Annals of emergency medicine
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To determine the effect of cardiology review of ECGs on emergency department practice. ⋯ The existing ECG review process as mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will likely have minimal influence on patient outcomes at our institution. We should establish the effectiveness of this mandated QA process before committing scarce resources to its performance.
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Case Reports
Use of the scapular manipulation method to reduce an anterior shoulder dislocation in the supine position.
We report the successful use of the scapular manipulation method to reduce an anterior shoulder dislocation in a multiply traumatized patient in the supine position. We discuss the treatment options for multiply traumatized patients with anterior shoulder dislocations in whom cervical spine injury is a possibility. Although larger patient studies are necessary for confirmation, we show that in this particular case the scapular manipulation technique was safely employed. To our knowledge, this is the first reported case of use of the scapular manipulation method with the patient in the supine position.
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To evaluate a combined cardiac marker approach with adjunct two-dimensional echocardiography in diagnosing acute myocardial infarction (AMI) in the emergency department. ⋯ Serum myoglobin shows greater sensitivity but is less specific than CK-MB in the early detection of AMI. Use of a combination of both rapid assays during a 3-hour time period in the ED appears to be superior to use of either enzyme assay alone. Two-dimensional echocardiography does not appear to be helpful in diagnosing AMI in the ED.
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To determine the correlates of compliance with follow-up appointments and prescription filling after an emergency department visit. ⋯ Not having an appointment made before leaving the ED was an independent correlate of missing follow-up appointments. Lack of insurance and dissatisfaction with discharge instructions were independent correlates of not filling prescriptions.