The American journal of emergency medicine
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Cocaine abuse has resulted in complications involving an increasing number of organ systems. This article presents a case report and discussion of renal infarction occurring in association with nasal insufflation of cocaine powder. Possible etiology and suggested workup of such patients is also discussed.
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Despite widespread concern that emergency ultrasound services are not widely available after regular business hours, data supporting or refuting this concern have not been reported. To determine the availability of emergency ultrasound services as perceived by directors of emergency departments (EDs) and radiology departments, direct mail survey was sent to both ED Directors and Directors of Radiology at 100 large teaching hospitals (more than 300 beds) and 100 smaller nonteaching hospitals (fewer than 300 beds) chosen at random from the American Heart Association Guide. ⋯ It was found that 24-hour in-house ultrasound services are rarely available even in large teaching hospitals, even as reported by Directors of Radiology. ED Directors and Directors of Radiology differ significantly in perceptions of ultrasound availability, clinical importance of emergency ultrasound, and desirability of ultrasound performance by ED physicians.
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To determine the reimbursement status of a helicopter aeromedical program and its sponsoring hospital, the financial records of all patients transported by a university hospital-based helicopter aeromedical service during a one-year period of time were examined. The flight program was able to collect only 43% of patient charges, recouping only 24% of its operating costs. The hospital collected 57% of its total charges to patients transported by the helicopter aeromedical program. ⋯ If cost-based payors had reimbursed on rates similar to the per-diem payors, the hospital would have recovered only 49% of its charges and the flight program, would have recovered only 26% of its charges, recouping only 15% of its operating costs. In conclusion, reimbursement for helicopter aeromedical services and for the care provided in aeromedically transferred patients is poor. Sponsoring institutions are consequently subjected to significant financial stress that possibly challenges the fiscal viability of some programs.
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To compare resuscitation outcomes in elderly and younger prehospital cardiac arrest victims, we used a retrospective case series over 5 years in rural advanced life support (ALS) units and a University hospital base station. Participants included 563 adult field resuscitations. Excluded were patients with noncardiac etiologies, those less than 30 years old, and those with unknown initial rhythms. ⋯ Early cardiopulmonary resuscitation (CPR) and ALS and initial rhythm VF were associated with the best resuscitation success. Age has less effect on resuscitation success than other well-known factors such as early CPR and ALS. Advanced age alone should probably not deter resuscitation attempts.
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This study was conducted to evaluate the safety and efficacy of intravenous adenosine therapy for prehospital treatment of narrow-complex tachycardias with a presumptive field diagnosis of paroxysmal supraventricular tachycardia (PSVT) by paramedics without direct physician control. A ten-month prospective case series was designed in an urban EMS system that has paramedics operating under standing orders before physician radio contact. All patients with PSVT field diagnosis were included. ⋯ Of those converted, 16 required a single dose (57.1%), nine required one additional dose (32.1%), and three required two additional doses (10.8%). None reverted to PSVT after adenosine conversion during the study period (conversion to arrival at emergency department). No significant difference in length of asystolic pause or in outcome was detected between the true PSVT cases and the AF cases receiving adenosine.(ABSTRACT TRUNCATED AT 250 WORDS)