The American journal of emergency medicine
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The purpose of this study was to identify how often fire department (FD) response to the scene of motor vehicle crashes (MVCs) is necessary for rescue and fire suppression. A retrospective review of MVCs between January 1, 1997 and December 13, 2000 occurring in a suburban municipality (population 79,000, 13 FDs) was conducted. Data abstracted included the total number of reported MVCs, MVCs with personal injury (PIAC), MVCs to which the FD responded, MVCs requiring any extrication, MVCs requiring extensive extrication, and MVCs requiring fire suppression. ⋯ At no time was fire suppression required. Routine FD response to MVCs for purposes of extrication or fire suppression is not warranted in this emergency response system. A prospective study, including a cost analysis, should be undertaken to further clarify the role of FD response to MVCs.
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Our objective was to assess parental expectations of diagnostic testing, time, and charges in a pediatric emergency department (PED) using a prospective survey-based study. Parents on arrival estimated the amount of testing, time, and charges expected to occur. A total of 266 of 294 (90.5%) of the questionnaires were completed and returned. ⋯ The average length of stay was 2 hours and 36 minutes and was correctly estimated within preset ranges by 86 of 253 (34.0%) and underestimated by 112 of 253 (44.3%). The mean total charge was $964 per visit and was correctly estimated within preset ranges by 91 of 260 (35.0%) and underestimated by 139 of 260 (53.3%). Despite being relatively accurate about the need for medications and radiographic and laboratory studies, parents are still more likely than not to underestimate the total charges and time associated with a PED visit.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized paired comparison trial of cutaneous treatments for acute jellyfish (Carybdea alata) stings.
The objective of the study was to compare cutaneous treatments (heat, papain and vinegar) for acute jellyfish (Carybdea alata) stings. Healthy adult volunteer subjects received a single-tentacle jellyfish sting on each forearm. One forearm was treated with hot-water immersion (40-41 degrees C). ⋯ At t = 20 minutes (the end of the study period), the differences between hot-water and comparison group VAS scores were 0.2 cm versus 1.8 cm, respectively. The mean difference between hot-water and comparison treatments was 1.6 cm (95% confidence interval, 0.9 to 2.3). This study suggests that the most efficacious initial treatment for C alata jellyfish envenomation is hot-water immersion to the afflicted site.
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The purpose of this study was to determine the etiologies responsible for altered mental status (AMS) in an emergency department (ED) population, to gauge the diagnostic (DX) value of the various features of the clinical evaluation, and to examine patient outcomes. Prospective identification of patients with AMS followed by a retrospective review of the medical record was performed in a university hospital E among ED patients with AMS. Three hundred seventeen patients (5% of the ED patient volume) were identified with a mean age of 49 years (57% men). ⋯ Common causes of AMS included neurologic, toxicologic, traumatic, and psychiatric syndromes. The patient history and physical examination were most useful in DX terms; ancillary investigations were less often DX. This group represented a minority of the ED population yet rates of ED resource use, hospital admission, and death were high.
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The purpose of this study was to evaluate the possibility to predict in the prehospital phase the occurrence of a life-threatening disease or death among ambulance transported patients with acute chest pain or other symptoms raising any suspicion of an acute coronary syndrome. All patients transported by ambulance during 3 months in the community of Göteborg because of symptoms raising any suspicion of an acute coronary syndrome were included in the study. In all, 930 transports (of 859 patients) fulfilled the inclusion criteria, of which 235 (25.3%) fulfilled the criteria for a life-threatening disease. ⋯ Predictors of 1 year mortality were age greater than 70 years, a history of myocardial infarction, symptoms of dyspnoea, a low oxygen saturation on admission of the ambulance crew and ST-depression, and no sinus rhythm on admission to the emergency department. Among patients with acute chest pain or other symptoms raising any suspicion of an acute coronary syndrome, factors associated with a life-threatening disease and death could be defined. Predictors for the risk of death during the first 30 days were age greater than 70 years, symptoms of dyspnoea, a low oxygen saturation, hypotension and decreased consciousness on admission of the ambulance crew, and ST-depression on ECG on admission to the emergency department.