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 361 records · Page 20Linked to original sources
PubMed1999

Medical emergencies in general dental practice in Great Britain. Part 2: Drugs and equipment possessed by GDPs and used in the management of emergencies.

OBJECTIVE: To ascertain the emergency drugs and equipment possessed by general dental practitioners (GDPs), the treatment provided and drugs used in management of the medical emergency events they reported. DESIGN: Postal questionnaire survey of a random sample of GDPs in Great Britain. SUBJECTS: 1500 GDPs, 1000 in England & Wales and 500 in Scotland. RESULTS: There was a 74% response. An aspirator, an airway, oxygen, adrenaline and an injectable steroid were possessed by about 90% of respondents; glucose, glyceryl trinitrate and a salbutamol inhaler by about 80%. Glucose was used in management of nearly one in ten of the events reported, an inhaler, glyceryl trinitrate and oxygen were the next most commonly used. Cardiopulmonary resuscitation (CPR) was carried out in management of 1.1-1.4% of events not associated with general anaesthesia (GA) and in 4.7-16% of events associated with GA, an average of once in 250 years of practice. CONCLUSIONS: Most respondents possessed drugs and equipment necessary to manage a medical emergency. Half the drugs recommended by the 'Poswillo report' to be available in every dental practice were not used in more than 8000 years of practice.

Adrenergic Agonists↗
PubMed2001

Emergency physicians and physician-assisted suicide, Part II: emergency care for patients who have attempted physician-assisted suicide.

Part I of this article reviewed key terms, events, and arguments in the heated national debate regarding physician-assisted suicide (PAS). Part II of the article examines the role of emergency physicians in caring for patients who present to the emergency department after an incomplete or unsuccessful attempt at PAS. The article considers the analogous cases of emergency care for other patients who have attempted suicide and care for terminally ill patients who refuse life-sustaining treatment. Morally relevant features of these situations are identified, including the decisionmaking capacity and the choices of the patient, the opinions of the patient's family or other surrogate decisionmakers, the presenting condition and medical history of the patient, the nature of the patient's suicide attempt, and the physician's own moral convictions. The article evaluates the 3 management options: aggressive intervention to preserve life, palliative care only, and assistance in completing the suicide. It concludes with several general recommendations for addressing these situations.

Emergency Medicine↗
PubMedDate not supplied

Emerging communication technologies in emergency medical services.

Advances in communication technologies are changing the face of emergency medical services (EMS). Two communication technologies in particular--cellular-enhanced 9-1-1 service and automatic crash notification (ACN)--will have a considerable impact on EMS. Although enhanced 9-1-1 service from land-line phones is now available in nearly every EMS system across the country, enhanced 9-1-1 service from cell phones currently does not exist. With more and more emergency calls made from cell phones, the implementation of this service is a clear priority. Automatic crash notification, a quickly emerging technology, can potentially provide EMS systems with invaluable data within seconds of when a collision occurs. However, many issues with regard to ACN systems need to be addressed, including liability concerns, access to ACN data, ability of drivers to understand the ACN system, and ACN system architecture. The potential interfaces between ACN systems and EMS systems create significant opportunities to enhance EMS resource management and care of patients involved in motor vehicle crashes. With both cellular-enhanced 9-1-1 and ACN in their infancy, EMS physicians and administrators have a valuable opportunity to provide leadership in the development of these services.

Accidents, Traffic↗
PubMed2001

Management of febrile infants and children by pediatric emergency medicine and emergency medicine: comparison with practice guidelines.

OBJECTIVES: Management of febrile infants and children remains controversial despite the 1993 publication in Pediatrics and Annals of Emergency Medicine of practice guidelines. Our aim was to determine the management of febrile infants and children by pediatric emergency medicine (PEM) fellowship directors and emergency medicine (EM) residency directors and compare their approach with the published practice guidelines. METHODS: Four case scenarios were sent to 64 PEM directors and 100 EM directors in the United States and Canada, describing four febrile, nontoxic infants and children aged 25 days (case 1), 7 weeks (case 2), 5 months (case 3), and 22 months (case 4). Respondents were asked to select which laboratory tests and radiographs they would obtain and to decide on treatment and disposition for each hypothetical case. RESULTS: Ninety-two percent (53/64) of PEM directors and 64% (64/100) of EM directors responded (overall response rate 74%). Compliance with the guidelines (PEM/EM) was 54%/16% for case 1, 31%/6% for case 2, 35%/19% for case 3, and 20%/11% for case 4. Only 11% of PEM and 2% of EM directors followed the guidelines for all four cases. Overall, directors performed fewer laboratory tests, ordered more chest radiographs and treated fewer patients with antibiotics than the expert panel suggested. EM directors ordered more chest radiographs (cases 1-4) and admitted more patients (case 2) than PEM directors. CONCLUSIONS: There is poor compliance with published practice guidelines in the management of febrile infants and children among PEM and EM directors.

Acute Disease↗
PubMed2004

Discharge from the accident and emergency department after smoke inhalation: influence of clinical factors and emergency investigations.

OBJECTIVES: Smoke inhalation has become the principal cause of death in burns patients. There are few guidelines for the management of smoke inhalation in the accident and emergency department. The aim was to identify what factors influence immediate management. METHODS: A retrospective case note review using data from three west of Scotland accident and emergency departments in 1999. Computerized record systems were used to identify suitable patients. RESULTS: Of 120 patients, 63 patients had incomplete data and were excluded. A total of 57 patients were classified into one of five categories: no burns, normal vital signs and examination (group 1, n=23); no burns, abnormal vital signs or examination (group 2, n=26); minor burns (<15% total body surface area) with or without abnormal vital signs or examination (group 3, n=5); major burns (>15% total body surface area) (group 4, n=2); in cardiac arrest on arrival (group 5, n=1). In groups 1 and 3, the result of two investigations significantly influenced management. In group 2, arterial blood gases and carboxyhaemoglobin levels were abnormal in 25% of cases, but only on one occasion did it influence an admission decision. CONCLUSION: Arterial blood gases, chest radiography and carboxyhaemoglobin estimation rarely influence immediate management. Patients presenting with normal vital signs and examination and short smoke exposure may be safe to discharge from the accident and emergency department without further investigation.

Adolescent↗
PubMed2006

Planning emergency patients: An attempt to change the nature of the emergency department.

Throughout the day, arrivals of patients at the emergency department (ED) are unannounced, unpredictable and fully determined by chance. Healthcare professionals in the ED naturally react as quickly as possible when patients arrive. We wondered whether they could somehow act in advance. We introduced a planning system that enabled the ED to regulate arrival times of emergency patients referred by the general practitioner. The system established direct contact between the general practitioner and the ED at the press of a button. As a result, the ED was able to schedule a fraction of its unpredictable patient demand. Implementation of the system at large was unsuccessful however. Changing the nature of the ED turned out to be far more difficult than expected. In our opinion, successfully planning emergency patients requires that the ED has full control over the referral process, and that scheduled patients are treated in a separate, undisturbed care process.

Appointments and Schedules↗
PubMed2006

Maternity emergency care: short course in maternity emergencies for remote area health staff with no midwifery qualifications.

OBJECTIVE: To improve the maternity emergency skills and knowledge of health service providers, without midwifery qualifications, in remote Australia. DESIGN: A descriptive paper utilising data from a needs assessment and course evaluations used to develop and refine a short course in maternity emergencies. SUBJECTS: Remote area health providers. INTERVENTIONS: A multidisciplinary short course, targeting non-midwives in remote areas, aimed at improving knowledge and skills in detection, management and referral of maternity emergencies. RESULTS: Ten courses have been delivered to 175 participants. Evaluations demonstrate a highly valued program, well received and supported by remote health staff. CONCLUSIONS: The course is an important strategy to improve the maternity services offered to women in remote Australia.

Australia↗
PubMed1995

Practice satisfaction, occupational stress, and attrition of emergency physicians. Wellness Task Force, Illinois College of Emergency Physicians.

OBJECTIVE: To define sources of job satisfaction and stress among emergency physicians and assess self-projected career longevity. DESIGN: A survey containing questions regarding emergency medicine (EM) practice satisfaction was mailed to 1,317 diplomates of the American Board of Emergency Medicine (ABEM). Specific sources of practice satisfaction and dissatisfaction, self-reported burnout or impairment, and plans for remaining in the specialty were assessed. Data were compared between two groups of physicians, namely, those residency-trained in EM and those attaining certification through the practice or special category tracts. RESULTS: Of the physicians returning the survey, 25.2% stated that they felt burned out or impaired and 23.1% planned to leave the practice of EM within five years. Perceptions of burnout/impairment and plans to stop practice were associated with less overall practice satisfaction but were not significantly different between the two groups of physicians. Burnout/impairment was linked with psychiatric, drug, or alcohol problems and the feeling that EM had contributed to that problem. CONCLUSION: This study confirms the relatively high levels of projected attrition in EM and supports the perception that stress and burnout are associated with the specialty. Differences in job satisfaction and stress between those ABEM diplomates who were residency-trained in EM and those who became eligible for the board examination through practice or special-category eligibility appear minor.

Adult↗
PubMed1997

The development and evaluation of a geriatric emergency medicine curriculum. The SAEM Geriatric Emergency Medicine Task Force.

OBJECTIVE: To summarize the processes used to develop a curriculum and model of care for the emergency medical treatment of elder patients and to assess the efficacy of the teaching material in a pilot course. METHODS: A survey of emergency medicine (EM) residency directors and geriatric fellowship directors was used to identify key topics for inclusion in the didactic material. An interdisciplinary consensus process was used to develop didactic as well as teaching material in geriatric EM. Pretests and posttests were administered to 46 participants in the initial course to assess knowledge gain. Subjective course evaluations were also done. RESULTS: Test scores significantly increased from 54% correct on the pretest to 77% correct on the posttest (p < 0.001). Significant improvement in knowledge as judged by pretest and posttest results occurred in 6 of the 7 teaching modules. Subjective evaluations demonstrated good to excellent ratings for each module as well as the overall workshop. CONCLUSIONS: The process of developing a curriculum for geriatric EM is described. The initial training of instructors was effective in improving participants' knowledge of geriatric issues in EM. Participants considered the training to be effective. The effect of the training on the emergency care of elder persons remains to be determined.

Aged↗
PubMed2000

Errors in emergency physician interpretation of ST-segment elevation in emergency department chest pain patients.

OBJECTIVE: To determine the rate of error in emergency physician (EP) interpretation of the cause of electrocardiographic (ECG) ST-segment elevation (STE) in adult chest pain patients. METHODS: The authors conducted a retrospective ECG review of adult chest pain patients in a university hospital emergency department (ED) over a three-month period (January 1 to March 31, 1996). ST-segment elevation was determined to be present if the ST segment was elevated >/=1 mm in the limb leads and >/=2 mm in the precordial leads in at least two anatomically contiguous leads. Initial EP ECG interpretation was compared with the final interpretation by a cardiologist supported by the results of various clinical investigations. The rate of incorrect ECG diagnosis was calculated. RESULTS: Two hundred two patients had STEs. The rate of ECG STE misinterpretation was 12 of 202 (5.9%). The most frequently misdiagnosed form of STE was left ventricular aneurysm, for which two of five cases were believed to represent acute myocardial infarction (AMI). The benign early repolarization (BER) pattern was the second most frequently misinterpreted STE entity-in a total of three cases, two were initially noted to represent pericarditis and one AMI. ST-segment elevation resulting from actual AMI was initially incorrectly noted to be noninfarction in etiology in two cases, one patient with BER and the other with left ventricular hypertrophy. CONCLUSIONS: Emergency physicians show a low rate of ECG misinterpretation in the patient with chest pain and STE. The clinical consequences of this misinterpretation are minimal.

Adult↗
PubMed2001

Preventive care in the emergency department: should emergency departments institute a falls prevention program for elder patients? A systematic review.

OBJECTIVE: To perform a systematic review of the emergency medicine literature to assess the appropriateness of an intervention to identify, counsel, and refer emergency department (ED) patients >64 years old who are at high risk for falls. METHODS: The systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. A reference librarian did two PubMed searches using the following: ED visits, patients >64 years old, falls, high risk, and effectiveness of intervention. Emergency Medical Abstracts, Science Citation Index, and the Cochrane Collaboration database were searched. Two team members reviewed the abstracts and selected pertinent articles. References were screened for additional pertinent articles. RESULTS: Twenty-six articles were reviewed. None were ED-based primary or secondary falls prevention in older patients. One randomized controlled trial of an intervention to decrease subsequent falls in elder community-dwelling patients who presented with a fall showed a structured interdisciplinary approach significantly reducing the number of falls. Two ED-based studies showed it was possible to identify ED patients at risk for falls. CONCLUSIONS: Based on one randomized controlled trial demonstrating a significant reduction in the risk of further falls, the burden of suffering caused by falls, and other studies demonstrating the value of interventions to reduce the risk of falling, the authors recommend that EDs conduct research to evaluate the effectiveness of clinical interventions to identify, counsel, and refer ED patients >64 years old who are at high risk for an unintentional fall.

Accidental Falls↗
PubMed2001

Safety net research in emergency medicine: proceedings of the Academic Emergency Medicine Consensus Conference on "The Unraveling Safety Net".

A primary goal of the Academic Emergency Medicine Consensus Conference, "The Unraveling Safety Net: Research Opportunities and Priorities," was to explore a formal research agenda for safety net research in emergency medicine. This paper represents the thoughts of active health services researchers regarding the structure and direction of such work, including some examples from their own research. The current system for safety net care is described, and the emergency department is conceptualized as a window on safety net patients and systems, uniquely positioned to help study and coordinate integrated processes of care.

Emergency Service, Hospital↗
PubMed2001

Pediatric emergency assessment tool (PEAT): a risk-adjustment measure for pediatric emergency patients.

OBJECTIVE: To develop a multivariable model predicting the level of care required by pediatric patients for use as a risk-adjustment tool in the evaluation of emergency medical services for children. METHODS: A random 10% sample of records of all visits over a 12-month period to a suburban, university-affiliated pediatric emergency department (PED) was selected and abstracted. The outcome variable, level of care received, was categorized in three levels: routine care only (R); diagnostic or therapeutic procedures performed in the ED but patient not admitted (EDT); and admission to hospital (ADM). Predictor variables included information routinely elicited and recorded at the time of triage. Using multinomial logistic regression, a predictive model was derived from a subset of 70% of the selected visits, and was validated in the remaining 30%. RESULTS: The total sample included 2,287 visits. The overall rate of each outcome was R-37%, EDT-53%, and ADM-10%. The final regression model included the following predictors significantly associated with the outcome: age, past medical history, temperature, abnormal respiratory rate or pulse oximetry in triage, chief complaint, and triage level (model likelihood ratio chi-square, 14 df = 332, p < 0.00001, R(2) = 0.14). The number of outcomes was well predicted by the model in both subsamples. Analysis of variance showed a significant association between Pediatric Emergency Assessment Tool (PEAT) score (weighted sum of the predicted probabilities of EDT and ADM) and both ED charges and time spent in the ED (p < 0.001). CONCLUSIONS: A model based on easily and routinely measured variables can accurately predict the level of care rendered in the PED. The predicted probabilities from such a model correlate well with other outcomes of care and may be useful in adjusting for differences in risk when evaluating quality of care.

Child, Preschool↗
PubMed2002

Preventive care in the emergency department: diagnosis and management of smoking and smoking-related illness in the emergency department: a systematic review.

UNLABELLED: Smoking remains the leading preventable cause of morbidity and mortality in the United States. The efficacy of emergency department (ED)-based patient screening and counseling for smoking cessation is not currently known. OBJECTIVES: To perform a structured, systematic review of the medical literature to assess the efficacy of limited screening and counseling for tobacco use cessation among adults in the primary care and ED settings, and develop recommendations for emergency physicians based on these data. METHODS: A two-person template-driven review of all English-language articles from Medline, the Cochrane Database, and two recent smoking cessation guidelines, with evidence graded according to the scheme of the U.S. Preventive Services Task Force (USPSTF), was performed. Recommendations were developed, and strength graded, based on this evidence. RESULTS: Of 2,078 citations reviewed, 16 were selected for inclusion, based on their methodologic strength and relevance to emergency medicine. Routine physician screening and counseling may increase quit rates at 6-12 months from 3% (usual care) to 8-11%. Interventions include brief counseling (<3 minutes), possibly supplemented with self-help literature, nicotine replacement therapy (NRT), and follow-up telephone calls. CONCLUSIONS: Strong evidence exists, in the primary care setting, that smoking cessation screening and counseling are effective. Limited data exist for ED-based practice, but, based on the burden of disease, relative ease of intervention, and likely efficacy, routine screening of all patients for tobacco use and referral of smokers to primary care and cessation programs are recommended.

Adult↗
PubMedDate not supplied

Improving emergency care for children: a model of collaboration between emergency departments.

OBJECTIVES: To determine whether a partnership between a tertiary paediatric hospital and a hospital with a mixed population of children and adults can improve emergency care for children. To describe the process of creating and maintaining such a partnership. METHODS: A partnership was created and various strategies employed to improve emergency paediatric care. This was evaluated by examination of demographic data, clinical audit, patient satisfaction surveys and staff satisfaction surveys. RESULTS: Paediatric attendances increased by 12% (P = 0.001), with a 33% increase in children under the age of 5 years (P = 0.001). Despite this there was a reduction of 6% in inpatient paediatric bed usage. Staff decision making and documentation improved during paediatric patient care, and parent and staff satisfaction with care of children improved. CONCLUSIONS: This initiative was successful in improving local paediatric facilities and patient care and is a new and innovative means of improving paediatric emergency care.

Adolescent↗
PubMed2005

Emergency physicians can reliably assess emergency department patient cardiac output using the USCOM continuous wave Doppler cardiac output monitor.

OBJECTIVES: 1 To develop a training package for ultrasonic cardiac output monitor (USCOM) cardiac output assessments and determine the number of proctored studies necessary for skill acquisition. 2 To develop criteria for acceptance of cardiac output results obtained with the USCOM. 3 To evaluate the reliability of USCOM cardiac output assessments in the ED. METHODS: The authors developed an audiovisual training package. Four emergency physicians and one geriatrician subsequently underwent hands-on training, and skill acquisition was assessed at the fifth, 10th, 15th and 20th examinations. Six image-scoring criteria were developed to assess acoustic image quality. Upon completion of training a protocol was developed to optimize interassessor reliability. Two trained emergency physicians then performed blinded examinations on ED patients using the protocol and interassessor reliability was evaluated. RESULTS: During training average image score improved between the fifth and 20th assessed patient from 4.6 (95% CI 4.0-5.3) to 5.5 (95% CI 5.0-6.0, Pt-test=0.02) out of 6 and average intra-assessor cardiac output difference improved from 17% (95% CI 4-25) to 5% (95% CI 0-11, Pt-test=0.02). Analysis of 52 cardiac output assessments in 21 ED patients demonstrated excellent interassessor correlation (r=0.96, 95% CI 0.90-0.98, P<0.001). The average interassessor difference in cardiac output and index was 0.2 L/min (4%, 95% CI 3-6) and 0.1 L/min/m2 (4%, 95% CI 2-6), respectively. CONCLUSION: Emergency physicians with no prior ultrasonographic experience can be trained to obtain reliable cardiac output estimations upon conscious ED patients with the USCOM over the course of 20 patient assessments.

Cardiac Output↗
PubMed1996

A major outbreak of asthma associated with a thunderstorm: experience of accident and emergency departments and patients' characteristics. Thames Regions Accident and Emergency Trainees Association.

OBJECTIVE: To investigate the time course of an epidemic of asthma after a thunderstorm, characteristics of patients affected, and the demand on emergency medical resources. DESIGN: Study of registers and records in accident and emergency departments and questionnaire to staff. SETTING: London area. SUBJECTS: All patients presenting at 12 accident and emergency departments with asthma or other airway disease. MAIN OUTCOME MEASURES: Numbers of patients, clinical features, information on shortage of resources--equipment, drugs and staff. RESULTS: The epidemic had a sudden onset on 24 June 1994; 640 patients with asthma or other airways disease attended during 30 hours from 1800 on 24 June, nearly 10 times the expected number. Over half (365) the patients were aged 21 to 40 years. A history of hay fever was recorded in 403 patients; for 283 patients this was the first known attack of asthma; a history of chronic obstructive airways disease was recorded in 12 patients. In all, 104 patients were admitted (including five to an intensive care unit). Several departments ran out of equipment or drugs, called in additional doctors, or both. CONCLUSIONS: This study supports the view that this epidemic was larger than previously reported epidemics and the hypothesis that "thunderstorm associated asthma' is related to aeroallergens. Demands on resources were considerable; a larger proportion of patients needing intensive care would have caused greater problems.

Adult↗
PubMed1985

Emergency care of the elderly in the short-stay ward of the accident and emergency department.

Review of a consecutive series of the elderly patients who presented unheralded to the Accident and Emergency Department of the Royal Gwent Hospital showed that a relative minority (11%) were difficult to manage because they had no obvious acute medical condition or injury which qualified them for admission by the firms to whom they were first referred. The difficulty was compounded by the shortage of geriatric beds. Judicious use of short-stay ward beds in the accident and emergency department relieved pressure on beds elsewhere and allowed a short space of time in which preparation could be made for the patient's further care in the community. Elderly patients were removed quickly from the stretcher area of the accident and emergency department to the quieter surroundings of the short-stay ward, where their immediate nursing requirements could be readily met. It was not then necessary for them to be on a trolley for hours while junior doctors haggled on the telephone or nurses were too busy to administer food, drink and bedpans.

Aged↗