Annals of emergency medicine
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Early electrical therapy for patients with ventricular fibrillation and ventricular tachycardia can result in a significant increase of lives saved from sudden cardiac death. Rapid defibrillation has become a goal of prehospital and emergency department cardiac care, and the use of automatic external defibrillators can aid in reaching this objective. The history, mechanics, and implications of automatic external defibrillators are presented.
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The medical records of 109 patients who presented to the emergency department during a five-year period with proven nontraumatic, spontaneous subarachnoid hemorrhage (SAH) were retrospectively reviewed. The clinical presentation, diagnostic modalities used, and accuracy of diagnosis by emergency physicians were analyzed. The most common historical features were headache (81 patients, or 74%), nausea or vomiting (85 patients, or 77%), and loss of consciousness (58 patients, or 53%). ⋯ The overall diagnostic accuracy by emergency physicians was 85%. The correct diagnosis was delayed in 16 patients (15%), the majority of whom had headaches and normal neurologic examinations. Atypical symptoms, the warning leak syndrome, and the need for prompt diagnosis and therapy are reviewed.
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Review
Accuracy of interpretations of emergency department radiographs: effect of confidence levels.
We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. ⋯ No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist.
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Injuries and fatalities from recreational hunting accidents have been studied much less than firearm accidents occurring in urban populations. The available data indicate that hunting accidents may account for a significant number of unintentional firearm accidents in areas outside commonly studied urban settings. ⋯ The development of automatic firearm safety devices, promotion of hunter safety programs, and greater participation by the medical community in preventive measures may impact the problem. Similar efforts have already been influential in reducing other forms of accidental injury through promotion of seat-belt use, local motorcycle helmet laws, use of infant car seats, and, most recently, regulations regarding all-terrain vehicles.
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Epidemiologic analysis of submersion cases admitted to the intensive and respiratory care unit showed that several interrelated factors preceded submersion. Accidental submersion and traffic accidents represented one third of the causes of submersion. Other relevant causes were illness (29.9%), psychosocial causes (20.1%), alcohol (18.1%), and suicide (9.1%). ⋯ WHO-ICD code 994.1 (drowning and nonfatal submersion) is the best entrance for epidemiologic analysis. Five hundred twenty deaths and 690 hospital admissions due to submersion occur in The Netherlands each year. About 460 victims die before they reach a hospital.