The American journal of emergency medicine
-
Correctly identifying and appropriately triaging patients who present to the ED with the broad range of symptoms suggestive of acute cardiac ischemia (ACI: unstable angina pectoris [UAP] and acute myocardial infarction [AMI]) remains one of the greatest challenges in EM. Although a number of diagnostic technologies have been described to aid in this triage process, each of these tests or technologies has limitations. We report a case series in which either the use of adjuncts with unknown performance or tests with known but not considered limitations could have contributed to the failure to appropriately triage and treat patients with ACI. ⋯ The limitations of a negative exercise electrocardiographic stress test (ETT) are illustrated in the second case. Finally, the limitations of a negative coronary angiogram, the "gold standard" test for symptomatic coronary artery disease, are discussed. We review the literature on technologies to aid in the evaluation of patients who present to the ED with symptoms suggestive of ACI.
-
Although it is generally believed that unintentional ingestions of fluoxetine by children are relatively safe, there are no large published studies supporting this concept. The goal of this retrospective study is to determine the signs and symptoms of these children. Inclusion criteria included fluoxetine exposures from six certified regional poison centers: <6 years old, known amount, single substance, 20 mg or more ingested, and follow up done to determine outcome. ⋯ In 48 cases, a milligram per kilogram dose was calculated, and the median dose ingested was 2.26 mg/kg. In 92% of the cases, the amount ingested was 60 mg or below. These children will have no adverse effects or only minimal effects and require no emergency treatment or gastric decontamination.
-
Response time is a very important factor in determining the quality of prehospital EMS. Our objective was to model the response by Israeli ambulances and to offer model-derived strategies for improved deployment of ambulances to reduce response time. Using a geographic information system (GIS), a retrospective review of computerized ambulance call and dispatch logs was performed in two different regional districts, one large and urban and the other rural. ⋯ Before using the GIS model, mean response times in the Carmel and Lachish districts were 12.3 and 9.2 minutes, respectively, with 34% and 62% of calls responded within 8 minutes. When ambulances were positioned within the modeled polygons, more than 94% of calls met the 8-minute criterion. The GIS simulation model presented in this study suggests that EMS could be more effective if a dynamic load-responsive ambulance deployment is adopted, potentially resulting in increased survival and cost-effectiveness.