The American journal of emergency medicine
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Emergency medical service providers frequently encounter patients with low acuity. Because of liability and safety concerns, emergency medical service systems often prohibit privately owned vehicle (POV) transport. Thus, prehospital resources are used with questionable benefit. In Sequoia and Kings Canyon National Parks, our primary objective was to determine the feasibility of POV. We assessed patient compliance, satisfaction, and safety. Our hypothesis was that POV is feasible with online physician medical control. ⋯ We conclude that POV with carefully selected patients and online physician medical control is feasible and deserves further study in other systems.
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The aim of this study was to estimate the sensitivity, specificity, and positive predictive value (PPV) of computed tomography (CT) without oral contrast for diaphragm injuries (DIs) in blunt abdominal trauma. ⋯ Although the low number of blunt DIs in this study limits its general applicability, CT imaging of the diaphragm without oral contrast appears to perform within the range of reported imaging techniques using oral contrast. Still, CT scanning appears to have an unsatisfactorily low sensitivity to be reliably used in eliminating the diagnosis of blunt DI.
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Case Reports
Dissecting abdominal aortic aneurysm in a young man: an uncommon presentation of abdominal pain.
Aortic dissection results from an intimal tear that allows blood to penetrate the wall of the aorta. Patients, typically males over the age of fifty with a history of hypertension, usually present with sudden onset of severe chest pain. An unusual presentation of a dissecting aortic aneurysm as a cause of abdominal pain in a 32-year-old male is discussed. Although a relatively uncommon cause of abdominal pain, it is important to keep this entity on the list of differential diagnoses and adequately rule it out before discharge from the emergency department.
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The impact of noise pollution on both the patient and the care provider has been extensively studied in the neonatal intensive care unit and in other critical care units. Noise pollution makes errors more probable and is one of the risk factors for provider burnout and negative outcomes for patients. The Environmental Protection Agency (EPA) recommends that the acceptable noise level in a hospital should not exceed 40 dB. ⋯ When compared to EPA accepted noise levels for hospital (40 dB), the ED under study had excessive noise on a regular basis. There are easily identifiable sources of noise pollution in the ED. By identifying and modifying sources of noise, stress in the ED may be decreased.