Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To mathematically model the supply of and demand for emergency physicians (EPs) under different workforce conditions. ⋯ The number of EM residency positions should not be decreased during any restructuring of the U.S. health care system. EM is likely to remain a specialty in which the supply of board-certified EPs will not meet the demand, even at present levels of EM residency output, for the next several decades.
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To compare and contrast the patient characteristics of ED patients at low risk for acute cardiac ischemia who were assigned to a chest pain observation service vs those admitted to a monitored inpatient bed for "rule-out acute myocardial infarction" (R/O MI). ⋯ Patients evaluated in a chest pain observation service appear to have different clinical characteristics than other individuals admitted to a monitored inpatient bed for "R/O MI." Investigators should address differences in clinical characteristics when making outcome comparisons between these 2 patient groups.
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A case of bilious vomiting in a 9-month-old male is reported. The differential diagnosis of infantile bilious vomiting is reviewed, and appropriate diagnostic studies are discussed. ⋯ The common manifestation of this pediatric surgical emergency may vary considerably from classic descriptions. Bilious emesis in infants must be considered a surgical emergency until proven otherwise; intussusception may manifest as bilious vomiting only.
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To determine the potential utility of cytokine and arachidonic acid metabolite levels in ED patients with systemic inflammatory response syndrome (SIRS) as a predictor of progression to severe sepsis. ⋯ While mean levels were significantly elevated when compared with those of normal control subjects, they had limited ability to predict the subset of patients likely to progress to severe sepsis. However, initial low levels of cytokines may have exclusionary prognostic value. Prospective validation of the latter finding is warranted.