Articles: emergency-department.
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Paramedics often provide advance notice of patients with suspected acute myocardial infarction (AMI) so that emergency department (ED) staff can prepare for early aggressive management and expeditious thrombolysis, but the validity of this practice is unclear. Our objective was to determine the accuracy of prehospital AMI diagnosis by Paramedic Level III (ALS) attendants. ⋯ ALS paramedics can accurately identify patients likely to benefit from early aggressive AMI management. These data have implications with respect to prehospital triage of chest pain patients, "early notification" protocols and future prehospital thrombolytic strategies.
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Reducing the number of unnecessary antibiotic prescriptions given for common respiratory infections has been recommended as a way to limit bacterial resistance. This study assessed the validity of a clinical sore throat score in 2 community emergency departments (EDs) and its impact on antibiotic prescribing. We also attempted to improve on this approach by using a rapid streptococcal antigen test. ⋯ An explicit clinical score approach to the management of GAS pharyngitis is valid in a community ED setting and could improve the pattern of antibiotic prescribing. While the addition of a rapid streptococcal antigen test significantly decreased the sensitivity of detecting GAS infections, a combined approach consisting of the clinical score and throat culture for patients with negative results on the rapid test would decrease antibiotic prescribing and telephone follow-up without decreasing the sensitivity of detecting GAS infection.
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Urethral catheterization is a technique frequently used in the pediatric emergency department. Intravesicular knotting of the catheter is a rare but potentially preventable complication that can involve significant morbidity. ⋯ The risk of intravesicular catheter knotting can be reduced with proper technique and the correct choice of catheters. We present a case report and list recommendations to minimize the risk of occurrence.
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To develop an operational definition and a parsimonious list of postulated determinants for urban emergency department (ED) overcrowding. ⋯ These results help to clarify the conceptual framework around ED overcrowding, and may provide a guide for future research. The relative importance of the determinants must be assessed by prospective studies.