J Emerg Med
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Observational Study
The Importance of Victim Chest Exposure During Cardiopulmonary Resuscitation: A Simulation Study.
During cardiopulmonary resuscitation (CPR), inaccurate positioning of the rescuer's hand might damage internal organs due to compression around the xiphoid process. ⋯ Exposing the chest during CPR can improve the rescuer's ability to recognize the CoC and INL, leading to more intense chest compression and reducing the risk of inaccurate compression.
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Point-of-care ultrasound (PoC US) is now taught and used in nearly all academic emergency departments (EDs), but prior surveys have shown that adoption in the community ED setting is much lower. ⋯ Most Connecticut EDs own an US machine and have hospital privileges for PoC US. However, a minority use or bill for PoC US regularly for diffuse applications, and most do not have a quality assurance program as described by ACEP guidelines.
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Extrication and spinal immobilization in the trauma patient with unknown injuries is a common practice of emergency medical services. High-speed crashes occurring in open-wheel racing seldom result in extrication or spinal immobilization. ⋯ In our IndyCar® racing experience, a protocol-led self-extrication system resulted in neither a mismanagement of an unstable spinal fracture nor neurological deficit, and reduced radiation exposure.
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Midlevel providers, including physician assistants (PA), have been recommended by some to fill the current inadequate supply of providers nationally, including in emergency medicine. ⋯ Laws governing PA practice in emergency departments differ by state, but generally allow for a broad scope of practice and limited direct supervision. Smaller, rural states were less likely to have tighter restrictions or oversight.
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Isolated distal deep vein thrombosis (DVT) is not traditionally viewed as a potentially life-threatening condition. There are conflicting recommendations regarding its evaluation and treatment, and wide variability in clinical practice. The presentation of this case highlights the fatal potential of this condition. ⋯ This is the report of a previously healthy young woman who presented to the emergency department with calf pain concerning for a DVT. She received two radiologist-performed duplex ultrasound examinations of the affected extremity, both of which were negative, but suffered a sudden cardiac arrest several hours after the second study. Autopsy attributed the death to DVT and pulmonary embolism. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the risk for fatal pulmonary embolization, even after normal serial ultrasound examinations to exclude DVT.