Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
An emergency department-based randomized trial of nonbronchoscopic bronchoalveolar lavage for early pathogen identification in severe community-acquired pneumonia.
Many patients with community-acquired pneumonia are treated empirically without an aggressive search for causative pathogens, an approach adopted largely because of the costs and difficulties encountered during efforts to identify the causative organisms. Blood and sputum cultures are not sensitive, and the more invasive techniques of bronchoscopy and lung biopsy are generally time consuming and not cost-effective. The technique of nonbronchoscopic bronchoalveolar lavage (BAL) has been shown to accurately diagnose the causes of nosocomial pneumonia. The purpose of this study was to determine whether an emergency department-based BAL protocol would lead to more frequent isolation of pneumonia pathogens and result in more changes to tailored antibiotic therapy in comparison with standard care. ⋯ ED-based BAL catheterization allows for early identification of pathogens in severe community-acquired pneumonia, which leads to changes in antibiotic therapy.
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We describe the development and current state of the practice of acute care medicine in Japan. Included are descriptions of the structure and organization of the critical care transfer system, out-of-hospital care system, and hospital classification. We also outline the training and equipment necessary for the various levels of out-of-hospital care providers, as well as that needed for certification as an emergency physician.
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In the United States, firearms are used to commit homicide more frequently than all other methods combined. According to the US Department of Justice, firearms are used to commit more than 1 million crimes each year. ⋯ To enhance cooperation between community emergency departments and law enforcement agencies, we created a unified firearm injury notification system for the City of Atlanta, Georgia, and 5 surrounding counties: Fulton, DeKalb, Cobb, Gwinnett, and Clayton. Our findings are reported here.
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We sought to validate the Ottawa Knee Rules for determining the need for radiography in patients with acute knee injury. ⋯ Prospective validation has shown the Ottawa Knee Rules to be 100% sensitive for identifying fractures of the knee and to have the potential to allow physicians to reduce the use of radiography in patients with acute knee injuries.
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An important responsibility of emergency departments is the management of injuries sustained in assaults. Most assaults, including many causing serious injury, are not reported and not recorded by the police. This is important because police investigation and the conviction of offenders has a substantial deterrent effect and because information about the circumstances of intentional injury is key to prevention. ⋯ They also provide the police with unique aggregate, nonconfidential information that is of substantial help in tackling violence. ED data can be used to measure and refine violence prevention initiatives and are being developed as the basis of a new, independent measure of police performance. Strategies, practical ideas to overcome obstacles, and directions for future research are suggested.