The American journal of emergency medicine
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The purpose of the present study was to evaluate the predictive ability of the Prehospital Index (PHI) in identifying injury severity and to develop a trauma triage scale that incorporates, along with the PHI, a subset of time independent variables to improve the predictive ability of the PHI-based triage instrument. This study included 1,291 trauma patients treated in Montreal, Canada. ⋯ This algorithm was a substantial improvement in detecting major versus non-major injuries (major injury defined based on death, intensive care unit admission, and surgery intervention) over the PHI alone (area under the receiver operating characteristic curve: 0.76 v 0.66, P <.05). Considering time independent variables could lead to better injury triage decisions.
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This study examined research training characteristics among pediatric emergency medicine (PEM) fellows. A 45-question survey was mailed to all registrants of the 1998 National PEM Fellows' Conference. Descriptions of curricular design and administrative support components, perceived barriers, and subjective stress related to research were obtained. ⋯ The most commonly cited barriers to more active participation in research were inadequate experience, inadequate time, and lack of administrative help. Stress in relationship to research was high (5.1 on a 1-7 Likert scale). PEM fellows report increasing levels of didactic exposure and administrative support for conducting research, however, PEM fellows still report experiencing significant amounts of stress and a number of perceived barriers.
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Review Case Reports
The prominent T wave: electrocardiographic differential diagnosis.
The prominent T wave is an abnormal T-wave morphology encountered in the earliest phase of ST-segment elevation acute myocardial infarction (AMI). Prominent T waves, however, are associated with other diagnoses, including hyperkalemia, early repolarization, and left ventricular hypertrophy (LVH). This article focuses on the electrocardiographic differential diagnosis of the prominent T wave with the presentation of 4 illustrative cases. We also recommend that the designation hyperacute should refer exclusively to the prominent T waves of ST-segment elevation AMI.
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Review Case Reports
Electrocardiographic ST segment elevation: left ventricular aneurysm.
Left ventricular aneurysm (LVA), also described as dyskinetic left ventricular segment, is defined as a localized area of infarcted myocardium that bulges outward during both systole and diastole. LVAs most often are noted after large anterior wall events but may also be encountered status after inferior and posterior wall injuries. ⋯ The STE is generally associated with well-developed, completed Q waves in the anterior precordial leads, and there will not be reciprocal ST depression in the contralateral leads. This article focuses on the electrocardiographic findings useful in making the diagnosis of left ventricular aneurysm as well as distinguishing LVA from other STE syndromes.
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Review Case Reports
Orthopedic pitfalls in the ED: radiographically occult hip fracture.
Acute hip fracture is among the most commonly encountered orthopedic injuries seen by the emergency physician. The majority of these fractures can be readily diagnosed on the basis of clinical findings and plain radiographs. ⋯ The emergency physician needs to remain vigilant for this potential orthopedic pitfall. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.