Annals of emergency medicine
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Review Meta Analysis
Systematic Review and Meta-analysis of the Benefits of Out-of-Hospital 12-Lead ECG and Advance Notification in ST-Segment Elevation Myocardial Infarction Patients.
Pre-hospital 12-lead ECG may improve short-term mortality and time to primary cardiac intervention in patients suffering acute myocardial infarct.
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Since its original development in Oregon in 1993, Physician Orders for Life-Sustaining Treatment (POLST) is quickly growing in popularity and prevalence as a method of communicating the end-of-life care preferences for the seriously ill and frail nationwide. Early evidence has suggested significant advantages over advance directives and do-not-resuscitate/do-not-intubate documents both in accuracy and penetration within relevant populations. ⋯ Although it was designed to be as clear as possible, unexpected challenges in the interpretation and use of POLST in the emergency department do exist. In this article, we will discuss the history, ethical considerations, legal issues, and emerging trends in the use of POLST documents as they apply to emergency medicine.
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The identification and treatment of reversible causes is paramount to the success of resuscitation in cardiac arrest, particularly when standard therapy has failed. Acute coronary occlusion is one such cause, and the introduction of primary percutaneous coronary intervention services may provide an opportunity for emergency revascularization in this setting. ⋯ The first patient had refractory ventricular fibrillation, and the second had an episode of ventricular fibrillation followed by true pulseless electrical activity: total cessation of ventricular activity. In both examples, external mechanical compression and primary percutaneous coronary intervention facilitated coronary revascularization and achieved return of spontaneous circulation, leading to survival to hospital discharge.
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We aimed to determine the association between scalp hematoma characteristics and traumatic brain injuries in young children with blunt head trauma who have no other symptoms or signs suggestive of traumatic brain injuries (defined as "isolated scalp hematomas"). ⋯ In patients younger than 24 months with isolated scalp hematomas, a minority received CTs. Despite the occasional presence of traumatic brain injuries on CT, the prevalence of clinically important traumatic brain injuries was very low, with no patient requiring neurosurgery. Clinicians should use patient age, scalp hematoma location and size, and injury mechanism to help determine which otherwise asymptomatic children should undergo neuroimaging after minor head trauma.