Harold K Simon, Debra A Ledbetter, Jean Wright
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90154-6
Published in issue: October 1997
xTo evaluate the cost-effectiveness of a “fast track” system for diverting lower acuity patients away from the pediatric emergency department (ED), 4,060 patients triaged to the fast track area of an urban pediatric ED with the 10 most common discharge diagnoses from 1/1/94 through 12/31/94 were retrospectively evaluated. Patients triaged as having nonurgent concerns qualified for treatment in a separate fast track area for 8 hours per day (fast track patients). These patients were compared with 5,199 seen in the main pediatric ED for the same concerns during the remaining hours when the fast track was not in operation (ED patients).
Frédéric Adnet, Frédéric Lapostolle, Stephen W Borron, B Hennequin, G Leclercq, M Fleury
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90155-8
Published in issue: October 1997
xTwo methods of endotracheal intubation of patients lying on the ground were compared for ease and speed of intubation and minimization of complications in a crossover study of prehospital-oriented emergency physicians. Intubation of a mannequin was attempted by the physicians in either a left lateral decubitus (LLD) position or a kneeling (K) position, followed by the alternate position. The LLD position afforded more rapid intubation, better glottic visualization, and less dental trauma. Eighty-seven percent of physicians completely visualized the glottis in the LLD position, versus 33% of the K position group.
Timothy Harrison, Stephen H Thomas, Suzanne K Wedel
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90156-X
Published in issue: October 1997
xThis study's goal was to analyze aeromedical emergency medical services (EMS) endotracheal intubation (ETI) success rates for in-flight intubations, and to retrospectively compare in-flight ETI success rates with those achieved in hospital and trauma scene settings. Patients undergoing flight crew ETI during a 3-year study period were reviewed, and flight team-performed intubations were classified as in-flight, hospital (at referring hospital), or ground (at trauma scene). Flight crews attempted ETI in 302 patients, with success in 291 patients (96.4%).
Lorraine G Thibodeau, Vincent P Verdile, Joel M Bartfield
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90157-1
Published in issue: October 1997
xThis study sought to determine the incidence of aspiration after urgent endotracheal intubation (ET) performed in the emergency department (ED), and to offer a descriptive evaluation of these intubations. In a retrospective review of 133 charts, 87 patients met inclusion criteria. Aspiration occurred in 3 (3.5%) patients (95% confidence interval, 0%, 7.4%). One had witnessed aspiration, and 2 had positive sputum cultures. None of the 87 patients had a positive chest radiograph or unexplained hypoxemia up to 48 hours after ET.
Ichiro Kukita, Kazufumi Okamoto, Toshihide Sato, Yoshihiro Shibata, Kenichiro Taki, Mitsuro Kurose, Hidenori Terasaki, Hirotsugu Kohrogi, Masayuki Ando
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90158-3
Published in issue: October 1997
xExtracorporeal life support (ECLS) was used to treat three patients with near-fatal status asthmaticus who did not respond to aggressive medical therapies and mechanical ventilation under controlled permissive hypercapnia. ECLS was instituted in patient 1 because Paco2 was excessively high and pH was excessively low, in patient 2 because hypoxemia and shock were not responsive to treatment, and in patient 3 because of sustained severe hypotension. ECLS supported adequate gas exchange until pulmonary function improved, diminishing the need for mechanical ventilation and preventing pulmonary complications.
Linda Kelley, David P Sklar, David R Johnson, Dan Tandberg
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90159-5
Published in issue: October 1997
xA study was done to prospectively compare the pain and distress of urethral mini-catheterization (MC) with the pain and distress of intravenous (IV) catheterization in women. Ten-centimeter visual analog scales were used on which the left end represented “no pain” or “no distress” and the right “the worst pain imaginable” or “extreme distress.” Distress was defined to include embarrassment, anxiety, or fear. A convenience sample of 40 adult women who presented to a university emergency department and were undergoing both procedures as part of their management appraised pain and distress after IV placement and urethral MC.
Beatrix Chandra Bansal, Thomas J Abramo
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90160-1
Published in issue: October 1997
xA case of subcutaneous emphysema and pneumomediastinum as a result of child abuse is presented to add to the spectrum of findings associated with child maltreatment. This case is a reminder that although most cases of subcutaneous emphysema resolve uneventfully, there still needs to be an aggressive search for a cause. In addition, in the pediatric age group, the history given should be carefully verified as being plausible because of the possibility that child abuse may be the true etiology.
Terence Alost, Ron D Waldrop
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90161-3
Published in issue: October 1997
xFew studies have examined differences in mechanism, presentation, and outcome of trauma in geriatric patients. This study compared pelvic fractures and associated injuries in geriatric and nongeriatric patients. The medical charts of all patients presenting to a large urban emergency medicine teaching program with a pelvic fracture between January 1, 1987 and December 31, 1993 were retrospectively reviewed by study-blinded physicians. Data collected included mechanism and site of injury, associated injuries, disposition (admission or discharge), need for operative repair, length of hospital stay, as well as subsequent deaths and causes.
Jeffrey S Jones, Christopher Holstege, Henry Holstege
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90162-5
Published in issue: October 1997
John R Mabee, Bronwyn Pritchard
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90163-7
Published in issue: October 1997
xA patient sustained a crush-type hyperextension injury to his wrist, and presented to the emergency department (ED) with wrist pain, swelling, and paresthesias along the median and superficial radial nerve distributions. His initial radiographic study was interpreted as showing a radial styloid fracture. The next day, he returned for a scheduled revisit with continued wrist pain and swelling. He also had loss of two-point discrimination in the median nerve distribution and loss of thumb opposition.
Koji Iida, Kaoru Kurisu, Kazunori Arita, Toshinori Nakahara, Minako Ohtani, Hideki Satoh
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90164-9
Published in issue: October 1997
xA 20-year-old man presented with hypovolemic shock caused by abdominal injury. Cerebral hemodynamics were evaluated by transcranial Doppler (TCD) sonography. Middle cerebral artery flow velocities decreased, and the pulsatility indices increased markedly. Particularly, the waveform of the left middle cerebral artery showed a systolic peak, suggesting an increased intracranial pressure. Actual intracranial pressure was 7 mm Hg, and the cerebral perfusion pressure (CPP) was 51 mm Hg. These abnormal Doppler signals seemed to be caused by a compromise in CPP and to be aggravated by hypovolemia.
Michael E Ivy, Stephen M Cohn
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90165-0
Published in issue: October 1997
xEvery year in the United States about 5,000 people sustain a cervical spinal cord injury. Vastly greater numbers present to hospitals after motor vehicle crashes and falls with potential cervical spine injuries (CSI) for evaluation. This group of patients requires very careful management while undergoing evaluation for potential CSI to minimize the potential for spinal cord injury. It is, therefore, incumbent on everyone caring for these patients to distinguish between fact and fiction in regard to CSI management.
Zeev Rotstein, Rachel Wilf-Miron, Bruno Lavi, Amir Shahar, Uri Gabbay, Shlomo Noy
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90166-2
Published in issue: October 1997
xUsing a public hospital's computerized database, we formulated a statistical model to explain emergency department (ED) patient volume for better staffing and resource allocation. All patients visiting the ED over a 3-year period were included in this retrospective study. Each observation described the total daily number of referrals and was defined by the following variables: day of the week, month of the year, holiday/weekday, relative order in a 3-year sequence, and number of visits to the ED on that day.
Mark Hauswald, Ernest Yeoh
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90167-4
Published in issue: October 1997
xMany of the costs associated with prehospital care in developed countries are covered in budgets for fire suppression, police services, and the like. Determining these costs is therefore difficult. The costs and benefits of developing a prehospital care system for Kuala Lumpur, Malaysia, which now has essentially no emergency medical services (EMS) system, were estimated. Prehospital therapies that have been suggested to decrease mortality were identified. A minimal prehospital system was designed to deliver these treatments in Kuala Lumpur.
Charles J McCabe, Ralph L Warren
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90168-6
Published in issue: October 1997
Andrew J.L Gear, Heather Wright, Wyn D Nguyen, David B Drake, Richard F Edlich
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90169-8
Published in issue: October 1997
Neal R Abarbanell, Mary Ann Marcotte
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90170-4
Published in issue: October 1997
Sunail Kumar, James G Petros, Lester J Sheehan, Raymond Sullivan
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90171-6
Published in issue: October 1997
