J Emerg Med
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The current domestic violence (DV) literature has evaluated the incidence and prevalence of DV via written surveys and verbal questioning performed by a variety of health care professionals. ⋯ Although the lifetime DV prevalence of 27.5% uncovered by our trained DV advocacy coordinator is similar to other reports, the acute incidence of 4.8% is higher than most other reported results using personal interviews. The use of a trained DV coordinator may improve detection rates of domestic violence in the ED.
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The diversion of ambulances from their intended emergency departments (EDs) occurs frequently, compromising patient care. Previously, we reduced ambulance diversion (AD) by 74% in a large urban area with 17 EDs. ⋯ By limiting the duration of AD events to progressively shorter periods of time using a region-wide, Internet-based EMS program, we reduced AD hours in 17 EDs by 87.4% and eliminated AD in one entire county. This original, collaborative 3-2-1 Plan may be readily reproduced across the country to progressively reduce and eliminate AD.
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Breech presentation and delivery are important complications of labor and delivery, which, although dealt with by the emergency physician infrequently, can represent major morbidity and mortality to both the mother and fetus if techniques are not performed correctly. ⋯ We have described a novel, seemingly safe, and effective technique to use in breech delivery when traditional techniques have failed.
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Patients frequently present to the Emergency Department (ED) with psychiatric complaints. The differential diagnosis for acute psychosis is extensive, and determining a possible etiology requires a thorough history and physical. Small details can help the physician in differentiating organic disease from non-organic disease. Many times patients are thought to be "crazy" without a thorough history and physical being done. ⋯ Cerebral beriberi, more commonly known as Wernicke's encephalopathy, is a difficult diagnosis to make in the ED. A thorough neurologic examination is difficult to perform in the ED environment, but it is necessary when trying to determine the etiology of the patient's altered mental status. The number of patients with Wernicke's encephalopathy may increase with bariatric surgery becoming more common. This disease can present with a wide variety of findings, and the classic triad is not very common. With this in mind, the physician should have a low threshold for administering thiamine intravenously.
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In Massachusetts, patients with chronic alcohol dependence can be committed to 30 days of mandatory inpatient alcohol detoxification (MAD). ⋯ MAD was associated with an immediate reduction in ED visits and hospital admissions that did not remain statistically significant long term, and a non-significant reduction in EMS transports.