Articles: emergency-department.
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The underuse of analgesics, or "oligoanalgesia," is common in emergency departments (EDs). To improve care we must understand our patients' pain experiences as well as our clinical practice patterns. To this end, we examined pain etiology, pain management practices and patient satisfaction in 2 urban EDs. ⋯ In the 2 EDs studied, we found high levels of pain severity for our patients, as well as low levels of analgesic use. When used, analgesic administration was often delayed. Despite these findings, patient satisfaction remained high. Despite recent efforts to improve pain management practice; oligoanalgesia remains a problem for our specialty.
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Clinical teaching is an integral part of emergency medical practice. With the growing number of medical students and residents in the emergency department there are increasing expectations for clinicians to teach. But there are many challenges and obstacles to overcome when teaching in a busy department. By incorporating diverse strategies and techniques, we can become more effective and efficient emergency medicine teachers.
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Emergency radiology · Jul 2002
Reappraisal of use of X-rays in childhood ankle and midfoot injuries.
To determine whether the Ottawa ankle rules (OAR) can be applied in children and what the potential reduction in the use of X-ray studies might be. ⋯ The Ottawa ankle rules are very sensitive and can be applied in children, resulting in a reduction in the use of X-rays studies.
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Emergency radiology · Jul 2002
Utilization of CT-PA in an emergency department with readily available V/Q scintigraphy.
To describe the role of computed tomographic pulmonary angiography (CT-PA) in the emergency department of an institution which utilizes ventilation-perfusion (V/Q) scintigraphy as its primary imaging modality for the diagnosis of pulmonary embolism. ⋯ V/Q scintigraphy is the primary imaging modality for suspected pulmonary embolism in our emergency department. However, when utilized, CT-PA played an important role in patient management by confirming or excluding pulmonary embolism or providing an alternative diagnosis in the majority of patients suspected of having pulmonary embolism.
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Research has demonstrated that experienced emergency physicians can identify a subgroup of patients with shoulder dislocation for whom pre-reduction radiographs do not alter patient management. Based on that research, a treatment guideline for the selective elimination of pre-reduction radiographs in clinically evident cases of anterior shoulder dislocation was developed and implemented. The primary objective of this study was to prospectively determine whether the treatment guideline safely eliminates unnecessary radiographs. ⋯ Experienced emergency physicians are frequently certain of the diagnosis of anterior shoulder dislocation on clinical grounds alone and can comfortably and safely use this guideline for the selective elimination of pre-reduction radiographs. Compliance with the guideline substantially decreases pre-reduction radiographs. Validation of the guideline in other settings is warranted.