Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Superiority of ipratropium plus albuterol over albuterol alone in the emergency department management of adult asthma: a randomized clinical trial.
The use of nebulized ipratropium in combination with beta-agonists for the treatment of acute asthma in adults is controversial. We wished to test the hypothesis that combined aerosol treatment results in a greater rate of airflow improvement and a lower proportion of hospital admission in adults with acute asthma. ⋯ These data suggest that ipratropium should be combined with initial albuterol nebulization in the ED treatment of acute asthma in adults, especially those with PEFRs less than 200 L/min.
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During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. ⋯ They are Integration of Health Services, EMS Research, Legislation and Regulation, System Finance, Human Resources, Medical Direction, Education Systems, Public Education, Prevention, Public Access, Communication Systems, Clinical Care, Information Systems, and Evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care.
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Because overall EMS system response depends on ambulance availability, we conducted a prospective study of the EMS turnaround interval. This interval represents the time elapsed from ambulance arrival at the hospital until the ambulance reports back in service. ⋯ In this system, ambulance call report documentation required the greatest subinterval of turnaround interval. The turnaround interval and its subintervals varied widely, and radio contact times correlated poorly with observed times at the ED. Attempts at improvement of overall system response through active management of the turnaround interval may be frustrated by reliance on radio-reported availability. [Cone DC, Davidson SJ, Nguyen Q: A time-motion study of the emergency medical services turnaround interval. Ann Emerg Med February 1998;31:241-246.].
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Because overall EMS system response depends on ambulance availability, we conducted a prospective study of the EMS turnaround interval. This interval represents the time elapsed from ambulance arrival at the hospital until the ambulance reports back in service. ⋯ In this system, ambulance call report documentation required the greatest subinterval of turnaround interval. The turnaround interval and its subintervals varied widely, and radio contact times correlated poorly with observed times at the ED. Attempts at improvement of overall system response through active management of the turnaround interval may be frustrated by reliance on radio-reported availability.
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The emergency department of the future will require the effective integration of information technologies into clinical care. This article proposes strategies for improving information management in emergency medicine to facilitate patient care, public health surveillance, clinical research, medical education, and health care management. [Cordell WH, Overhage JM, Waeckerle JF, for the Information Management Work Group: Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs. Ann Emerg Med February 1998;31:172-178.].