J Emerg Med
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The development of Emergency Medicine in the United States has evolved in diverse manners, depending particularly on the societal needs and academic support available in each city and institution. Significant personal and literary experiences are described with regard to the author's role in the development of Emergency Medicine at Bellevue Hospital Center and the New York City Poison Center in New York City. Critical quotations of literary and philosophic importance for the author are utilized to demonstrate the importance of literature in the development of a philosophy of life, a residency program in Emergency Medicine, a residency program in Medical Toxicology and an academic Department of Emergency Medicine. Critical societal events during the last quarter of the 20(th) century are related to this personal formative literature and the development of Emergency Medicine.
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The National Emergency Medical Extranet (NEME) project was a collaborative multi-center effort to create a plan for a networked system to improve emergency clinical care through real-time information support, and simultaneously provide benefit through information support for public health initiatives. This article presents a review of the NEME project and its recommendations, which are particularly relevant given the desire for improved communication and surveillance systems in today's healthcare and public health environments. Participants in the NEME project performed an environmental assessment and a proposed conceptual architecture for NEME. ⋯ In conclusion, issues and consensus recommendations in the planning of a NEME are documented. These recommendations should be considered in future efforts to design, develop and implement wide area information networks to support Emergency Medicine. A review of current activities evolving from NEME is presented, and further research and development is encouraged to create and implement NEME systems.
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Emergency physicians are often the first clinicians to evaluate patients with acute atherothrombotic events. Platelet adenosine diphosphate (ADP) receptor antagonists, by specifically and irreversibly blocking ADP-induced platelet activation and aggregation, may reduce the injury associated with this process and can prevent recurrent ischemic events. ⋯ Familiarity with ADP receptor antagonists and knowledge about their appropriate use is important to the emergency physician in the management of ACS and potentially in that of transient ischemic attacks (TIAs), ischemic strokes, and acute peripheral arterial obstruction. This review addresses the pathophysiology of atherothrombosis and evaluates the potential use of ADP receptor antagonists in the Emergency Department setting.
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Internuclear ophthalmoplegia (INO) is characterized by pathognomonic findings on neurological examination. It results from a lesion in the medial longitudinal fasciculus (MLF) and is rarely caused by head trauma. ⋯ In the context of trauma, INO occurs frequently in association with other neurological findings and should prompt a thorough investigation and ICU admission. A case of an individual with acute post-traumatic INO is reported and discussed.