Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The objective was to validate the Vancouver Chest Pain Rule in an emergency department (ED) setting to identify very-low-risk patients with acute chest pain. ⋯ This study showed a lower sensitivity and higher specificity when applying the Vancouver Chest Pain Rule to this population as compared to the original study.
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The objective was to identify the correlates of willingness to pay for ambulance transports from a rural city to a regional hospital in Guatemala. ⋯ The primary correlates of willingness to pay for ambulance transport in Santiago Atitlán, Guatemala, are household income, location of residence (rural district vs. urban district), and respondents' education levels. Furthermore, severity of emergency significantly appears to influence how much individuals are willing to pay for ambulance transport. Willingness-to-pay information may help public health planners in resource-poor settings develop price scales for health services and achieve economically efficient allocations of subsidies for referral ambulance transport.
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Ultrasound (US) has well-documented utility in critical procedures performed in the emergency department. It has been described as a "skill integral to the practice of emergency medicine" in the 2007 Model of Clinical Practice of Emergency Medicine. One of the ideal uses for US in critical care may be in the performance of emergent cricothyroidotomy. To the best of our knowledge there is currently no description of how to perform an US-guided open cricothyroidotomy in the literature. ⋯ Ultrasound-guided bougie-assisted cricothyroidotomy is a novel technique that may be beneficial in emergent open cricothyroidotomy. The data suggest that this technique is rapid, with a median time to completion of 26.2 seconds. The data also suggest that the procedure may have a low failure rate, with 20 of 21 cadavers undergoing successful cricothyroidotomy.
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The Institute of Medicine has stated that analyzing data according to sex and gender may change practices used by clinicians and taught in medical education. Gender-specific medicine embraces the concept that differences between men and women encompass the entire organism, not just their reproductive biology, and that recognizing these differences will improve the precision and quality of health care for both men and women. Research conducted to date has deepened our scientific understanding of sex and gender differences in the etiology, diagnosis, progression, outcomes, treatment, and prevention of many conditions that affect both women and men. ⋯ Collaborations between women's health researchers across fields of medicine will be essential, given the large knowledge deficits to be addressed and the gender-based issues that span all specialties. We provide one model for a multifaceted initiative targeting improvements in gender medicine for the specialty of EM. If emergency health services are to meet the needs of both women and men at modern-day standards, then they must acknowledge the emerging science demonstrating that sex and gender differences influence the delivery of high-quality clinical care.
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Contrast-enhanced computed tomography (CECT) of the pulmonary arteries (CTPA) has become the mainstay to evaluate patients with suspected pulmonary embolism (PE) and is one of the most common CECT imaging studies performed in the emergency department (ED). While contrast-induced nephropathy (CIN) is a known complication, this risk is not well defined in the ED or other ambulatory setting. The aim of this study was to define the risk of CIN following CTPA. ⋯ In this population, CIN was at least as common as the diagnosis of PE after CTPA; the development of CIN was associated with an increased risk of severe renal failure and death within the subsequent 45 days. Clinicians should consider the risk of CIN associated with CTPA and discuss this risk with patients.