Articles: emergency-services.
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In a review by questionnaire of the emergency visits to 185 Florida hospitals, the number of annual estimated visits appears to exceed national estimates. In addition, the concept that in excess of 75% of patients are not true emergencies is not borne out. In spite of changes in the emergency medical services system, only 10% of patients came by ambulance or rescue vehicle. ⋯ Some 40% of Florida's emergency departments have full-time emergency physicians. Although nearly 70% of the emergency patients were seen by these physicians, 2.4% were seen by interns only, and a total of 10% were seen by house officers only. There was a great variety of referral patterns among the Health Service Agencies.
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The contribution of the electrocardiogram to the clinical judgment used by the physician in the emergency room to determine the necessity for hospitalizing patients was evaluated. Thirty-five percent of all 1,578 patients with presumed myocardial infarction referred to the Chaim Sheba Medical Center, Tel Hashomer, Israel, for a one-year period had subsequently diagnosed myocardial infarctions. The ECG in the emergency room detected only 65 percent of these. ⋯ When the myocardial infarction was not evident on the ECG and the abnormalities on the tracings were identical for patients with subsequent myocardial infarctions and those without, again the physician made the right choice more often than the wrong. The follow-up ECG also attested to the good judgment of the physician in the emergency room. Of the emergency room ECGs of patients without subsequent myocardial infarctions who were admitted to the hospital, 17 percent showed myocardial infarction by follow-up, while this happened to only 2 percent of those denied admission.