The American journal of emergency medicine
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Evaluation of the electrocardiogram (ECG) is a complex, subjective process with the potential for interobserver disagreement. The objective of this study was to determine the ECG patterns with discrepant interpretations, the rates of disagreement in the determination of both the presence of ST segment elevation (STE) and morphology. ECGs were reviewed in a retrospective fashion by attending EPs for STE and waveform morphology. ⋯ Fourteen ECGs (8.2% of 171 ECGs with STE determined by at least 2 EPs) had ST segment morphology interpreted in a discrepant fashion. Disagreement in the determination of electrocardiographic ST segment elevation by EPs occurs frequently and is related to the amount of STE present on the ECG. Electrocardiographic patterns responsible for this interpretive disagreement of ST segment elevation can represent an unfortunate but potentially predictable source of error in emergency medical care.
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The objective of this study was to determine the rate of positive ED diagnostic evaluations and significant interventions during the hospitalization of infants after an apparent life-threatening event (ALTE). The study was performed at a single, tertiary care children's hospital. Patients under 6 months of age were identified for a potential ALTE from the ED chief complaint log. ⋯ Risk factors for significant medical interventions included prematurity, a positive medical history, and age >60 days. The overall rate of either positive ED diagnostic evaluations or significant medical interventions during hospitalizations of infants after an ALTE is low. A majority of these patients can be best managed with a limited ED diagnostic evaluation and a period of observation.
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Pain is an important but understudied and often overlooked aspect of emergency medical care. This study examined the management of pain after discharged of patients from the emergency department (ED). We hypothesized that pain management after discharge would be adequate, and that patients would use their medications as prescribed. ⋯ The patients in the study were quite satisfied with their pain control. Most filled their prescriptions and did so in a timely manner. Those who did not fill prescriptions for medications reported the least satisfaction with pain control.