DOI: http://dx.doi.org/10.1016/S0735-6757(98)90054-7
Published in issue: January 1998
Scott H Plantz, Lance W Kreplick, Edward A Panacek, Tejas Mehta, Jon Adler, Robert M McNamara
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90055-9
Published in issue: January 1998
xThe opinions and experiences of board-certified emergency physicians regarding employment structure and finances, professional society policies, and quality of patient care have never been formally studied. A survey questionnaire was sent to a random sample of 1,050 emergency physicians certified by the American Board of Emergency Medicine. The survey contained 29 multiple choice questions. Of the 1,050, 465 (44.3%) of the surveys were returned. Respondents averaged 13.5 years of emergency medicine practice, 83% were members of the American College of Emergency Physicians, and 44% were emergency medicine residency trained.
Richard L Summers, Robert M Anders, Louann H Woodward, Aryanna K Jenkins, Robert L Galli
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90056-0
Published in issue: January 1998
xPulse oximetry is commonly used to rapidly determine oxygen saturation and is incorporated in emergency triage as a screening for potential cardiopulmonary complications. This study examined the effect of routine pulse oximetry measurements on emergency department (ED) triage classification. Using a portable pulse oximeter, oxygen saturation of 1,235 adults presenting to a university-based, urban ED was obtained and each patient was assigned a classification of severity based on a standard 1-to-4 scale before and after the measurement.
David C Seaberg, Bruce A MacLeod
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90057-2
Published in issue: January 1998
xTriage nurse ordering of tests can reduce patient time in the emergency department. This benefit must be balanced with the extra expense and potential morbidity of unnecessary tests. This study examined whether triage nurse ordering of lab tests and X-rays correlated with physician ordering. In Phase I, a prospective study, triage nurses completed an order form for each patient triaged during randomly selected 2-hour blocks over a 3-week period. In Phase II, Phase I was repeated with test ordering guidelines derived from Phase I results.
Markku Kuisma, Teuvo Määttä, Jukka Repo
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90058-4
Published in issue: January 1998
xThe purpose of the study was to determine the epidemiology and the etiology of cardiac arrests witnessed by emergency medical services (EMS) personnel and the survival from resuscitation according to the Utstein style. Consecutive prehospital cardiac arrests witnessed by EMS personnel in the Helsinki City EMS system between January 1, 1994 and December 31, 1995 were included in this prospective cohort study. A total of 809 cardiac arrests were registered during the study period, 108 (13.3%) of which were EMS-witnessed.
Feng Xiao, Peter Safar, Ann Radovsky
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90059-6
Published in issue: January 1998
xIt has been shown in dogs that mild hypothermia (34°C) during or immediately after ventricular fibrillation cardiac arrest can improve cerebral outcome. The effect of mild hypothermia on outcome after 8 minutes of asphyxiation (5 minutes' cardiac arrest) was studied for the first time in rats. Restoration of spontaneous circulation was with external cardiopulmonary resuscitation and observation to 72 hours. Three groups of 10 rats each were studied. At 72 hours postarrest, compared with the normothermic control group 1, final overall performance categories (OPC) and neurological deficit scores (NDS) were numerically better in the resuscitative (post-arrest) hypothermia group 2 and significantly better in the protective (pre-intra-arrest) hypothermia group 3 (P < .05).
Patrick M Rao, James T Rhea, Robert A Novelline, Charles J McCabe
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90060-2
Published in issue: January 1998
xThe objective of this study was to determine computed tomography (CT) appearance of recurrent and chronic appendicitis. In 100 consecutive appendiceal CT examinations of proven appendicitis, 18 patients met criteria for recurrent (multiple discrete episodes) or chronic (continuous symptoms >3 weeks, pathological findings) appendicitis. CT findings were reviewed. Ten patients had recurrent appendicitis, 3 had chronic appendicitis, 3 had both, and 2 had pathological chronic appendicitis. CT findings in 18 recurrent/chronic cases were identical to 82 acute appendicitis cases, including pericecal stranding (both 100%), dilated (>6 mm) appendix (88.9% versus 93.9%), apical thickening (66.7% versus 69.5%), adenopathy (66.7% versus 61.0%), appendolith(s) (50% versus 42.7%), arrowhead (27.8% versus 22.0%), abscess (11.1% versus 11.0%), phlegmon (11.1% versus 6.1%), and fluid (5.6% versus 19.5%).
Edward A Ramoska
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90061-4
Published in issue: January 1998
xThis study analyzed the effect information sharing through physician profiling would have on emergency physician behavior. It is a before-and-after audit of laboratory use in a community hospital. A 9-month control period was followed by a 15-month period in which the physicians' laboratory use was presented and discussed at monthly meetings. The laboratory use decreased 17.8%, from a mean of 2.36 studies per patient during the control period to 1.94 during the final quarter of the study. The actual laboratory costs per month decreased 17.7%, from a mean of $32,415 per month to $26,687 per month.
Jeffrey W Morse, Thomas Babson, Chris Camasso, Anneke C Bush, Philip A Blythe
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90062-6
Published in issue: January 1998
xThe objectives of this study were to determine the speed of irrigation and the infection rate of two new irrigation devices. In the clinical portion of this two-part study, 208 patients with traumatic wounds were randomized to one of two new irrigation device groups, the cap/bottle or the port/bag, to determine irrigation times and infection/complication rates. Wounds were irrigated in less than 4 minutes in 97% of patients using a mean of 786 mL. The combined infection/complication rates were: port group, 1 of 99 (1%); cap group, 4 of 108 (4%), P = .356.
Anthony Ciccone, John R Allegra, Dennis G Cochrane, Ronald P Cody, Lisa M Roche
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90063-8
Published in issue: January 1998
xThe most common diagnoses of elderly patients in the emergency department (ED) were compared among three age subgroups: 65 to 74, 75 to 84, and 85 and older. The computerized billing records for patient visits to 10 northern New Jersey hospital EDs for the years 1985 to 1991 were retrospectively analyzed. The most frequently occurring ICD-9-CM codes for elderly patients were compared among the three age subgroups. Elderly persons comprised 174, 146 (14% of the total) patient visits. The 176, 146 patient visits were assigned 259,440 ICD-9-CM codes.
Christopher Beach, David Manthey
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90064-X
Published in issue: January 1998
xAcute aortic dissection may have variable presentations, making the diagnosis clinically challenging. Acute neurologic syndromes secondary to dissection of the aorta are uncommon. However, including aortic dissection in the differential diagnosis is imperative. This report describes the first reported case of an acute thoracic aortic dissection presenting with the chief complaint of unilateral lower extremity numbness. Peripheral ischemic neuropathy as the result of vascular occlusion is uncommon.
Rodney W Smith, David R Nelson
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90065-1
Published in issue: January 1998
xThis is a retrospective review of all patients seen at an urban emergency department for 9 days after an ice storm because of a fall on ice. Date of presentation, age, sex, and anatomic location and type of injury were tabulated. Risk factors for fractures were identified. A total of 327 injuries were identified in 259 patients. Back injury was most common (19.3%). Ninety-one patients sustained 93 fractures. Ankle fractures were most common (24.7%), followed by fractures of wrist (19.4%) and hip (14.0%).
Malcolm Nelson, Ron D Waldrop, John Jones, Zelma Randall
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90066-3
Published in issue: January 1998
xThe emergency department (ED) provides a substantial amount of critical care. The purpose of this study was to quantitate the critical care provided in an urban ED. The study was performed at a large urban hospital with an annual ED volume of 70,000 patients. All patients requiring critical care in the ED or hospital were prospectively observed between September 1 and November 30, 1993. Patients requiring recovery room care or neonatal intensive care were excluded. Data collected included age, disposition, length of stay, triage acuity assignment in the ED, primary diagnosis, and critical care procedures.
Carolyn J Sachs, Larry J Baraff, Corinne Peek
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90067-5
Published in issue: January 1998
xThe purpose of this study was to quantify the proportion of men and women seen in a university emergency department (ED) for treatment of injuries resulting from intimate partner violence (IPV) that require reports to law enforcement authorities. A total of 1,516 adult ED patients were asked to complete a written survey instrument; 1,003 patients (66.2%) completed the survey. Two percent of patients reported they presented to the ED for treatment of injuries resulting from IPV. Three percent reported IPV within the last year, and 10% reported that they had ever been physically abused by a partner.
Aijaz Ahmed, Meenakshi Aggarwal, Erik Watson
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90068-7
Published in issue: January 1998
Raymond G Hart, William R Ahrens
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90069-9
Published in issue: January 1998
xThe death of a pediatric patient in the emergency department generates an intense emotional response in the physician and staff. A majority of emergency physicians describe this as the most stressful event in emergency medicine. Few emergency physicians are instructed in the complexities of dealing with the death of a child. The authors have developed a teaching module that introduces aspects of pediatric death-telling through the eyes of parents who have personally experienced the death of a child.
Barry Brenner, Martin S Kohn
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90070-5
Published in issue: January 1998
xTreating asthma in the emergency department (ED) always involves the potentially difficult decision as to whether to discharge the patient, to continue treatment, or to admit to the hospital. The following are useful guidelines. (1) The duration of the bronchospasm, frequency of visits, history of previous endotracheal intubation, pulse rate, and accessory muscle use are findings affecting successful discharge from the ED. (2) Patients with peak expiratory flow rate (PEFR) of <20% and who do not respond to inhalant therapy, with PEFR values persisting at <40% of predicted, will require 4 or more days to resolve and should be admitted to the hospital.
Milford Fulop
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90071-7
Published in issue: January 1998
xThe differential diagnosis of electrolyte disorders has traditionally been framed in terms of pathophysiology, and analysis of clinical problems has usually proceeded in the same way. However, easier access to rapid-response laboratory analysis has prompted physicians who encounter patients with serious electrolyte abnormalities to try to establish the cause by quickly obtaining further simple tests. In that vein, this article and the algorithms that are presented are intended to assist the preliminary laboratory differential diagnosis of low and high serum levels of sodium, potassium, and calcium.
William J Brady
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90072-9
Published in issue: January 1998
Linda P Thomas, Leonard R Friedland
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90073-0
Published in issue: January 1998
xRecent studies have shown that discharging to home an emergency department (ED) patient with croup if the patient is clinically stable 3 to 4 hours after being treated with nebulized racemic epinephrine (NRE) is safe and cost-effective. The objective of this study was to determine if EDs in our geographic area are using NRE cost-effectively in the management of croup. A survey was mailed to the ED medical directors of 23 hospitals in Ohio, Kentucky, and Indiana within a 150-mile radius of our teaching/referral children's hospital.
Howard A Smithline, Michael L Gerstle
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90074-2
Published in issue: January 1998
xChanges to Federal regulations pertaining to waiver of informed consent for acute care research were debated by the research and regulatory communities for more than 2 years before being finalized in October of 1996. Input from the general public was limited. This survey investigated the opinions of emergency medicine patients concerning wavier of informed consent for acute care research. A convenience sample of 212 patients were approached at a tertiary care academic urban emergency department.
Yeong-Liang Lin, Chuhsing Kate Hsiao, Huel-Ming Ma, Hong-Yuan Hsu, Shih-Ming Wang, Yung-Zu Tseng
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90075-4
Published in issue: January 1998
xNational Health Insurance (NHI) was introduced in Taiwan on March 1, 1995. To evaluate the influence of NHI on the volume and severity of emergency department (ED) visits, a retrospective analysis was conducted. The results showed that NHI did not result in a substantial increase in ED volume (P > .05), but the severity as measured by triage nurses did increase (P < .01). There was no change in the number of admissions to the intensive care units of patients transferred from smaller hospitals, but its percentage significantly decreased (P < .05), which may be a result of the significant increase in the total number of interhospital transfers.
Gustavo Rodrigo, Carlos Rodrigo
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90076-6
Published in issue: January 1998
Philippe Lheureux
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90077-8
Published in issue: January 1998
Richard C Christensen
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90078-X
Published in issue: January 1998
Gervais Khin-Lin Wansaicheong, Anantharaman, Chan Lai Peng
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90079-1
Published in issue: January 1998
Timothy Bosinski, George R Bailie, George Eisele
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90080-8
Published in issue: January 1998
Bruce S Ushkow, Joel M Bartfield, Paul R Reicho, Nancy Raccio-Robak
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90081-X
Published in issue: January 1998
Douglas R Migden, Robert F Reardon
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90082-1
Published in issue: January 1998
Vicken Y Totten, Mohammed H Fani-Salek, Kanjuraman Chandramohan
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90083-3
Published in issue: January 1998
Ron Eliashar, Jean-Yves Sichel, Itzhak Dano, Daniel Saah
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90084-5
Published in issue: January 1998
Roberto Gines, Edward Truemper
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90085-7
Published in issue: January 1998
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90086-9
Published in issue: January 1998
