The American journal of emergency medicine
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Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. ⋯ Total hospital gross revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services.
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Acute myocardial infarction (AMI) is one of many causes of electrocardiographic ST segment elevation (STE) in ED chest pain (CP) patients; at times, the electrocardiographic diagnosis may be difficult. Coexistent ST segment depression has been reported to assist in the differentiation of non-infarction causes of STE from AMI-related ST segment elevation. The objective was to determine the effect of AMI diagnosis on the presence of STD among ED CP patients with electrocardiographic STE. ⋯ When all CP patients with electrocardiographic STE are considered, the presence of ST segment depression is not helpful in distinguishing AMI from non-AMI. If one considers only patterns which lack electrocardiographic ST segment depression caused by altered intraventricular conduction, the presence of ST segment depression strongly suggests the diagnosis of AMI. In these cases, reciprocal ST segment depression is of considerable value in establishing the electrocardiographic diagnosis of STE AMI.
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The study objective was to identify the demographic, physiologic, and anatomic variables associated with outcomes of patients with intracranial hemorrhages. We performed a prospective study of all patients with known or suspected intracranial hemorrhages transferred from a community hospital to the neurosurgical service of tertiary care centers in Toronto. Outcomes measured were patient disposition (admitted v discharged immediately), management (neurosurgical interventions v observation) and survival until discharge v death. ⋯ Additionally, The presence of bilateral unreactive pupils, absent corneal reflex and absent vestibulo-ocular reflex independently predicted mortality in 100% of patients (not statistically significant). Other clinical findings including any pupillary abnormality and GCS <=5 combined with age => 62 negated the possibility of normal functional outcome (not statistically significant). These findings may have wide-ranging implications regarding the transfer and treatment of patients with intracranial hemorrhages, use of resources and counseling of families.
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Letter Clinical Trial
Preliminary results using the laryngeal tube for supraglottic ventilation.