J Emerg Med
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Working as a paramedic carries the risk of witnessing events and personal experiences associated with emergency life-threatening circumstances that may result in symptoms associated with posttraumatic stress. This problem is well known but still underestimated. ⋯ Polish paramedics who agreed to take part in the survey were shown to have a high rate of PTSD. Multi-center screening and early supportive management is recommended.
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Randomized Controlled Trial
Diltiazem vs. Metoprolol in the Management of Atrial Fibrillation or Flutter with Rapid Ventricular Rate in the Emergency Department.
Diltiazem (calcium channel blocker) and metoprolol (beta-blocker) are both commonly used to treat atrial fibrillation/flutter (AFF) in the emergency department (ED). However, there is considerable regional variability in emergency physician practice patterns and debate among physicians as to which agent is more effective. To date, only one small prospective, randomized trial has compared the effectiveness of diltiazem and metoprolol for rate control of AFF in the ED and concluded no difference in effectiveness between the two agents. ⋯ Diltiazem was more effective in achieving rate control in ED patients with AFF and did so with no increased incidence of adverse effects.
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Intravenous tissue-plasminogen activator remains the only U.S. Food and Drug Administration-approved treatment for acute ischemic stroke. Timely administration of fibrinolysis is balanced with the need for accurate diagnosis. Stroke mimics represent a heterogeneous group of patients presenting with acute-onset focal neurological deficits. If these patients arrive within the extended time window for acute stroke treatment, these stroke mimics may erroneously receive fibrinolytics. ⋯ Stroke mimics remain a heterogeneous entity that is difficult to identify. All studies in the literature report that stroke mimics treated with intravenous fibrinolysis have better clinical outcome than their stroke counterparts. Although symptomatic intracranial hemorrhage remains a real threat, literature searches have identified only two cases of symptomatic intracranial hemorrhage in stroke mimics treated with fibrinolytics.
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Whereas most patients with urolithiasis pass their stones spontaneously and require only symptomatic management, a minority will require urologic intervention. ⋯ Our study reports eight risk factors associated with urologic intervention within 90 days in patients presenting to the ED with renal colic. These risk factors should be considered when making management, prognostic, and disposition decisions for patients with suspected urolithiasis.
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Patient satisfaction impacts emergency medicine in multiple ways, including patient-physician rapport, patient compliance with medical recommendations, and individual physician and hospital reimbursement issues. ⋯ Despite differences between patients placed in regular treatment rooms vs. hallway treatment areas, overall satisfaction levels are lower for those patients treated in hallway treatment areas. This difference is likely attributable primarily to their hallway location, and stakeholders should therefore take appropriate steps to address such discrepancies.