Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine how ambulance transportation is associated with resource use in the emergency department (ED). ⋯ This preliminary study indicates that patients arriving at the ED by ambulance use significantly more resources than their walk-in counterparts.
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It is difficult to differentiate septic arthritis from other causes of monoarticular arthritis solely with a history and physical examination. The clinician must rely on ancillary tests to make a diagnosis, such as the white blood cell count of peripheral blood (WBC), the erythrocyte sedimentation rate (ESR), and the white blood cell count of the joint fluid (jWBC) obtained from arthrocentesis. Although it is known that septic arthritis is associated with abnormalities in these tests, the majority of the data are based on studies in the pediatric population. In addition, although several emergency medicine texts indicate that a jWBC greater than 50,000 cells/mm(3) is "positive," it is known that septic arthritis can occur in patients with low jWBCs. ⋯ The WBC, ESR, and jWBC are extremely variable in adults with septic arthritis. Laboratory tests do not rule out septic arthritis with accuracy.
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To determine what proportion of eligible patients, when referred to a primary care physician for pneumococcal vaccination with a prescription, actually obtain the vaccination. To ascertain the number of eligible patients who would receive the vaccination in the emergency department (ED), if available. ⋯ The percentage of ED patients who used prescription referral to the primary care network for pneumococcal vaccination was approximately 10%. The use of a referral by prescription method in this setting was not a reliable means of increasing the number of patients receiving the pneumococcal vaccination.
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Comparative Study
Dose-dependent hemodynamic effect of digoxin therapy in severe verapamil toxicity.
Calcium chloride (CaCl(2)) alone is an ineffective antidote in severe calcium channel antagonist overdoses. Digoxin has been evaluated as a therapy to increase the effectiveness of calcium in severe calcium channel antagonist overdoses. ⋯ There is a dose-dependent effect of digoxin on systolic blood pressure and maximal ventricular pressure in the setting of severe verapamil toxicity treated with high-dose CaCl(2).