Annals of emergency medicine
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To determine emergency department patients' perceptions of their illness urgency, their attempts to get care elsewhere, and the proportion of patients referred to the ED. ⋯ In addition to their lack of access to other providers, patients' perceived need for immediate care and referrals by health professionals contribute to ED use for nonemergency conditions.
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Comparative Study
Abdominal compressions increase vital organ perfusion during CPR in dogs: relation with efficacy of thoracic compressions.
Abdominal compressions can be interposed between the thoracic compressions of standard CPR (SCPR). The resulting interposed abdominal compression CPR (IAC-CPR) may increase blood pressures and patient survival, particularly if applied as a primary technique after in-hospital cardiac arrest. We used a predominant cardiac compression canine model to study the effects of IAC-CPR on blood pressures and total and vital organ perfusion as a function of time after cardiac arrest and efficacy of SCPR. ⋯ Compared with predominant cardiac compressions alone (SCPR), the addition of interposed abdominal compressions (IAC-CPR) improves total and vital organ oxygen delivery through enhanced venous return and perfusion pressures.
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To assess current emergency medicine faculty scheduling practices, preferences, and recent changes. ⋯ Residency faculty prefer and have moved toward working shorter shifts. They are also working fewer night shifts per month and fewer night shifts in a row.
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Rupture of an abdominal aortic aneurysm into the inferior vena cava is uncommon. A classic syndrome of high-output heart failure, continuous abdominal bruit, and renal insufficiency has been described and permits a clinical diagnosis if an aortocaval fistula is considered in the differential diagnosis. ⋯ Physicians should consider abdominal ultrasonography and aortography in stable patients, followed by prompt surgical intervention. We report the case of a patient with an aortocaval fistula.
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Most patients who seek medical attention for sore throat are concerned about streptococcal tonsillopharyngitis, but fewer than 10% of adults and 30% of children actually have a streptococcal infection. Group A beta-hemolytic streptococci (GAS) are most often responsible for bacterial tonsillopharyngitis, although Neisseria gonorrhea, Arcanobacterium haemolyticum (formerly Corynebacterium haemolyticum), Chlamydia pneumoniae (TWAR agent), and Mycoplasma pneumoniae have also been suggested as possible, infrequent, sporadic pathogens. Viruses or idiopathic causes account for the remainder of sore throat complaints. ⋯ Several antimicrobials have demonstrated superior efficacy compared with penicillin in eradicating GAS and are administered less frequently to enhance patient compliance. In previously untreated GAS throat infections, cephalosporins produce a 5% to 22% higher bacteriologic cure rate; after a penicillin treatment failure, these differences are greater. Amoxicillin/clavulanate and the extended-spectrum macrolides clarithromycin and azithromycin may also produce enhanced bacteriologic eradication in comparison to penicillin.(ABSTRACT TRUNCATED AT 400 WORDS)