Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The mechanism of death in patients struggling against restraints remains a topic of debate. This article presents a series of five patients with restraint-associated cardiac arrest and profound metabolic acidosis. The lowest recorded pH was 6.25; this patient and three others died despite aggressive resuscitation. ⋯ Restrictive positioning of combative patients may impede appropriate respiratory compensation for this acidemia. Public safety personnel and emergency providers must be aware of the life threat to combative patients and be careful with restraint techniques. Further investigation of sedative agents and buffering therapy for this select patient group is suggested.
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To assess the feasibility and effectiveness of an ED-based tuberculosis (TB) screening program. ⋯ An ED-based TB screening program is feasible and can identify many patients requiring treatment. Targeted screening of high-risk groups could reduce the program cost, but would miss some cases.
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Survival analysis is a group of statistical methods used to analyze data representing the time to an event of interest, e.g., the duration of survival after an out-of-hospital cardiac arrest or the length of time a patient stays in the ED. Survival analysis properly accounts for patients who are lost to follow-up and for patients who have not yet experienced the event of interest at the end of the study's observation period (censored data). This article acquaints the reader with the terminology, methodology, and limitations of survival analysis. Specific methods discussed include life tables, the Kaplan-Meier product limit estimate, the log-rank test, and the multivariate Cox proportional hazards model.
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Comparative Study
Retrospective review of emergency department patients with non-variceal upper gastrointestinal hemorrhage for potential outpatient management.
To determine the number of ED patients with non-variceal upper gastrointestinal hemorrhage (NVUGIH) who could have been managed as outpatients through application of previously developed clinical guidelines. ⋯ In a non-HMO urban teaching hospital, 18 patients with NVUGIH met criteria for outpatient management in a six-month period and none developed a complication during a mean in-hospital stay of 2.1 days.
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To determine the incidence of clinically significant intracranial injury in the anticoagulated patient suffering minor head trauma without loss of consciousness (LOC) or acute neurologic abnormality. ⋯ The incidence of clinically significant intracranial injury is extremely low in the anticoagulated patient suffering minor blunt head trauma without LOC or acute neurologic abnormality. CT scanning may not be necessary in these patients. Larger prospective studies are needed to confirm these findings.