Abstract:
STUDY OBJECTIVES:To assess the timing of key decisions and clinical events in the treatment of acute myocardial infarction with thrombolytic therapy. DESIGN:Prospective study of emergency department patients. SETTING:EDs in 11 urban and two rural hospitals. TYPES OF PARTICIPANTS:Patients with presumed acute myocardial infarction for whom a decision was made in the ED to administer thrombolytic therapy. MEASUREMENTS AND MAIN RESULTS:Statistical analyses included determination of frequency of response, cross tabulation analysis, and Wilcoxon rank sum tests. In 210 thrombolytic-treated patients (mean age, 57 +/- 14.1 years), a median time of 155 minutes elapsed between pain onset and therapy; 67% of the delay was pre-ED arrival. The median time between ED arrival and the initial ECG was six minutes. The median time required for physicians to make a treatment decision was 20 minutes, followed by another median time of 20 minutes for staff to begin drug infusion. The median total hospital (door-to-needle) time was 50 minutes. Significantly shorter delays occurred in urban, teaching, and high-volume hospitals; when thrombolytics were stocked and/or started in the ED; and when emergency physicians treated without involving private attending physicians. Although 95% of patients received tissue plasminogen activator, six patients treated with anisoylated plasminogen-streptokinase activator complex experienced a significantly faster door-to-needle time (P less than .05). CONCLUSION:Thrombolytics should be stocked and started in the ED. Emergency physicians should generally make the decision to administer thrombolytic therapy with reference to accepted protocols without awaiting an ED consultation from either private attendings or cardiologists.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Gonzalez ER,Jones LA,Ornato JP,Bleecker GC,Strauss MJdoi
10.1016/s0196-0644(05)81749-4subject
Has Abstractpub_date
1992-10-01 00:00:00pages
1215-21issue
10eissn
0196-0644issn
1097-6760journal_volume
21pub_type
杂志文章,多中心研究abstract::There are currently 20 autonomous departments of emergency medicine in United States medical schools. EDs seeking autonomous status should institute a faculty development program to channel faculty energy into worthwhile research projects; establish protected time for clinical faculty to increase research productivity...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82395-9
更新日期:1991-06-01 00:00:00
abstract::Sexually transmitted bowel and rectal diseases are common in gay men and are caused by a wide variety of infectious agents. Each of the entities implicated in the gay bowel syndrome is considered separately and epidemiologic considerations responsible for the appearance of such a syndrome are examined. The emergency p...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(80)80310-6
更新日期:1980-09-01 00:00:00
abstract::Intravenous (IV) fibrinolytic therapy, a recent area of research, has a great deal of applicability in emergency medicine. We report our experience with 30 patients treated with this method. Thirty consecutive patients in the early stages of acute evolving myocardial infarction (AMI) were assigned to receive high-dose...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80283-3
更新日期:1985-05-01 00:00:00
abstract:STUDY OBJECTIVE:To determine whether pediatric patients with acute, mild to moderate acetaminophen exposures, treated with home monitoring alone, develop systemic signs of hepatic injury. METHODS:A prospective, observational study of calls to a regional poison center over a 25-month period was performed. Patients were...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(00)70074-6
更新日期:2000-03-01 00:00:00
abstract::An important responsibility of emergency departments is the management of injuries sustained in assaults. Most assaults, including many causing serious injury, are not reported and not recorded by the police. This is important because police investigation and the conviction of offenders has a substantial deterrent eff...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1067/mem.2001.114317
更新日期:2001-10-01 00:00:00
abstract::We examined the hemodynamic effects of congesting cuffs (rotating tourniquets) in 12 patients with first acute myocardial infarction and new onset of congestive heart failure 24 to 48 hours after admission. Congesting cuffs were applied for two periods of 15 minutes each, 15 minutes apart, and inflated to 30 mm Hg and...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80570-x
更新日期:1987-07-01 00:00:00
abstract:STUDY OBJECTIVE:Buffered lidocaine was compared with plain lidocaine as a local anesthetic for simple lacerations. DESIGN:Randomized, double-blind, prospective clinical trial. SETTING:Urban emergency department. TYPE OF PARTICIPANTS:Ninety-one adult patients with simple linear lacerations were enrolled. Patients wit...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(05)82603-4
更新日期:1990-12-01 00:00:00
abstract::Pulmonary embolism, although uncommon in children, occurs in as many as 104 per 100,000 pediatric patients. Undiagnosed and untreated pulmonary embolism has a high mortality rate; thus, a high index of clinical suspicion and reliable diagnostic modalities are necessary to ensure prompt and accurate diagnosis. We repor...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81131-x
更新日期:1991-01-01 00:00:00
abstract::The traditional use of the throat culture to guide treatment of potential streptococcal pharyngitis recently has been questioned because of the following facts: antibiotic therapy within the first 48 hours of illness reduces the severity and symptoms of streptococcal pharyngitis; more rapid treatment of streptococcal ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80573-x
更新日期:1986-03-01 00:00:00
abstract:STUDY OBJECTIVE:The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. We evaluate the STONE score in a multi-institutional cohort compared with physician gestalt and hypothesize...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2015.08.019
更新日期:2016-04-01 00:00:00
abstract:STUDY OBJECTIVES:To determine the sensitivity and specificity of the urine ketone dip test as a screening test for ketonemia in hyperglycemic patients and to compare the performance of the urine ketone dip test with the anion gap and serum bicarbonate level. METHODS:This was a prospective study conducted in an urban, ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(99)70128-9
更新日期:1999-09-01 00:00:00
abstract::Ketamine produces rapid and consistent pediatric sedation with a predictable onset and recovery time. A wide margin of safety is afforded without the respiratory and cardiovascular depression commonly seen with alternative agents. The efficacy of ketamine is well established in anesthesia and dentistry and has extensi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(05)82569-7
更新日期:1990-09-01 00:00:00
abstract:STUDY OBJECTIVE:Ultrasonographically guided intravenous peripheral catheters have dismal dwell time, with most intravenous lines failing before completion of therapy. Catheter length in the vein is directly related to catheter longevity. We investigate the survival of an ultralong ultrasonographically guided intravenou...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2019.11.013
更新日期:2020-08-01 00:00:00
abstract::A retrospective review of all patients admitted to an urban teaching hospital emergency department with the complaint of overdose, poisoning, or ingestion during a 10-month period was conducted. Analysis of these 82 episodes involving 69 individuals revealed: 1) a preponderance of women in the 20- to 40-year old range...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80453-2
更新日期:1981-01-01 00:00:00
abstract:STUDY OBJECTIVE:This study seeks to examine whether the finding of an abnormal estimated glomerular filtration rate (eGFR) in the emergency department (ED) was associated with acute coronary syndrome in the population of patients presenting for investigation of chest pain. METHODS:We used prospectively collected data ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2013.01.011
更新日期:2013-07-01 00:00:00
abstract::A case is presented of a vaginal foreign body. A drinking glass was inserted in the vagina of an intoxicated patient by her irate lover. Infection followed. The emergency care is described, including the method of extraction of the object, along with discussion of the principles involved and associated complications. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80287-9
更新日期:1981-09-01 00:00:00
abstract:STUDY OBJECTIVE:Emergency department (ED) patients with atrial fibrillation or flutter are at risk of stroke, and guidelines recommend anticoagulation for patients with increased cardiovascular risk. Emergency physicians have a unique opportunity to provide appropriate anticoagulation for such patients, and we wished t...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2013.04.004
更新日期:2013-12-01 00:00:00
abstract:STUDY OBJECTIVE:To determine whether the use of diclofenac ophthalmic solution is a safe and effective analgesic in the treatment of traumatic corneal abrasions in the emergency department. METHODS:We conducted a prospective, randomized, double-blinded, placebo-controlled clinical trial. Consenting consecutive patient...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(00)70132-6
更新日期:2000-02-01 00:00:00
abstract::We present the cases of three patients with preexisting bundle-branch block in whom wide-complex tachycardias were considered to be of supraventricular origin because QRS morphologies were essentially unchanged from those during normal sinus rhythm. The patients experienced adverse effects from medications for suprave...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(95)70245-8
更新日期:1995-07-01 00:00:00
abstract:STUDY OBJECTIVE:Availability of timely follow-up care is essential in emergency medicine. We describe nonprice barriers to care experienced by callers reporting to be emergency department (ED) patients in need of follow-up care. METHODS:This was a secondary analysis of data collected during a survey of ambulatory clin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2007.10.027
更新日期:2008-05-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the safety of lidocaine in the setting of cocaine-induced myocardial infarction (MI). DESIGN:A retrospective, multicenter study. SETTING:Twenty-nine university, university-affiliated, or community hospitals during a 6-year period (total of 117 cumulative hospital-years). PARTICIPANTS:Pati...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/s0196-0644(95)70041-2
更新日期:1995-12-01 00:00:00
abstract::During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the cou...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:
更新日期:1998-02-01 00:00:00
abstract::The case of a patient who developed severe acute respiratory failure during therapy for salicylate intoxication is described. The individual with aspirin overdose is at risk for this complication because of the potential for treatment modalities to cause or worsen lung edema initiated by the effects of salicylates on ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80349-6
更新日期:1981-02-01 00:00:00
abstract::Blunt abdominal trauma is a common presentation to the emergency department. Ischemic colitis is a rare complication of this and its possible sequelae are important for an emergency physician to recognize. A 21-year-old man presented to the emergency department with abdominal pain and hourly episodes of bright red blo...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2011.01.014
更新日期:2011-08-01 00:00:00
abstract:STUDY OBJECTIVE:Influenza has been linked to emergency department (ED) crowding, yet few studies have examined this association. We describe the relationship between ED crowding and influenza outbreaks. METHODS:A retrospective time series analysis was conducted in Toronto from January 1996 to April 1999 (n=170 weeks)....
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2003.12.008
更新日期:2004-07-01 00:00:00
abstract::We report the cases of three patients with residual symptoms from diving decompression sickness, each of whom presented to a recompression chamber three to seven days following original exposure. All three had complete resolution of symptomatology despite the delayed treatment. The late resolution of symptoms is evide...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80450-9
更新日期:1985-03-01 00:00:00
abstract::Maprotiline, a new tetracyclic antidepressant, has a pattern of toxicity that is different from that of tricyclics. Maprotiline overdosage appears more likely to cause seizures but less likely to cause the peripheral autonomic and cardiac manifestations seen with tricyclics. Two cases of maprotiline overdose resulting...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80016-5
更新日期:1984-06-01 00:00:00
abstract:STUDY OBJECTIVE:Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of sca...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2013.02.005
更新日期:2013-06-01 00:00:00
abstract::There is general agreement that physical examination alone is inadequate for abdominal evaluation in the multiply injured blunt trauma patient; but controversy exists regarding the preferred method of detecting intraabdominal injuries requiring celiotomy. Both peritoneal lavage and the newer computed tomography imagin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80269-0
更新日期:1989-12-01 00:00:00
abstract::We present the case of a 27-year-old man who sustained a minor head injury and presented with complaints of headache and vomiting. The diagnosis of vertex epidural hematoma is discussed. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70145-8
更新日期:1994-08-01 00:00:00