J Emerg Med
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The study objective was to determine if Emergency Department (ED) patients experience breaches of privacy and confidentiality during their ED stay and to determine if the type of room in which the patient is placed affects privacy. We surveyed a convenience sample of ED patients at the conclusion of their ED stay regarding their privacy and confidentiality. Overall, 36% of patients overheard conversations with similar frequencies in walled and curtained rooms. ⋯ Patients felt more comfortable giving their history and having physical examinations performed in walled vs. curtained rooms. Inappropriate or unprofessional comments by staff were heard by 1.6% of patients. Health care providers in the ED need to be aware of breaches in confidentiality and privacy, as our patients deserve respect of their privacy and confidentiality during their ED visit.
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This study's objective was to determine the effect of paramedic experience on orotracheal intubation success in prehospital adult nontraumatic cardiac arrest patients. This retrospective study analyzed all attempted intubations of prehospital adult nontraumatic cardiac arrest patients between January 1, 1997 and April 30, 1997 in an urban, all ALS service. Data were abstracted from EMS reports and intubation data forms. ⋯ There was no correlation between months of experience and intubation success rate. In conclusion, the number of patients in whom intubation was attempted per paramedic was significantly correlated with the intubation success rate. Months of experience per paramedic had no significant correlation with intubation success rate.
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There have been relatively few attempts to document the optimal medical support for wilderness expeditions, and none of these previous reports includes physician-level providers. Here we document our experience with physician-level medical support to an annual wilderness expedition in Alaska. This report utilizes data collected from 1994 to 2000 as part of the medical response to the Juneau Icefield Research Project, an annual research expedition to the Alaskan wilderness involving up to 60 students and professors. ⋯ The majority of diseases encountered included gastrointestinal illness, minor orthopedic injuries, urinary tract infections, illness related to sun exposure, and kidney stones. Several patients required evacuation by helicopter to the nearest medical facility. The logistical challenges of medical treatment in this setting are discussed.
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The diagnosis of ethylene glycol poisoning is based on nonspecific clinical symptoms and signs and indirect and direct laboratory measurement. Few institutions have timely access to direct measurement of ethylene glycol. ⋯ These cases demonstrate the need to recognize the false elevation of lactate in some chemistry analyzers due to the interference of glycolic acid, a metabolite of ethylene glycol. Using the "lactate gap" in comparing the measurement of lactate with two commonly used chemical analyzers aids in differentiating ethylene glycol poisoning from lactic acidosis.
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The use of sulfonylurea medications in the treatment of type 2 diabetes mellitus is common. Patients who present to the Emergency Department after ingestion of excessive amounts of suflonylurea medications often have hypoglycemia refractory to dextrose administration. ⋯ We present a case of a 20-year-old woman who ingested 900 mg of glyburide causing refractory hypoglycemia resistant to treatment with intravenous dextrose, glucagon, and diazoxide. Octreotide administration rapidly reversed hypoglycemia allowing patient stabilization and eventual discharge without any significant adverse events.