J Emerg Med
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Letter Case Reports
Spontaneous rupture of arteriovenous fistula in a chronic dialysis patient.
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Randomized Controlled Trial Clinical Trial
A randomized study of electronic mail versus telephone follow-up after emergency department visit.
This study was conducted to determine whether electronic mail (e-mail) increases contact rates after patients are discharged from the emergency department (ED). Following discharge, patients were randomized to be contacted by telephone or e-mail. The main outcome was success of contact. ⋯ The telephone was nearly two times better than e-mail. The median time of response was 48 h for e-mail and 18 h for telephone. It is concluded that the telephone is a better modality of contact than e-mail for patients discharged from the ED.
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Comparative Study
Ottawa Knee Rule: a comparison of physician and triage-nurse utilization of a decision rule for knee injury radiography.
The Ottawa Knee Rule (OKR) is a clinical decision rule for the ordering of knee radiographs by physicians in patients with blunt knee injuries. However, in many Emergency Departments, radiographs are also ordered by nurses during triage. This study was designed to compare application of the OKR by triage nurses and physicians. ⋯ No fractures were missed by physicians or nurses. Triage nurses and EPs in this study had fair agreement in their application of the OKR. Triage nurses greatly overestimated knee injuries, while maintaining sensitivity, at the expense of specificity and cost savings.
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Prolonged QT syndrome may be either congenital, as in Jervell and Lange-Nielsen or Romano-Ward syndromes, or acquired in nature. Affected children are at risk for syncope, seizures, dysrhythmias and sudden death. Physicians should consider long QT syndrome (LQTS) in all patients who present with syncope. ⋯ An electrocardiogram with manual calculation of the QT interval should be performed on all patients with a suggestive history. Furthermore, the diagnosis of LQTS warrants evaluation of all other family members. With recognition and appropriate treatment of affected patients, the potentially fatal consequences of LQTS may be prevented.
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Comparative Study
Accuracy of the precordial V-Quick patch in persons with cardiac or pulmonary disease.
The aim of this study was to demonstrate the equivalence of 12-Lead Electrocardiograms (EKG) obtained with the new V-Quick patch and traditional tab-style electrodes. Using a within-subject design, a convenience sample of 100 subjects with either cardiac or pulmonary disease underwent two 12-lead EKGs, one with the traditional tab-style electrodes and one with the precordial patch. Computer-generated measurements of waveform axes and amplitude were obtained for both EKGs. ⋯ Furthermore, a four-factor ANOVA found no significant difference (p > 0.05) in the Q, R and S wave amplitude between the type of electrode, gender and type of disease. A subset of 29 EKGs read by three experts found intra- (.90) and inter-rater (.84) reliability to be strong. In conclusion, the precordial V-Quick patch provided equivalent EKGs to those obtained using standard tab-style electrodes.