Prehospital transport time intervals for acute stroke patients.

Background: Recognizing factors that cause prehospital stroke delays may improve time of presentation to the Emergency Department (ED) and allow earlier treatment of acute stroke patients.

Study Objectives: To determine the impact of stroke recognition by emergency medical dispatchers (EMD) and paramedics (PM) on ED arrival time in a large urban Emergency Medical Services system.

Methods: Retrospective study of patients aged 18 years or more identified as having acute stroke by EMD, PM, or stroke neurologists from January 1, 2005 to December 31, 2005.

Accuracy of stroke recognition by emergency medical dispatchers and paramedics--San Diego experience.

Background: Prehospital personnel in Emergency Medical Service (EMS) systems have varying levels of accuracy in stroke recognition. Identifying the accuracy of emergency medical dispatcher using Medical Priority Dispatch Systems (MPDS) stroke protocol and paramedics may help understand the accuracy of stroke recognition in about 3000 emergency medical dispatch systems and prehospital systems world wide.

Objective: Our aim was to assess the accuracy of stroke identification in emergency medical dispatchers (EMD) with high compliance to MPDS protocol and paramedics using Cincinnati Prehospital Stroke Scale (CSS).

Central venous access by air medical personnel.

Background: Vascular access is vital in the resuscitation of critically ill and injured patients for both fluid resuscitation and the delivery of medications. However, peripheral access is not always possible in patients with hypovolemia or difficult anatomy. Central venous access is an alternative vascular access strategy for air medical crews, offering the advantage of relatively predictable anatomy, even in unstable patients.

The feasibility of a regional cardiac arrest receiving system.

Background: Patients suffering out-of-hospital cardiac arrest (OOHCA) are generally transported to the closest ED, presumably to expedite a hospital level of care and improve the chances of return for spontaneous circulation (ROSC) or provide post-resuscitative care for patients with prehospital ROSC. As hospital-based therapies for survivors of OOHCA are identified, such as hypothermia and emergency primary coronary interventions (PCI), certain hospitals may be designated as cardiac arrest receiving facilities. The safety of bypassing non-designated facilities with such a regional system is not known.

Blood cultures do not change management in hospitalized patients with community-acquired pneumonia.

Objectives: To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community-acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower-spectrum antibiotics based on the results.

Methods: This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community-acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available.

Nonoccupational postexposure HIV prevention: emergency physicians' current practices, attitudes, and beliefs.

Study Objective: We surveyed emergency physicians to determine current practices, knowledge, attitudes, and beliefs regarding nonoccupational postexposure prevention practices.

Methods: Two thousand randomly selected practicing emergency physicians from the American College of Emergency Physicians' national database and all graduating emergency medicine residents in 2000 were surveyed. Knowledge, role responsibility, self-efficacy, and attitudes and beliefs were measured and composite scores developed.

Progesterone as a predictor of ectopic pregnancy when the ultrasound is indeterminate.

The objective of this study was to evaluate a progesterone cutpoint of 5.0 ng/mL ability to identify abnormal pregnancy (abnormal intrauterine pregnancy and ectopic pregnancy) as well as ectopic pregnancy alone in 2 subclasses of indeterminate ultrasounds. This was a prospective observational study of emergency department patients with abdominal pain or vaginal bleeding and an indeterminate transvaginal ultrasound.