Articles: emergency-department.
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This clinical policy focuses on critical issues in the evaluation and management of patients with acute myocardial infarction or unstable angina. A MEDLINE search for articles published between January 1993 and December 1998 was performed using combinations of the key words chest pain, acute myocardial infarction, unstable angina, thrombolytics, primary angioplasty, 12-lead ECG, ST-segment monitoring, cardiac serum markers, and chest pain centers. Subcommittee members and expert peer reviewers also supplied articles with direct bearing on the policy. ⋯ Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected acute myocardial infarction or unstable angina. Ann Emerg Med. May 2000;35:521-544.].
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To estimate the level of knowledge that Canadian emergency physicians have of the costs of common diagnostic tests and interventions in the emergency department (ED). ⋯ Emergency physicians have a limited knowledge of the costs of the tests and interventions they use on a daily basis. They tend to overestimate lab and pharmaceutical costs but underestimate imaging costs. Cost-awareness programs for emergency physicians are most likely to be beneficial if they focus on imaging modalities.
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To determine the prevalence of influenza vaccination in patients who present to the emergency department (ED) who meet current guidelines for its use. To evaluate the feasibility of an ED-based program to provide influenza vaccine to at-risk patients. ⋯ Up to 50% of patients eligible for influenza vaccine are not adequately immunized. Administering influenza vaccine in the ED is acceptable to patients and should reduce influenza rates in at-risk populations. There is a role for administering influenza vaccine in the ED.
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We sought to evaluate the safety and efficacy of a shorter N -acetylcysteine (NAC) regimen in the treatment of acute acetaminophen overdose. ⋯ This observational study suggests that a shorter course of oral NAC therapy in patients who do not show evidence of hepatotoxicity within 36 hours of an acute acetaminophen overdose is safe and effective. [Woo OF, Mueller PD, Olson KR, Anderson IB, Kim SY. Shorter duration of oral N -acetylcysteine therapy for acute acetami-nophen overdose. Ann Emerg Med . April 2000;35:363-368.].
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Recent reports suggest a short series of cardiac troponin (cTnT) testing effectively identifies patients at risk for cardiac events. However, there are few studies validating this strategy. The purpose of this study was to determine the ability of cTnT levels to predict short- and long-term outcomes in low-risk patients with suspected acute coronary syndromes. ⋯ Determination of troponin T levels has a low sensitivity and high specificity for predicting outcomes in low-risk patients evaluated for suspected acute coronary syndromes. This study does not support a strategy of relying solely on troponin testing for disposition decisions. [Peacock WF IV, Emerman CL, McErlean ES, Deluca SA, van Lente F, Rao JS, Nissen SE: Prediction of short- and long-term outcomes by troponin T levels in low-risk patients evaluated for acute coronary syndromes. Ann Emerg Med. March 2000;35:213-220.].