Articles: emergency-services.
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The initial electrocardiogram is crucial in accurately selecting patients with chest pain for thrombolytic therapy. An electrocardiogram with a large amount of ST-segment elevation and depression is "visually alarming," and therefore, may influence the efficiency of patient treatment with thrombolytic therapy. It was hypothesized that the amount of ST-segment deviation present on the initial electrocardiogram was an important variable in determining the time to initiation of thrombolysis in the emergency department. ⋯ Regression analysis of multiple clinical variables revealed that ST-segment sum was the only variable that significantly influenced the time to thrombolysis (r = -0.42; p < 0.001). For patients treated in < or = 30 minutes, the average ST-segment sum was 21.1 +/- 13.5 vs 11.5 +/- 11.4 mm for those treated in > or = 60 minutes (p = 0.01). In 10 patients mistakenly treated with thrombolytic therapy, the electrocardiographic processes responsible for ST-segment elevation included the early repolarization variant, left ventricular hypertrophy, old anterior AMI with persistent ST-segment elevation, and conduction delay.(ABSTRACT TRUNCATED AT 250 WORDS)
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To improve understanding of the patterns of injury morbidity and mortality in an urban African-American population. ⋯ Interpersonal intentional injury occurs frequently in this population. More attention needs to be paid to prevention and intervention to reduce the toll of this violence. The high prevalence of injury in certain age strata may make general, population-based efforts for injury prevention more efficient than efforts targeted to subgroups.
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Multicenter Study Comparative Study
Emergency-department diagnosis of acute myocardial infarction and ischemia: a cost analysis of two diagnostic protocols.
To assess the potential cost savings of the emergency-department (ED) diagnosis of acute myocardial infarction (AMI) and other myocardial ischemia using a nine- hour ED evaluation protocol. ⋯ At both centers, hospital charges related to the acute evaluation of chest pain were significantly lower with this ED diagnostic protocol for AMI and myocardial ischemia.
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The objective of this study was to examine the use of limited, goal-directed, two-dimensional ultrasound studies performed by emergency physicians and to assess the frequency, variety, and accuracy of their readings. A 1-year prospective study was performed by using an emergency department (ED) ultrasound machine with a 3.5-mHz mechanical oscillating sector transducer and a 5.0-mHz vaginal transducer. In a series of proctoring sessions, radiologists trained emergency physicians to do limited, goal-directed ultrasonography. ⋯ Eleven categories of ultrasound use were reported. The three studies most commonly performed were for gallbladder disease (53%), intrauterine pregnancy (28%), and abdominal aortic aneurysms (7%). Accuracy of ED gallbladder ultrasonograms for 65 patients showed a sensitivity of .86, specificity of .97, PPV of .97, and NPV of .85.(ABSTRACT TRUNCATED AT 250 WORDS)