J Emerg Med
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Comparative Study
Hemodynamic effect of external chest compressions at the lower end of the sternum in cardiac arrest patients.
Little is known about the hemodynamic effects of chest compression at different positions on the sternum during cardiopulmonary resuscitation (CPR). ⋯ Compared to standard compression, alternative compression results in a higher peak arterial pressure and end-tidal CO2 pressure, but no change in coronary perfusion pressure.
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Comparative Study
Pilot study comparing sepsis management with and without electronic clinical practice guidelines in an academic emergency department.
Sepsis is a potentially life-threatening condition that requires urgent management in an Emergency Department (ED). Evidence-based guidelines for managing sepsis have been developed; however, their integration into routine practice is often incomplete. Care maps may help clinicians meet guideline targets more often. ⋯ A sepsis eCPG experienced variable use; however, physicians using the eCPG achieved more quality-of-care targets for SS/SS. Strategies to increase the utilization of eCPGs in Emergency Medicine seem warranted.
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Comparative Study
Emergency Medicine resident anesthesia training in a private vs. academic setting.
Airway management is an essential part of any Emergency Medicine (EM) training program. Academic centers typically provide training to many learners at various training levels in a number of medical specialties during anesthesiology rotations. This potentially creates competition for intubation procedures that may negatively impact individual experiences. ⋯ Number of intubations performed and residents' rating of the educational value were more favorable for a private practice anesthesiology rotation. Alternative settings may provide benefit for training in areas that have competition among trainees.
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Disturbing trends regarding the sex, age, and race of gunshot victims have been reported in previous national studies; however, gunshot trends have not been well documented in individual cities in the southeastern United States. ⋯ Our study demonstrates that black patients between 18 and 25 years of age presenting to this trauma center are more likely to be victims of gun violence than their non-black counterparts. Our study evaluates trends in gun violence in the Southeast, particularly in relation to race, age, and insurance status.
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Uterine perforation is a rare but recognized complication of abortion. Perforations may not be recognized at the time of the procedure, and patients may present days or weeks later with sequelae of the complication. ⋯ Intrauterine bowel after abortion has been described only a handful of times in the literature. Uterine perforation during abortion is usually asymptomatic and generally can be managed conservatively, but herniation of bowel through the uterine defect can result in obstruction and strangulation. Intrauterine bowel requires prompt laparotomy and possible resection of non-viable bowel. Although ultrasound and CT scans may aid in diagnosis of this rare complication, a clinical suspicion for uterine perforation should be maintained by health care providers when treating patients who have had an abortion.