The American journal of emergency medicine
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Review Case Reports
The prominent T wave: electrocardiographic differential diagnosis.
The prominent T wave is an abnormal T-wave morphology encountered in the earliest phase of ST-segment elevation acute myocardial infarction (AMI). Prominent T waves, however, are associated with other diagnoses, including hyperkalemia, early repolarization, and left ventricular hypertrophy (LVH). This article focuses on the electrocardiographic differential diagnosis of the prominent T wave with the presentation of 4 illustrative cases. We also recommend that the designation hyperacute should refer exclusively to the prominent T waves of ST-segment elevation AMI.
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Review Case Reports
Electrocardiographic ST segment elevation: left ventricular aneurysm.
Left ventricular aneurysm (LVA), also described as dyskinetic left ventricular segment, is defined as a localized area of infarcted myocardium that bulges outward during both systole and diastole. LVAs most often are noted after large anterior wall events but may also be encountered status after inferior and posterior wall injuries. ⋯ The STE is generally associated with well-developed, completed Q waves in the anterior precordial leads, and there will not be reciprocal ST depression in the contralateral leads. This article focuses on the electrocardiographic findings useful in making the diagnosis of left ventricular aneurysm as well as distinguishing LVA from other STE syndromes.
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Multicenter Study
Injury surveillance in the ED: design, implementation, and analysis.
Comprehensive, population-based surveillance for nonfatal injuries requires uniform methods for data collection from multiple hospitals. To show issues related to design and implementation of multihospital, emergency department (ED), injury surveillance, a city-wide system in the United States is discussed. From October 1, 1995 to September 30, 1996 all injury-related ED visits among District of Columbia residents <3 years of age were ascertained at the 10 hospitals where city children routinely sought care. ⋯ Based on this experience, suggestions to facilitate design of multihospital, injury surveillance in other locations are offered. Importantly, injury-related visits were reliably ascertained from ED logs, and for most variables, a systematic sample of injury-related visits was representative of the total injured population. However, there is a need for more complete documentation of circumstances surrounding injuries and for standardization of data elements on ED logs and treatment records.
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The purpose of the present study was to evaluate the predictive ability of the Prehospital Index (PHI) in identifying injury severity and to develop a trauma triage scale that incorporates, along with the PHI, a subset of time independent variables to improve the predictive ability of the PHI-based triage instrument. This study included 1,291 trauma patients treated in Montreal, Canada. ⋯ This algorithm was a substantial improvement in detecting major versus non-major injuries (major injury defined based on death, intensive care unit admission, and surgery intervention) over the PHI alone (area under the receiver operating characteristic curve: 0.76 v 0.66, P <.05). Considering time independent variables could lead to better injury triage decisions.
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This article describes parenteral analgesic and sedative (PAS) use among patients treated in US emergency departments (EDs). Data representing 6 consecutive years (1992-1997) from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined and analyzed. Patients were identified as having received PAS if they received fentanyl, ketamine, meperidine, methohexital, midazolam, morphine, nitrous oxide, or propofol. ⋯ A total of 43,725 pediatric and 114,207 adult ED encounters were analyzed and represented a weighted sample of 555.3 million ED visits. For patients with orthopedic fractures, African-American children covered by Medicaid insurance were the least likely to receive PAS (OR 0.2, 95% confidence interval [CI] 0.1-0.6). These results suggest that variations may be occurring among ED patients receiving PAS.