Annals of emergency medicine
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To demonstrate the degree to which pulse oximetry overestimates actual oxyhemoglobin (O2Hb) saturation in patients with carbon monoxide (CO) poisoning. This phenomenon has been reported in fewer than 20 humans in the English medical literature. ⋯ There is a linear decline in O2Hb saturation as COHb saturation increases. This decline is not detected by pulse oximetry, which therefore overestimates O2Hb saturation in patients with increased COHb levels. The pulse oximetry gap increases with higher levels of COHb and approximates the COHb level. In patients with possible CO poisoning, pulse oximetry must be considered unreliable and interpreted with caution until the COHb level has been measured.
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Comparative Study Clinical Trial
ED use of rapid lactate to evaluate patients with acute chest pain.
To test the hypothesis that ED arrival venous lactate levels can be used to diagnose acute myocardial infarction (AMI) and to identify patients with critical illness in the triage of ED patients presenting with chest pain. ⋯ The blood lactate concentration obtained on ED arrival identifies those chest pain patients with critical cardiac illness (eg, AMI, severe congestive heart failure [CHF], decompensated arrhythmias). A normal blood lactate result has a high negative predictive value for AMI. An elevated lactate level used in conjunction with ECG and history distinguishes patients with significant myocardium at risk who are likely to benefit from more urgent attention and interventions by the attending physician. Additionally, hyperlactatemia clearly correlates with mortality and the need for ICU management in the acute cardiac patient presenting to the ED.
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Tenure was designed to guarantee academic freedom through lifelong job security. Productive research, especially in the basic sciences, is the main criterion for tenure at most institutions; therefore faculty in more clinically focused specialties may experience more difficulty obtaining tenure. We examined the relationship between academic emergency medicine and tenure. ⋯ Most eligible emergency medicine faculty members are not tenured or on track to become tenured, and fewer emergency medicine faculty are tenured compared with the more traditional specialties. Emergency medicine may be vulnerable to being considered less academic unless its faculty members gain access to the tenure process.
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Previously published research (phase I) demonstrated a concerning misinterpretation rate of cranial computed tomography (CT) scans by emergency physicians. This study (phase II) determined whether an abbreviated educational session would improve emergency physician interpretation skills of cranial CT scans. ⋯ Within the limits of this study, we conclude that emergency physicians' interpretation skills of cranial CT scans may be improved using a 1-hour educational session.
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Comparative Study Clinical Trial Controlled Clinical Trial
Prevention of gastrointestinal iron absorption by chelation from an orally administered premixed deferoxamine/charcoal slurry.
To investigate the effect of an orally administered premixed slurry of deferoxamine mesylate (DFO) and activated charcoal (AC) on the gastrointestinal (GI) absorption of ferrous sulfate under physiologic conditions. ⋯ In this model, a premixed 1:3 (weight/weight) DFO/ AC slurry reduced the GI absorption of ferrous sulfate in adult volunteers under physiologic conditions.