The American journal of emergency medicine
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The study objective was to determine what percentage of a hospital's medical staff have heard of the Emergency Medical Treatment and Active Labor Act (EMTALA) statute, and of those who have heard of it, to determine the extent of their knowledge. A questionnaire was mailed to 600 members of the active medical staff of an urban, 900-bed, private, tertiary-care hospital asking if they had ever heard of the EMTALA statute, and if so, to complete a 20-question multiple-choice quiz on specifics of EMTALA law. The main results were whether they had ever heard of EMTALA; if knowledge of EMTALA was related to specialty, age, years in practice, or frequency of ED call; and the quiz scores and any relationship they might have to those same demographic factors. ⋯ Questions concerning definition of a transfer, definition of an emergency medical condition, investigations of EMTALA, on-call staff responsibilities, and the number of hospitals cited for EMTALA violations were answered correctly by <50% of the respondents. Most members of the medical staff of a large, tertiary-care hospital have never heard of EMTALA, and of those who have, the extent of their knowledge is limited. This presents challenges for the hospital to facilitate education efforts to reduce liability.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomized, controlled trial of benzodiazepines and nitroglycerine or nitroglycerine alone in the treatment of cocaine-associated acute coronary syndromes.
The purpose of the present study was to compare the use of lorazepam plus nitroglycerine (NTG) versus NTG alone in the reduction of cocaine induced chest pain in the emergency department. The secondary objective of the study was to help determine the safety of lorazepam in the treatment of cocaine- associated chest pain. The study was a prospective, randomized, single-blinded, controlled trial conducted at an university-affiliated urban emergency department (ED). ⋯ All patients in the study were admitted to the hospital, but no patient in either group had an acute myocardial infarction or cardiac complications in the ED. No adverse side effects were noted for either group. The early use of lorazepam with NTG was more efficacious than NTG alone, and appears to be safe in relieving cocaine-associated chest pain.
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A review of the literature on advanced airway management indicates that the intubating laryngeal-mask airway (ILMA) may be an ideal device for airway control in the rural trauma patient. The ILMA is an advanced laryngeal-mask airway designed to allow oxygenation of the unconscious patient as well as blind tracheal intubation with an endotracheal tube. The ILMA is an easy-to-use airway with a high success rate of insertion, and requires little training. ⋯ The ILMA has also been reported to cause less hemodynamic change and less injury to the teeth and lips than direct laryngoscopy. Further, the ILMA was found to be easier and faster to use with a higher success rate than either the combitube or endotracheal tube for unskilled healthcare providers. Limitations and complications of the ILMA may include aspiration, esophageal intubation, damage to the larynx or other tissues during blind passage of a tracheal tube, and edema of the epiglottis.
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Our ED at Louisiana State University developed a unique approach to airway management by having four diagnosis-based protocols for rapid sequence intubation (RSI). This study examines protocol use and outcome from RSI in an academic ED. The study objective was to identify variables that are predictive of adverse outcomes in patients requiring RSI. ⋯ Adult trauma patients who fit the protocols B or D or adult medical patients who fit protocol B were at higher risk for adverse outcomes with RSI. This could alert the physician to a population at higher risk for adverse outcomes. Variables available in a diagnosis-based protocol RSI system can be used to predict adverse outcome among patients requiring RSI.