J Emerg Med
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The objective of this study was to determine whether digital photography could be used to calculate hemoglobin. This prospective blinded study was conducted in a tertiary care Emergency Department (ED). A convenience sample of 65 patients provided consent; 44 patients were enrolled for formula derivation and 19 for prospective analysis. ⋯ Pearson's rank order correlation between the calculated and measured hemoglobin was r(77) = 0.634, p < 0.01 for the derivation group and r(36) = 0.522, p < 0.01 for the evaluation group. It is possible to derive an objective method that correlates conjunctiva color with measured hemoglobin and, when applied prospectively, is able to predict hemoglobin concentration in ED patients. This technology has broad applications in regions with limited resources.
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This study explores the effects of minimizing Emergency Department (ED) bypass on individual hospital's ED census, ambulance transports, and admissions. Five hospitals in a geographic area collected data over 3 weeks. The first and third week represented controls, whereas the second week hospitals minimized their usage of bypass. ⋯ There were several statistical shifts in the proportion of ambulance runs and admissions seen by individual hospitals. Clinically, these shifts in patients were minor and within ED capacity. Hospitals in a given geographic area may successfully reduce the number of hours on bypass with possible minor shifting in the number of ambulance runs and admissions that are within ED capacity.
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The National Childhood Vaccine Injury Act of 1986, as amended, established the Vaccine Injury Compensation Program (VICP). The VICP went into effect on October 1, 1988 and is a Federal "no-fault" system designed to compensate individuals, or families of individuals, who have been injured by covered vaccines. ⋯ There was no compensation for any of the autism/thimerosal claims. On the basis of the deaths and extensive suffering to patients and families from the adverse reactions to vaccines, all physicians must provide detailed information in the Vaccine Information Statement to the patient or the parent or legal guardian of the child about the potential dangers of vaccines as well as the VICP.
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The purpose of this study was to assess whether greater operator confidence correlates with more accurate focused abdominal ultrasounds (FAUS) by residents. This was a prospective study of novice residents performing FAUS in patients with abdominal pain. FAUS included focused assessment with sonography for trauma, gall bladder, renal, and aortic examinations. ⋯ Sensitivity and specificity were 14% (95% CI 4-37 %) and 71% (95% CI 48-88 %) with a confidence level of 2/5 but 85% (95% CI 73-93 %) and 100% (95% CI 97-100 %) with a confidence level of 5/5. Greater operator confidence correlates with improved accuracy in FAUS. This should be considered in the development of training guidelines.
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Multicenter Study
Can urine dipstick be used as a surrogate for serum creatinine in emergency department patients who undergo contrast studies?
Contrast-induced nephropathy (CIN) is a complication associated with contrasted computed tomography (CT). Elevated creatinine (Cr) is often used to screen for CIN. This study evaluates dipstick urinalysis (Udip) detection of Cr > 1.5 mg/dL. ⋯ Thirty-five patient visits (among 26 patients) had negative urine dip and Cr > 1.5 mg/dL, but each reported at least one of the following at triage: prior renal disease, hypertension, diabetes, congestive heart failure, or age > 60 years. Udip is a sensitive screening test, but alone is not accurate enough to predict patients at potential risk for CIN (Cr > 1.5 mg/dL). However, combining Udip results with risk factor screening may allow a rapid method for predicting which patients may safely undergo contrast CT scanning in the ED, but this needs prospective evaluation.