 1:2,000 adrenalin, 11.8% cocaine) is a topically applied anesthetic. ⋯ TAC was significantly better (P less than .002) with regard to patient compliance with the suturing process than lidocaine or placebo. Seventeen percent of patients who received placebo had initial anesthesia. These results suggest that TAC, when applied correctly, may be the preferred anesthetic for laceration repair in children.