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PubMed2000

The emergency department gynaecologist and emergency postcoital contraception.

The emergency department gynaecologist is often faced with requests for emergency postcoital contraception. The physician on duty is usually very busy and does not always have enough time to perform a complete evaluation of the woman's state of health. The emergency gynaecologist who prescribes postcoital contraception also has a number of other problems to cope with in regard to the pharmacological preparations on the market, the efficacy of various methods, the monitoring of side-effects which are not, always, tolerated by all patients and the outcome of his therapeutic prescription. All these aspects should be emphasized in the "first aid" counselling offered to the patients. In conclusion, we consider that any women who decides to use postcoital contraception should have the right to receive assistance of guaranteed quality throughout the period that elapses between taking the drug and the subsequent menstrual cycle. This is not strictly guaranteed by an emergency gynaecological service.

Contraceptives, Postcoital↗

PubMed1999

Impact on an accident and emergency department of Glasgow's new primary care emergency service.

OBJECTIVE: To determine the impact, in terms of new attendance figures and types of patients attending, on a city centre accident and emergency (A & E) department following the establishment of out-of-hours primary care emergency centres (PCECs) in Glasgow. METHODS: A questionnaire survey of A&E patients attending out-of-hours at Glasgow Royal Infirmary A&E department, a city centre department with approximately 68,000 new annual attendances, one week before (Group A), twelve weeks after (Group B) and one year after (Group C) the introduction of PCECs. Main outcome measures were attendance numbers within working hours and out-of-hours, reason for A&E attendance, duration of presenting condition, whether primary care services were contacted and awareness of the new primary care emergency centres. RESULTS: In respect of out-of-hours attendances, 612 questionnaires were completed for group A, 715 for group B and 645 for group C. There was no significant difference in the type of presenting complaints between the groups, i.e. illness or injury. The majority of patients presented within 24 hours of the onset of their condition (82%, 79% and 80% of patients in groups A, B and C respectively). There was a reduction in those attending with conditions of more than one week's duration (8% in group A, 7% in group B and 5% in group C). There was a decrease in the number of patients who considered their problem to be non-urgent (27% in group A, 22% in group B and 16% in group C). Prior to the introduction of the PCEC service 18% of patients (108) had contacted their GP before attending, compared with only 9% (63) of group B and 9% (57) of group C patients. Of these patients there was a significant decrease in the number of patients attending following GP referral. Of the patients who had not contacted the primary care services only 35% (201) knew of the introduction of PCECs 12 weeks later, increasing to 52% (291) after one year (p < 0.01). Significance calculations were performed using a Difference of Proportion Test with a 99% significance level. CONCLUSIONS: Our results suggest that the new PCEC service has not had a significant impact on the number or type of patients attending this A&E department, with fewer self-referred patients contacting primary care services after its introduction. Following the introduction of the PCECs there was a trend towards more patients attending A&E following telephone advice although amongst self-referred A&E patients there remained a large proportion who claimed to be unaware of the new service 12 weeks after, and one year after, the introduction of PCECs. Continued evaluation of the effect on A&E of the new centres will be required to plan future resources for the provision of emergency care.

After-Hours Care↗

PubMed2004

The role of wildlife in emerging and re-emerging zoonoses.

There are huge numbers of wild animals distributed throughout the world and the diversity of wildlife species is immense. Each landscape and habitat has a kaleidoscope of niches supporting an enormous variety of vertebrate and invertebrate species, and each species or taxon supports an even more impressive array of macro- and micro-parasites. Infectious pathogens that originate in wild animals have become increasingly important throughout the world in recent decades, as they have had substantial impacts on human health, agricultural production, wildlife-based economies and wildlife conservation. The emergence of these pathogens as significant health issues is associated with a range of causal factors, most of them linked to the sharp and exponential rise of global human activity. Among these causal factors are the burgeoning human population, the increased frequency and speed of local and international travel, the increase in human-assisted movement of animals and animal products, changing agricultural practices that favour the transfer of pathogens between wild and domestic animals, and a range of environmental changes that alter the distribution of wild hosts and vectors and thus facilitate the transmission of infectious agents. Two different patterns of transmission of pathogens from wild animals to humans are evident among these emerging zoonotic diseases. In one pattern, actual transmission of the pathogen to humans is a rare event but, once it has occurred, human-to-human transmission maintains the infection for some period of time or permanently. Some examples of pathogens with this pattern of transmission are human immunodeficiency virus/acquired immune deficiency syndrome, influenza A, Ebola virus and severe acute respiratory syndrome. In the second pattern, direct or vector-mediated animal-to-human transmission is the usual source of human infection. Wild animal populations are the principal reservoirs of the pathogen and human-to-human disease transmission is rare. Examples of pathogens with this pattern of transmission include rabies and other lyssaviruses, Nipah virus, West Nile virus, Hantavirus, and the agents of Lyme borreliosis, plague, tularemia, leptospirosis and ehrlichiosis. These zoonotic diseases from wild animal sources all have trends that are rising sharply upwards. In this paper, the authors discuss the causal factors associated with the emergence or re-emergence of these zoonoses, and highlight a selection to provide a composite view of their range, variety and origins. However, most of these diseases are covered in more detail in dedicated papers elsewhere in this Review.

Animals↗

PubMedDate not supplied

[Antisepsis and disinfection in emerging and re-emerging viral diseases].

Prevention and therapy of emerging and re-emerging viral diseases may be inefficient due the inavailability of specific vaccines, active chemotherapic drugs, acceptable pesticides, and vector control measures. To reduce contact spreading of viral infections, some biocides, as chlorine compounds or phenolic compounds, associated with detergents, may assume a leading position as safe substances with antiviral properties for the environmental decontamination. Detailed instructions on their use may be introduced in future guidelines related to emerging and re-emerging viral diseases.

Antisepsis↗

PubMed1986

Emergency gastrointestinal endoscopy and endoscopy for the emergency department.

Endoscopic procedures usually are not performed in the Emergency Department. However, on some occasions, it is essential that trained emergency physicians be able to perform endoscopic examinations. All physicians working in the Emergency Department should have an understanding of the role of endoscopy in the evaluation and treatment of gastrointestinal disorders, since in some cases, for example, those of massive upper and lower gastrointestinal hemorrhage, foreign body extraction, or functional and obstructive disorders of the colon, endoscopic procedures may be required on an emergency basis.

Colonoscopy↗

PubMedDate not supplied

[Integrated services in emergency medicine: the Regional Center for Emergency Medical Assistance].

According to the law of 8 July 1964, the Belgian State is responsible for the treatment of the emergencies in the public ways and places. Due to an important spontaneous private extension, among the 502.600 annual calls the 252.000 specifically medical cases are in practice selected, estimated and practically handled by the Responsible of the Call Center 900, that is to say a fire man, who also answers the 57.400 annual demands for medical advice. There is neither doctor on the scene of the emergency nor during transportation in 85% of the cases. Emergency Medical Support (EMS) may no longer be conceived without the presence of the doctor. The Regional Emergency Medical Support Centers (CRAMU) harmoniously and efficiently integrate, with everyone in his place, all the clinical institutions, their common medical regulating center, the SAMU (EMS Center) and the call center 900 where the specifically medical calls are selected and directed to the SAMU. The concrete results of the first experimental CRAMU in Charleroi are presented, after a three years experience.

Belgium↗

PubMed1995

Emergency brain resuscitation. A Working Group on Emergency Brain Resuscitation.

Past efforts to reverse or limit the effects of acute stroke have been largely unsuccessful, in part because of the inability to evaluate and treat most patients soon after stroke onset. One important factor in the delay of treatment has been the nihilistic attitude of medical personnel, including physicians, toward the need to rapidly evaluate and treat patients with stroke. This is important for non-neurologists because most patients with stroke are cared for by internists, family physicians, and emergency physicians. We present the concept of emergency brain resuscitation as one method of galvanizing and motivating health professionals to take a more proactive and aggressive approach to treating the patient with acute stroke. Laboratory and clinical data support the potential efficacy of emergency brain resuscitation teams, which will use standard and experimental techniques to treat patients with stroke. A cost-benefit analysis suggests that emergency brain resuscitation may lower the costs associated with stroke by reducing length of hospital stay, disability, and lost wages. The formation of pilot programs is a logical first step toward evaluating and refining this concept.

Animals↗

PubMed1993

Children's behavior in emergency and non-emergency dental situations.

This study evaluated children's behavior during emergency and non-emergency visits to the dentist. Three methods were used to evaluate behavior: 1) the Palmar Sweat Index, 2) the Taylor Manifest Anxiety Scale, and 3) the Frankl Behavior Scale. Forty children, 6-12 years of age, were seen in a pediatric dental clinic. All children had no previous dental experiences. Twenty patients were seen for new patient examinations and twenty patients had emergency examinations and treatment. This study showed that children exhibit equal levels of stress whether for a screening appointment or an emergency visit. The Palmar Sweat Index has the potential of being a viable evaluation for detecting non-verbally expressed anxiety.

Child↗

PubMed1998

[Emergency room admissions in cocaine users in Spanish hospitals: first evidences of acute complications related to crack use. Work Group for the Study of Emergencies from Psychostimulants].

BACKGROUND: Acute complications of cocaine are increasing in Spain, nevertheless little information is available on its clinical and toxicological characteristics. MATERIAL AND METHOD: Records from medical emergency rooms of 14 hospitals from Madrid, Valencia and Gran Canaria were reviewed. Records were selected if the term "cocaine" was mentioned, excluding those related with injuries or obstetric, gynecologic and pediatric problems. Emergency room episodes were classified in three groups according its relation with cocaine use. RESULTS: 223 episodes were directly related to cocaine, some of these simultaneously related to heroin (36%) or alcohol. The proportion of all emergency room episodes related to cocaine was threefold higher in Gran Canaria than in Madrid and Valencia. In Gran Canaria most of episodes (72%) were related to cocaine smoking, generally crack, but in Madrid and Valencia most were due to intravenous cocaine use. The most common signs and symptoms were anxiety, mydriasis, syncope, tachycardia, shortness of breath, confusion or coma, agitation, chest pain and palpitations. Mental disorders were the most common diagnoses. 13% of patients were admitted as inpatients to hospital or were referred to another hospital (23.6, 17.3 and 2.2%, if cocaine was smoked, injected and sniffed, respectively). Cardiovascular diagnosis were less frequent in episodes simultaneously related to opioids than in not opioids-related episodes (1.1% vs 10.7%; p = 0.005). Furthermore, 219 not cocaine-related episodes were identified. The relation to cocaine could not be established in other 275 episodes. CONCLUSIONS: This work show for the first time in Spain the presence of crack-related emergency episodes and suggests that injecting and smoking cocaine has a greater impact on public health than sniffing this drug.

Acute Disease↗

PubMed1997

Do internists and emergency physicians agree on the appropriateness of emergency department visits?

The purpose of this study was to determine the levels of agreement between three methods of assessing appropriateness of emergency department (ED) visits. In particular, we tested the agreement between internists and emergency physicians reviewing the ED nurses' triage notes, containing information that might be available by telephone to an internist. For 892 adult patient ED visits reviewed, we found only moderate agreement (kappa = 0.47) between these groups. In cases of disagreement, emergency physicians were 10.3 times more likely than internists to classify those with minor discharge diagnoses as appropriate for ED care. As managed care grows, the determination of ED appropriateness may depend on open discussions between physician groups, as well as on access to timely care in office settings.

Adult↗

PubMed2002

The Emergency Medical Treatment and Active Labor Act: what emergency nurses need to know.

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal statute that should be recognized and understood by all nurses who work in an emergency department or other settings where patients with potential emergencies may present themselves for care. It is a law that imposes specific legal requirements on hospitals in terms of medical screening, stabilization, and transfer of patients, regardless of whether they are outpatients or inpatients. As agents of the hospital, nurses are responsible for maintaining compliance with EMTALA regulations. This article reviews the components of EMTALA and the ways in which they are applied to clinical nursing practice.

Documentation↗

PubMed2002

The triage of psychiatric patients in the hospital emergency department: a comparison between emergency department nurses and psychiatric nurse consultants.

The triage of patients in the hospital emergency department (ED) has developed as an efficient method to determine the level of urgency and provide appropriate care and treatment. The triage process has been found to be less effective for patients presenting with mental health related problems. Triage guidelines specifically tailored for mental health needs have been introduced in the attempt to overcome existing problems, however, the effectiveness of these guidelines has not been extensively tested. This paper presents the findings of a study conducted in a large metropolitan hospital in Melbourne, Australia. All presentations to the ED for psychiatric problems (n = 137) were triaged using the mental health guidelines over a 3-month period. The same presentations were triaged by psychiatric nurse consultants employed in the ED and the results compared. The results indicate a high level of difference in the triage ranking by the two groups of nurses, with emergency nurses tending to classify presentations as more urgent than their psychiatric nurse colleagues. These findings suggest that mental health education for emergency nurses is necessary if the guidelines are to be used effectively and improve outcomes for patients presenting with psychiatric problems.

Adult↗

PubMed2002

Emergency contraception provision: a survey of emergency department practitioners.

OBJECTIVES: To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called "opt-out" or "abortion-related conscience clauses") with those of practitioners from states without these laws. METHODS: Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed. RESULTS: The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with "abortion-related conscience clauses" and those from other states. CONCLUSIONS: Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. "Abortion-related conscience clauses" did not seem to influence willingness to offer EC.

Adolescent↗

PubMed2005

Reliability of ophthalmic accident and emergency referrals: a new role for the emergency nurse practitioner?

BACKGROUND AND OBJECTIVES: Annual attendances at the accident and emergency (A&E) department of St Bartholomew's and The Royal London NHS Trust exceed 100,000 people of which 6% are ophthalmic. This study evaluated the accuracy of eye referrals from A&E senior house officers (SHOs) and emergency nurse practitioners (ENPs) and the impact any inaccuracies may have had on out of hours work. METHODS: Over a four week period a record of all referrals from the A&E department was made. The doctor receiving the referral made a note of clinical variables as reported by the referring clinician. When the patient was subsequently reviewed by an ophthalmologist, a record was again made of these findings. Any discrepancies were recorded. RESULTS: A total of 67 patients were recruited. ENPs were found to be consistently more accurate than SHOs in every aspect of the assessment, most notably in visual acuity (p = 0.0029), and provisional diagnosis (p = 0.012). Furthermore, had the examination findings been accurate, 58% of all SHO referrals seen after hours would have been triaged to the next available clinic but only 10% of ENP referrals could have been seen at the next clinic session (p = 0.027). CONCLUSION: This study found ENPs to be more accurate than A&E SHOs in history taking, recording visual acuity, describing ocular anatomy, and making provisional diagnoses. A significant reduction in out of hours ophthalmic workload may be achieved in the authors' unit if ENPs were to see all eye emergencies.

Clinical Competence↗

PubMed2006

Best evidence topic report. Rapid sequence induction in the emergency department by emergency medicine personnel.

A short cut review was carried out to establish whether there are significant differences in the performance of emergency physicians and anaesthetists when carrying out rapid sequence intubation (RSI) in the emergency department. A total of 407 papers were found of which 12 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. The clinical bottom line is that there is little or no difference in the rates of success and complications between emergency department clinicians and anaesthetists performing RSI.

Anesthesiology↗

PubMed2001

Hospital and emergency ambulance link: using IT to enhance emergency pre-hospital care.

Emergency ambulances traditionally inform receiving hospitals of impending arrival of patients only in instances of load and go situations, which on average constitute less than 5% of ambulance runs. Information transmitted is usually sparse. For all other runs, information is made available only on arrival at the emergency department (ED). There have also been numerous limitations associated with voice transmissions.A comprehensive electronic ambulance case record was created as a pilot project in Singapore between three emergency ambulances and the busiest ED there. All information captured by the ambulance crew, including vital signs information and ECGs was entered or downloaded onto a ruggardised PC in the ambulance and this complete ambulance record was transmitted to the ED. Transmission was wireless via the public mobile data network. A 3-month analysis of this pilot run revealed the following. (1) It was possible to capture a complete ambulance case record electronically at a mean time of 94 s vs 7 min 7 s for the traditional written record. (2) Air transmission time for data was approximately 4 s unless ECG wave forms were also transmitted resulting in transmission times frequently exceeding 60 s. (3) At least 68% of data was transmissible in 75% of Hospital & Emergency Ambulance Link (HEAL) ambulances as opposed to only 25% in less than 5% of non-HEAL ambulances. (4) Paramedics' time in the ED decreased from 15 to 8 min as a result of HEAL. (5) The waiting time for critical care patients to be seen at the ED decreased from 35 to 17 min if brought by HEAL ambulances.(6) The HEAL system was able to effectively prompt paramedics in carrying out critical aspects of treatment in close to 100% of instances. (7) The pilot HEAL system was able to demonstrate a limited amount of automated audit of specific aspects of ambulance runs. Having demonstrated the feasibility of the HEAL system, it is a matter of time before enhanced features such as electronic data collection at patient site, voice activated data entry, transmission of data from site, automated ambulance audits and an enhanced level of professional care in the ambulances become common-place reality.

Ambulances↗

PubMed2005

Delayed emergence process does not result in a lower incidence of emergence agitation after sevoflurane anesthesia in children.

BACKGROUND: Emergence agitation (EA) is more frequent after sevoflurane anesthesia than other inhalational agents but the etiology remains unclear. We investigated whether the EA after sevoflurane anesthesia is related to rapid emergence. METHODS: Eighty-five patients, aged 1-7 years, undergoing elective urology surgery were studied. After induction, anesthesia was maintained with 2.0-2.5% sevoflurane and 50% N(2)O. BIS was monitored continuously throughout surgery and emergence. At the end of surgery, the children were randomly assigned to one of two groups: group I, immediate cessation of sevoflurane; or group G, gradual decrease of sevoflurane with the rate of 0.1%.min(-1). Emergence agitation score was recorded during recovery. RESULTS: Times from immediate cessation or start of decrease of sevoflurane to BIS 70, 80, 90 and extubation were significantly longer in group G. The incidence of severe agitation (score > or =3) was not significantly different between group I and group G: which were 35.7% and 32.6%, respectively. CONCLUSION: Prolonged recovery did not reduce the incidence of EA following sevoflurane anesthesia in children.

Anesthesia Recovery Period↗

PubMedDate not supplied

[Congenital syphilis: an emerging emergency also in Brazil]

OBJECTIVE: To highlight to the fact that some newborns are not identified as having congenital syphilis, and will present to an emergency room within a few months with a severe disease. METHOD: Review of the charts concerning 3 patients with congenital syphilis, as well as review of the literature using Medline and Lilacs databases, covering the period from 1988 to 1999. RESULTS: We describe the case of 3 infants whose diagnosis of congenital syphilis was only established after the neonatal period, when they presented to the emergency room and were admitted to the pediatric intensive care unit. The first patient had neurosyphilis and nephrotic syndrome, the second had neurosyphilis, and the third had hepatitis. We discuss the clinical aspects of the cases, and comment on other clinical manifestations of congenital syphilis that should be within the purview of pediatric emergency medicine. We analyze the reasons for the failure to diagnose syphilis at birth, and describe some risk factors for gestational syphilis. CONCLUSIONS: Considering the rising incidence of syphilis in Brazil, and the possibility that the congenital infections are not recognized at birth, emergency physicians must keep a high degree of suspicion and an awareness of maternal risk factors, prenatal serology pitfalls, as well as of the several clinical presentations of congenital syphilis that can develop in the first months of life.

Journal Article↗