The American journal of emergency medicine
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We hypothesized that diabetic patients in the emergency department (ED) have poorer glycemic control than patients seeking care at primary care clinics. A convenience sample of hemoglobin A1c (HbA1c) values was gathered retrospectively from the ED, Endocrinology, and Family Medicine Clinics. Results were divided into controlled, poorly controlled, and extremely poorly controlled. ⋯ The first peak represents well-controlled diabetic patients. The second, higher peak comprises a larger number of patients (approximate n = 134, 73% of all 207 ED patients) who have poorer glycemic control. We conclude that a large number of ED diabetic patients have poorer glycemic control than the other clinics.
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Comparative Study
Documentation and coding of ED patient encounters: an evaluation of the accuracy of an electronic medical record.
The aim of the study was to describe a paper-based, template-driven and an electronic medical record used for capturing emergency care clinical information and to compare the accuracy of these documentation systems for coding patient encounters using the American Medical Association Current Procedural Terminology-2004 (AMA CPT-2004) evaluation and management codes intended for provider reimbursement. ⋯ A keystroke-driven, electronic medical record that resides on a knowledge platform that incorporates a clinical structured terminology, administrative coding schemata, AMA CPT-2004 codes and uses object-oriented, open-ended, branching chain clinical algorithms that "force" physician documentation of the clinical elements provides an equally accurate capture and representation of ED clinical encounter data as a paper-based, template-driven documentation system both in terms of the presence or absence of both the medically necessary, discrete data elements and the textual documentation-dependent, medical decision-making elements.
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To assess the potential of bedside lung ultrasound to diagnose the radiologic alveolar-interstitial syndrome (AIS) in patients admitted to an emergency medicine unit and to estimate the occurrence of ultrasound pattern of diffuse and multiple comet tail artifacts in diseases involving lung interstitium. ⋯ Comet tail artifact B line is a lung ultrasound sign reasonably accurate for diagnosing AIS at bedside.
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This study was designed to determine whether digital intubation is a valid option for definitive airway control by emergency physicians. ⋯ Although the gold standard for routine endotracheal intubation remains to be direct laryngoscopy, its effectiveness in certain situations may be limited. We believe that digital intubation provides emergency physicians with another option in securing the unprotected airway.
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The purpose of this study is to prospectively evaluate the cortisol response and determine the relative adrenal insufficiency after return of spontaneous circulation (ROSC). ⋯ Relative adrenal insufficiency may be associated with the increased mortality rate in patients with return of circulation after cardiac arrest. Although basal cortisol values were normal to high, treatment of relative adrenal insufficiency with corticosteroids may decrease the mortality rate. Additional studies are needed to confirm this association and to determine the effectiveness of treating relative adrenal insufficiency.