Annals of emergency medicine
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I examine whether female and male emergency department (ED) patients are equally likely to have been nonfatally shot or struck with a gun by someone they know versus by a stranger. ⋯ The cause of firearm-related injuries varies by sex. Before releasing firearm-injury victims from the ED, health care providers should consider 2 important factors: (1). the patient's relationship to the perpetrator, and (2). the availability and previous use of firearms in the victim's home. This information may be helpful in formulating posttreatment plans to enhance the victim's safety.
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Multicenter Study Comparative Study
The Canadian C-spine rule performs better than unstructured physician judgment.
We compare the predictive accuracy of emergency physicians' unstructured clinical judgment to the Canadian C-Spine rule. ⋯ Interobserver agreement of unstructured clinical judgment for predicting clinically important cervical spine injury is only fair, and the sensitivity is unacceptably low. The Canadian C-Spine rule was better at detecting clinically important injuries with a sensitivity of 100%. Prospective validation has recently been completed and should permit widespread use of the Canadian C-Spine rule.
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Review
Does gastric lavage really push poisons beyond the pylorus? A systematic review of the evidence.
Classically, treatment of acute self-poisoning involves resuscitation and supportive care, followed by gastric emptying, administration of activated charcoal, and use of specific antidotes. Recently, however, the practice of gastric emptying has fallen out of favor in the West because physicians have recognized its complications and the lack of evidence for clinical benefit from its practice. Authoritative position statements have stated that forced emesis should not be used and that gastric lavage should be used in restricted settings. ⋯ However, analysis of the data presented in this article shows no significant difference in the number of radio-opaque marker pellets present in the small bowel after gastric lavage, ipecac-induced forced emesis, or no intervention. The second, an observational study using human volunteers, showed significantly less poison in the small bowel after gastric lavage than after no intervention. In conclusion, it seems that no published data support the statement that gastric lavage forces poison into the small bowel.
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We describe errors occurring in a busy ED. ⋯ Reported errors occurred in almost every aspect of emergency care. Ninety-eight percent of errors in the ED do not result in adverse outcomes. System changes need to be implemented to reduce ED errors.
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We determine which services, if any, an emergency department (ED) could provide to help a patient who left the ED without being seen by a physician wait longer to see a physician. ⋯ Communication of estimated waiting time and the availability of immediate treatments for minor injuries or symptoms might increase the time patients are willing to wait and therefore might decrease an ED's rate of patients leaving without being seen.