The American journal of emergency medicine
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The objective of this study was to develop a decision rule for ordering x-rays in knee injuries. Phase I was a retrospective chart review of 201 consecutive patients receiving knee radiographs in the emergency department in a 10-month period. Logistic regression was performed on 11 clinical indicators to develop a clinical decision rule. ⋯ The misclassification rate was 20%. Using this decision rule, the number of x-rays taken could have been reduced by 78%. A larger multicenter validation study of this knee radiograph decision rule is needed before widespread clinical usage.
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An academic emergency group was surveyed to determine if scheduling night shifts in blocks ("floats") improved attitudes and functioning. Seven physicians worked most of their nights as floats. Another four chose only isolated nights. ⋯ Physicians have different adaptability to night work. For some, concentrating night shifts is a useful strategy for improving shift work. This would require shorter shifts and larger groups than are now commonplace.
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Inhalation of volatile halogenated hydrocarbons may produce life-threatening cardiac and neurological toxicity. A 15-year-old boy developed ventricular fibrillation immediately after intentional inhalation of a fluorinated hydrocarbon from an automobile air conditioner recharge unit. ⋯ Aspiration pneumonitis and rhabdomyolysis complicated his hospital course before complete neurological recovery. The mechanism and treatment of cardiac arrhythmias after volatile fluorinated hydrocarbon inhalation are reviewed.