Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Emergencies”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

[Emergency colonic surgery. Value of intervention in delayed emergency].

OBJECTIVES: Currently, there is a trend towards emergency colectomy in patients requiring immediate care for lesions involving the large bowel. However, the therapeutic indications have not been fully identified. We therefore retrospectively evaluated our experience with 123 emergency situations. METHODS: Among 745 cases requiring colonic surgery from January 1985 to August 1992, 123 were seen in emergency for intestinal obstruction (n = 69; 56.1%), peritonitis (n = 41; 33.3%) or haemorrhage (n = 13; 10.6%). The mean age of the patient was 71 years and 50% were over 75. The left colon was involved in 76.4% of the cases. Diverticulitis was seen in 43.1% and 39% had cancer of the colon. RESULTS: Emergency resection and anastomosis was performed in 55 cases (44.7%) without colostomy. In 62 patients (50.4%) a colostomy was created; 46 were later removed. In 61 cases, the patients underwent emergency surgery within 24 hours and in the other 62, delayed surgery was performed after one day of hospitalization. Overall hospital mortality was 11.4% (14/123), 20% for patients over 75 and 3.2% for those under 75. Mortality after delayed operations was lower (6.5%) than after emergency surgery (17.2%). There was also a higher rate of colon resections without colostomy in delayed procedures (62.9% vs 26.2%). CONCLUSIONS: Our experience leads us to recommend delayed surgery whenever possible in order to decrease operative mortality and number of operations.

Adult↗
PubMed1997

[Relevance of the 112-emergency calls among the clientele of the emergency department of the Herlev hospital admitting office].

It is a common view, shared by Emergency Department staff and ambulance crews, that a large number of patients unnecessarily use Emergency Service ambulances instead of transporting themselves to the hospital by other, more appropriate means. In this retrospective study, 528 consecutive Emergency Service calls to the Herlev Hospital Casualty/Emergency Department during a six week period were reviewed for relevance. Attention was solely aimed at the relevance of the use of Emergency Service ambulances in each case, but not on patient or health care providers' perception of urgency. All calls resulting in admission to hospital were pre-defined as being relevant. Seventeen point six percent of all calls were deemed irrelevant. Thirty-three percent of all calls not resulting in admission were deemed irrelevant. The results confirm Emergency Department health care providers' and ambulance crews' view that Emergency Service ambulances are used inappropriately by the public.

Ambulances↗
PubMed1998

Analysis of cost and of non-medical care load of patients seen in an accident and emergency department--the importance of clinical classification of emergency patients.

The aim of this study was to propose a method for calculating the costs incurred by the passage of a patient through an emergency department and to show that the scheme for clinical classification of emergency patients known as CCMU (Classification Clinique des Malades des Urgences) can identify groups of patients with different costs and non-medical care loads. All cases seen in the emergency department of a French hospital over an 8-week period were prospectively included. All non-medical and medical procedures, CCMU and GEMSA (Groupe d'Etude Multicentrique des Services d'Accueil) categories were recorded. Accounts for the same period were analysed in order to determine the true cost of each patient's passage through the emergency department. Qualitative data were analysed by ANOVA and logarithmic regression. The median cost of a patient's passage through the emergency department was 322 FF. CCMU identified groups of patients, including those with psychiatric problems, with very different non-medical care loads and costs, the latter varying from 158 FF (CCMU I) up to 1823 FF (CCMU V). This classification could be used as one of the elements defining homogenous groups of emergency department patients in future.

Analysis of Variance↗
PubMed1984

The 911 emergency telephone number: impact on emergency medical systems access in a metropolitan area.

The telephone number 911 is designated for public use in requesting emergency assistance. It is thought to reduce response time by reducing the interval between the decision to call for assistance and the notification of an agency that can dispatch the appropriate services. The experience of the Twin Cities metropolitan area of Minneapolis-St. Paul provides a unique opportunity to examine this assumption. Prior to the introduction of the 911 emergency telephone number on December 1, 1982, the area was serviced by over 100 different seven-digit emergency telephone numbers. Before the introduction of 911, 347 callers who activated the emergency medical services (EMS) system were interviewed, and after 911 was introduced, 305 callers were interviewed. Activation of the EMS system by making one call in less than 1 minute was achieved by 219 of 347 callers (63%) in the pre-911 phase and by 251 of 305 callers (82%) in the post-911 phase (P less than 0.001). Compliance (use of an appropriate emergency number for the first call) was demonstrated by 139 of 347 callers (40%) in the pre-911 phase, and 225 of 305 callers (74%) in the post-911 phase (P less than 0.001). Rapid activation of the EMS system was rarely achieved by calling a hospital or physician first. Overall, 911 was found to be a more efficient means of activating the EMS system.

Consumer Behavior↗
PubMed1980

Six years experience with an emergency department based mobile emergency care delivery system.

The purpose of mobile emergency care is to provide on a basis of 24 hours out of 24, the necessary material (ambulances wiwth resuscitation equipment) and personnel (ambulance-drivers, nurses and doctors), in order to care for the victim of accident or sudden illness on the spot and during transport to the hospital. The experience gained with a mobile emergency care delivery system, organized within the Emergency Department of the University Hospital Sint-Rafaël Leuven, Belgium, is analyzed and discussed. The conclusions of the study stress the advantages, as far as economics and efficiency are concerned, of the integration of the mobile emergency care delivery system in the emergency department of the highly specialized university hospital.

Adolescent↗
PubMed1995

[Medical emergency service. Descriptions of a one-year activity at an emergency communication center].

The emergency medical communication centre, Vestfold Central Hospital, receives emergency medical calls (phone 113), from 200,000 citizens in Vestfold county. Calls are categorised by urgency (red, yellow or green) according to the Norwegian Index to Emergency Medical Assistance, a criteria-based dispatch manual. In 1993, 2,440 red (suspected life-threatening conditions), 3,502 yellow and 6,505 green calls were received. The frequency of red and yellow calls did not differ much through the day, but varied between different municipalities in the county. The cause of emergencies varied by month. Acute illness increased in May and December, accidents in June, July and December. Psycho-social emergencies (violence, suicide, drug abuse) seemed to vary in a circadian manner. Efforts were made 628 times to give basic life support instruction by telephone. An ambulance was the most frequent response, general medical practitioners were called upon relatively seldom. The response was estimated to adequate in 79% of the incidents, exaggerated in 9% and inadequate in 3%.

Emergency Medical Service Communication Systems↗
PubMed1994

Plagiorchis elegans: emergence, longevity and infectivity of cercariae, and host behavioural modifications during cercarial emergence.

We investigated changes in the behaviour of Stagnicola elodes associated with the emergence of Plagiorchis elegans cercariae. Within 15 min of the reduction in light intensity, which triggered the onset of cercarial emergence, infected snails moved to the top of the water column and remained there for 2-3 h. Seventy-nine percent of all cercariae that emerged from the snail did so during this period. Uninfected snails showed no such behavioural changes following the change in light intensity. Cercariae were released in a dense cloud around the snail at the water surface and dispersed passively. Within 3-4 h more than 80% of all cercariae had settled in the bottom 5 cm of the water column. The infectivity of cercariae increased from less than 20% upon emergence from the snail to greater than 75% 4-6 h post-emergence, and then declined steadily to below 5% by 24 h post-emergence. Cercarial longevity was greater than 30 h and exceeded the period of infectivity. This may be related to steadily falling endogenous glycogen levels. A delay in attaining maximum infectivity may represent an adaptive mechanism allowing time for cercarial dissemination, thus reducing superinfection, and subsequent parasite-associated mortality, of second intermediate hosts.

Aedes↗
PubMed1993

Drug emergency patients are a burden for the medical care system: inadequate care for drug emergency patients.

During the course of the Drug Emergency Study in Bremen it became obvious that there are many problems left unsolved related to the medical care of intoxicated heroine addicts. From January to June 1992 there were 1230 drug emergencies, 409 hospital admissions and 644 emergency transportation. With or without antidote treatment, most patients leave the medical care system as soon as possible because of withdrawal symptoms. The physicians involved answered a short questionnaire about these problems: 80% of the physicians are dissatisfied with the present medical care situation for intoxicated drug addicts and feel that these patients are a burden for the hospitals (81%) and for themselves (73%); 93% of the physicians think that a central drug emergency unit, offering medical and psycho-social care would solve the present problems and would be a possibility for lowering drug emergencies and, as a further result, drug mortality.

Attitude of Health Personnel↗
PubMed1995

Artificial neural networks for screening patients needing emergency cranial computed tomography scans in emergency departments.

RATIONALE AND OBJECTIVES: We evaluated the potential for a neural network to screen candidates for emergency cranial computed tomography (CT) scans in an emergency department setting. METHODS: Data were collected from 1625 patients undergoing emergency cranial CT scanning in two different emergency departments (EDs). Singular value decomposition (SVD) was used to remap input data for network training. Data were randomly divided into six subsets, and one was reserved as a test set to analyze network performance. Five networks were then trained on data from the five remaining sets using fivefold cross-validation. Each trained network was allowed an independent vote on need for CT scanning in each case from the test set. The majority vote was used as the final prediction. A similar analysis was done on data from each individual ED. Results are compared with prior statistical studies of the same data. RESULTS: The network performed well when predicting clinical variable patterns that consistently produced negative CT scans and on patterns that were ambiguous in terms of the CT scan results. It performed poorly, however, on patterns that consistently predicted positive scans. This last finding appears to have resulted from inadequate training material. The two populations from which data were taken were shown to be distinct, but a network trained on the combined data performed as well as the networks from the individual EDs in predicting patients requiring CT scanning. Variables with the greatest contribution to the networks' prediction were consistent with those in prior statistical studies. CONCLUSION: Although preliminary in nature, neural networks show promise as a screening device for selecting patients for emergent cranial CT scanning.

Analysis of Variance↗
PubMed1997

Factors influencing termination of resuscitative efforts in children: a comparison of pediatric emergency medicine and adult emergency medicine physicians.

OBJECTIVES: To examine factors that influence termination of resuscitative efforts (TORE) and compare pediatric emergency medicine (PEM) and general emergency medicine (GEM) physicians regarding TORE in children. DESIGN: Cross-sectional survey. PARTICIPANTS: All physicians board-certified in PEM as of November 1993 and a random sample of board-certified GEM physicians listed in the 1993 American College of Emergency Physicians directory. INTERVENTIONS: Self-administered questionnaires were mailed to participants who were asked about experience providing pediatric cardiopulmonary resuscitation (CPR) and demographic information. We posed a series of management questions eliciting factors that influence TORE decision-making in single context and case scenario format. Specific emphasis was placed on the influence of time and epinephrine dosing. RESULTS: One hundred and sixty (70%) PEM and 127 (62%) GEM responded. These groups differed significantly in years of experience (PEM 8.2, GEM 11.8), urban practice setting (PEM 84%, GEM 32%) and number of pediatric cardiopulmonary resuscitations per year (PEM 10.6, GEM 4.8), P < 0.001 for all. There were no significant differences between groups regarding features pathognomonic of death. PEM were more likely to consider low blood pH and iatrogenic causes of arrest as factors influencing TORE; GEM were more likely to consider co-morbid conditions (P < 0.05 for all). Medians for time estimates of minimum minutes of pulselessness that influence TORE were: PEM 26 to 30 minutes, GEM 31 to 35 minutes for both prehospital and emergency department settings (P < 0.05 for each). Approximately 20% of all respondents did not place a strict limit on time of pulselessness when determining TORE. No difference was observed between groups regarding maximum doses of epinephrine used prior to TORE. However, fewer GEM (50%) than PEM (75%) utilize "high dose" epinephrine according to current Pediatric Advanced Life Support (PALS) guidelines (P < 0.05). PEM physicians were more than two times more likely to terminate resuscitative efforts if return of spontaneous circulation was not achieved by 25 minutes compared to GEM physicians for both prehospital time of pulselessness [odds ratio 2.1, 95% confidence interval (1.01, 4.5)] and emergency department time of pulselessness [odds ratio 2.2, confidence interval (1.1, 4.6)]. CONCLUSIONS: 1) Several laboratory and clinical factors significantly influence physician's decisions regarding TORE; 2) regardless of setting, time of pulselessness does appear to be an influential factor in determining when to terminate resuscitation in children for most physicians; 3) PEM physicians are more likely to terminate resuscitative efforts than are GEM physicians if return of spontaneous circulation is not achieved by 25 minutes; 4) a significant number of PEM and GEM physicians do not use high dose epinephrine in accordance with current PALS recommendations.

Adolescent↗
PubMed2006

Impact of domestic violence posters on female caregivers' opinions about domestic violence screening and disclosure in a pediatric emergency department.

OBJECTIVES: The objectives of this study were to examine female caregivers' attitudes about the display of domestic violence (DV) resources in a pediatric emergency department (ED) and to explore whether these resources engendered positive feelings about DV screening and encouraged disclosure. METHODS: We conducted a cross-sectional survey in a pediatric ED during 2 distinct periods, comparing responses of female caregivers before (pre) and after (post) displaying DV posters and cards. Women were surveyed about (1) personal experience with DV, (2) the appropriateness of DV posters and screening in a pediatric ED, and (3) willingness to divulge DV, if abused. RESULTS: The 2 groups (pre, n = 133; post, n = 136) did not significantly differ with respect to age, race, education, or personal DV history. The majority endorsed that "it is appropriate to have DV posters," with the post group responding in this manner more often than the pre group (pre, 85%; post, 95%; odds ratio [OR], 3.3; 95% confidence interval [CI], 1.3-8.5). The post group was less likely to prefer pediatric ED DV screening (pre, 76%; post, 63%; OR, 0.5; 95% CI, 0.3-0.9) and tended to be less likely to say that they would divulge (pre, 85%; post, 75%; OR, 0.6; 95% CI, 0.3-1.1). In both groups, women with a DV history were less likely than women without this history to say that they would disclose DV to their pediatric ED provider (P < 0.001). CONCLUSIONS: These results suggest the need for further exploration of how to most effectively help and provide resources for abused women in this setting.

Adolescent↗
PubMed2006

Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department.

This study examined the emergency nurse practitioner candidate (ENPC) scope of practice in a Victorian emergency department (ED). The emergency nurse practitioner (ENP) role is relatively new in Victoria and the scope of the ENP(C) practice is yet to be defined. International research literature regarding the ENP role has focused on outcomes such as patient satisfaction, waiting times and/or ED length of stay, accuracy and adequacy of documentation, use of radiography, and patient education, health promotion and communication issues. A prospective exploratory design was used to conduct this cohort study. There were 476 ENPC-managed patients between 14 July 2004 and 31 March 2005 with an average age of 29 years. The majority (77.2%) of ENPC-managed patients were discharged from the ED. The majority of the ENPC time was devoted to clinical practice (55%) and development of clinical practice guidelines (25%). Of patients managed by the ENPC, 49.6% required medications, 51% required diagnostic imaging and 8.6% required pathology testing during their ED stay. The most common discharge referrals were made to local medical officers (73.5%) and the most common referrals made for patients requiring admission were made to the plastic surgery (37.3%) and orthopaedic (35.5%) units. Extensions to the current scope of emergency nursing practice are pivotal to effective management of specific patient groups by ENP. The ENP model of care is an important strategy for the management of increased service demands in Victoria; however, little is known about the scope of the ENPC practice and many outcomes of the ENP care are yet to be defined. Further research to better understand the relationships between ENP outcomes is required if the contribution that ENPs make to emergency care is to be accurately quantified.

Adolescent↗
PubMed2000

Emergency department workplace interruptions: are emergency physicians "interrupt-driven" and "multitasking"?

OBJECTIVE: Although interruptions have been shown in aviation and other work settings to result in error with serious and sometimes fatal consequences, little is known about interruptions in the emergency department (ED). The authors conducted an observational, time-motion task-analysis study to determine the number and types of interruptions in the ED. METHODS: Emergency physicians were observed in three EDs located in an urban teaching hospital, a suburban private teaching hospital, and a rural community hospital. A single investigator followed emergency staff physicians for 180-minute periods and recorded tasks, interruptions, and breaks-intask. An "interruption" was defined as any event that briefly required the attention of the subject but did not result in switching to a new task. A "break-intask" was defined as an event that required the attention of the physician for more than 10 seconds and subsequently resulted in changing tasks. RESULTS: The mean (+/-SD) total number of patients seen at all three sites during the 180-minute study period was 12.1 +/- 3.7 patients (range 5-20). Physicians performed a mean of 67.6 +/- 15.7 tasks per study period. The mean number of interruptions per 180-minute study period was 30.9 +/- 9.7 and the mean number of breaks-in-task was 20.7 +/- 6.3. Both the number of interruptions (r = 0.63; p < 0.001) and the number of breaks-in-task (r = 0.56; p < 0.001) per observation period were positively correlated with the average number of patients simultaneously managed. CONCLUSIONS: Emergency physicians are "interruptdriven." Emergency physicians are frequently interrupted and many interruptions result in breaks-in-task.

Adult↗
PubMed2000

Interpretation of Emergency Department radiographs: a comparison of emergency medicine physicians with radiologists, residents with faculty, and film with digital display.

OBJECTIVE: We determined the relative value of teleradiology and radiology resident coverage of the emergency department by measuring and comparing the effects of physician specialty, training level, and image display method on accuracy of radiograph interpretation. MATERIALS AND METHODS: A sample of four faculty emergency medicine physicians, four emergency medicine residents, four faculty radiologists, and four radiology residents participated in our study. Each physician interpreted 120 radiographs, approximately half containing a clinically important index finding. Radiographs were interpreted using the original films and high-resolution digital monitors. Accuracy of radiograph interpretation was measured as the area under the physicians' receiver operating characteristic (ROC) curves. RESULTS: The area under the ROC curve was 0.15 (95% confidence interval [CI], 0.10-0.20) greater for radiologists than for emergency medicine physicians, 0.07 (95% CI, 0.02-0.12) greater for faculty than for residents, and 0.07 (95% CI, 0.02-0.12) greater for films than for video monitors. Using these results, we estimated that teleradiology coverage by faculty radiologists would add 0.09 (95% CI, 0.03-0.15) to the area under the ROC curve for radiograph interpretation by emergency medicine faculty alone, and radiology resident coverage would add 0.08 (95% CI, 0.02-0.14) to this area. CONCLUSION: We observed significant differences between the interpretation of radiographs on film and on digital monitors. However, we observed differences of equal or greater magnitude associated with the training level and physician specialty of each observer. In evaluating teleradiology services, observer characteristics must be considered in addition to the quality of image display.

Analysis of Variance↗
PubMed2005

Effect of an on-site emergency physician in a rural emergency department at night.

INTRODUCTION: The problem of emergency department (ED) overcrowding is an issue of some concern and staffing profile has been identified as a contributing factor. The aim of this study was to assess the effect of having an emergency physician on-site at night in a rural base hospital ED in terms of the ED length of stay, waiting times, admissions, specialist consultations, the use of diagnostic tests, and ED representations within 7 days. METHODS: A retrospective analysis was performed of the ED database at Tamworth Base Hospital in rural New South Wales, Australia. A comparison was made between 125 patients seen when an emergency physician was in the department (Group A) and 117 patients seen when an emergency physician was not on site (Group B). RESULTS: The mean ED length of stay was 48 min for Group A and 96 min for Group B. There were 15 admissions from Group A and 27 from Group B. There were significantly less pathology tests and consultations for the patients in Group A compared with Group B. There was no significant difference in waiting times or in the re-presentation rate between the two groups. CONCLUSIONS: The presence of an on-site emergency physician resulted in a significantly shorter ED length of stay, lower admission rate, less initial pathology tests, and fewer telephone consultations.

Adult↗
PubMed1996

Recommendations for ensuring early thrombolytic therapy for acute myocardial infarction. The Heart and Stroke Foundation of Canada, the Canadian Cardiovascular Society and the Canadian Association of Emergency Physicians for the Emergency Cardiac Care Coalition.

OBJECTIVE: To recommend practical steps to ensure early thrombolytic therapy and thereby reduce mortality and morbidity associated with acute myocardial infarction (AMI). OPTIONS: Various factors were considered that influence time to thrombolysis related to patients, independent practitioners and health care systems. OUTCOMES: Reduction in morbidity and mortality associated with AMI. EVIDENCE: Early initiation of thrombolytic therapy reduces morbidity and mortality associated with AMI. The ECC Coalition analysed the factors that might impede early implementation of thrombolytic therapy. VALUES: Published data were reviewed, and recommendations were based on consensus opinion of the Emergency Cardiac Care (ECC) Coalition. The ECC Coalition comprises 20 professional, nongovernment and government organizations and has a mandate to improve emergency cardiac care services through collaboration. BENEFITS, HARMS AND COSTS: Early thrombolytic therapy reduces morbidity and mortality associated with AMI. Implementation of the recommendations will result in reduced time to thrombolytic therapy, streamlining of current practices and enhanced cooperation among health care professionals to expedite care. Depending on existing practices, implementation may require protocol development, and public and professional education. Although costs are associated with educating the public and health care professionals, they are outweighed by the financial and social benefits of reduced morbidity and mortality. RECOMMENDATIONS: Early recognition of AMI symptoms by the public and health care professionals, early access to the emergency medical services system and early action by emergency care providers in administering thrombolytic therapy (within 30 minutes after the patient's arrival at the emergency department). VALIDATION: No similar consensus statements or practice guidelines for thrombolytic therapy in Canada are available for comparison.

Emergency Medical Services↗
PubMed1997

[Emergencies associated with the consumption of designer drugs, hallucinogens and amphetamines treated at 15 Spanish hospitals in 1994. Work Group on the Study of Emergencies due to Psychostimulants].

The clinical records of patients attended at emergency hospitals in fifteen hospitals in Madrid, Valencia and Gran Canaria during 1994 were retrospectively analyzed. Seventy-three emergencies related to the consumption of design drugs, hallucinogens or amphetamines (100 times lower than because of opiates or cocaine) were recorded. Apart from the responsible drug for the emergency visit, in most cases the usual consumption of other substances was mentioned. Acute psychopathological reactions predominated. Three patients were admitted and five were derived to other hospitals; the remaining patients improved and were discharged. The number of emergencies on account of these drugs is relatively low, with a proportion of less than one in 10,000 emergencies attended in these areas and might not radically change if the current predominant consumption pattern is maintained.

Adolescent↗