J Emerg Med
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Case Reports
A case report of a severe musculoskeletal injury in a wheelchair user caused by an incorrect wheelchair ramp design.
The Americans with Disabilities Act (ADA) gives all Americans with disabilities a chance to achieve the same quality of life that individuals without disabilities enjoy. In this case report, we will be discussing the consequences of having inaccessible ramps to persons with disabilities that can result in severe musculoskeletal injuries in a wheelchair user. While going down an inaccessible ramp in the garage of a hospital, a wheelchair tipped over, causing a fracture to the user's right femur. ⋯ This led to the redesign and construction of safe ramps for individuals using wheelchairs as well as for pedestrians using canes, within 1 month after the patient's injury, making it safe for wheelchair users as well as pedestrians using the parking facilities. The ADA specifies guidelines for safe ramps for patients with disabilities. It is important to ensure that hospital ramps comply with these guidelines.
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Review Case Reports
Cerebral venous sinus thrombosis in the emergency department: retrospective analysis of 17 cases and review of the literature.
Cerebral venous sinus thrombosis (CVST) is a rare but serious cause of neurologic impairment. Due to its relative rarity, there is limited research that describes the incidence and clinical features of CVST in the emergency department (ED). ⋯ CVST is rare, but it can have significant associated morbidity and mortality. Whereas the clinical outcome and functional outcomes of treated patients can vary, prompt recognition of the disease is important.
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Multicenter Study
Standardization of severe sepsis management: a survey of methodologies in academic and community settings.
Evidence-based therapies for severe sepsis include early antibiotics, early goal-directed therapy, corticosteroids, recombinant human activated protein C, glucose control, and lung protective strategies. ⋯ Implementation of a sepsis management protocol incorporating evidence-based therapies can be accomplished in both academic and community hospitals, with minimal additional staffing. The presence of a protocol champion and education program is crucial to success, and may result in improved patient outcome.
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Rapid sequence intubation (RSI) has been instituted in some prehospital settings to improve the success of endotracheal intubation (ETI); whether RSI improves outcomes is unclear. ⋯ Patients selected for RSI-ETI were less seriously injured, with better prognostic factors than intubated patients for whom RSI was not used. After adjusting for these differences, use of prehospital RSI-ETI was not associated with improved survival.
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In 1995, a Society for Academic Emergency Medicine in-service survey reported high rates of verbal and physical abuse experienced by Emergency Medicine (EM) residents. We sought to determine the prevalence of abuse and harassment 10 years later to bring attention to these issues and determine if there has been a change in the prevalence of abuse over this time period. ⋯ Abuse and harassment during EM residency continues to be commonplace and is underreported.