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PubMed1989

The use of a new design irrigator for the emergency treatment of chemical eye injuries in an accident and emergency department.

The introduction of a hand-held drench hose into a district general hospital accident and emergency department, for the emergency irrigation of chemically injured eyes is reported. The hose is described, together with the technique of irrigation. The advantages that a high-flow, low pressure system affords over conventional irrigation methods are discussed. The system appears to offer a simple, immediately available, effective tool for emergency eye care, which is suitable for use by a variety of personnel.

Burns, Chemical↗

PubMed2004

Is a third year clerkship in emergency medicine correlated with a career choice in emergency medicine?

BACKGROUND: The factors medical students use to choose emergency medicine (EM) as a career path have not been well studied. The role of a 3rd year clerkship in EM in a student's choice of EM residency is not known. PURPOSE: The purpose of this survey was to determine whether a 3rd year clerkship in EM is correlated with a student's choosing EM as a career choice, as evidenced by the number of students who apply for or matching in EM in medical schools in the United States. METHODS: The deans of American medical schools were surveyed by mail, using a seven-part questionnaire inquiring as to type of exposure, number of students, length of the exposure, number of students applying for and matching in EM in the past 3 years. The data was analyzed using SPSS software. RESULTS: The survey was returned by 71 of the 125 medical schools (56.8 percent) in the country. The average class size was 129.9 students. Over one half of the medical schools (58.8 percent) provided EM exposure in the 3rd year; in 38.7 percent it was a required clerkship. The number of students applying for or matching in EM was not correlated with a required or elective rotation in EM, departmental status, percentage of board certified emergency physicians, emergency department volume, or a residency training program in EM (p >.05). CONCLUSIONS: This study did not demonstrate a correlation of a 3rd year rotation in EM with the number of students applying or matching in EM.

Adult↗

PubMed1993

Developments in the delivery of emergency care in Japan and the present state of our hospital's emergency care.

Japan is far behind Western nations in emergency care, such as the United States where paramedics are placed under the M-ICU system and France in which the SAMU system is in force. This paper is an attempt to introduce developments in the delivery of emergency care in the Japanese rural setting and the present state of emergency care delivered at our hospitals, while checking them against national policy.

Ambulances↗

PubMed1994

Implementation of provisions of the Ryan White Comprehensive AIDS Resources Emergency Act regarding emergency response employees--CDC. Final notice.

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (Pub. L. 101-381) includes provisions for emergency response employees (EREs) who may be exposed to potentially life-threatening disease during the course of an emergency. This notice sets forth the final list of diseases to which these provisions apply; final guidelines describing circumstances under which exposure to listed diseases may occur; and final guidelines for determining whether an exposure to the listed diseases has occurred. The final list of diseases and guidelines incorporate comments received by CDC on a draft list and guidelines (57 FR 54794, November 20, 1992).

Centers for Disease Control and Prevention, U.S.↗

PubMed1999

Emergency protocols in prehospital emergency medicine in Slovenia.

Emergency medicine is a branch of medicine in which prompt and accurate information is of crucial importance, because a patient's survival and the final outcome of a treatment very often depends on it. Therefore the standardization of prehospital emergency service administration with uniform documentation, methods of annotation of technical data as well as uniform gathering and data analysis are necessary. Wanting to process a fair amount of data and specially to disburden personnel, a need for computer aided processing is evident. Application that was developed in strong collaboration with EMS project team and information science engineers definitely improves data quality. Firstly when team members, especially physicians, are constrained to fulfill paper forms and secondly when data are entered into the computer, because all inconsistencies are being reconsidered and corrected if necessary. The developed application also gave the opportunity to the emergency team for prompt and accurate information.

Data Collection↗

PubMed2000

Emerging multiresistant strains: recommended precautions in the emergency room and surgical setting.

The current success in treatment of surgical site infections may be jeopardized by the continued emergence of antibiotic resistance in bacteria common to these infections. The effectiveness of vancomycin against methicillin-resistant staphylococci may decrease as more cases of VISA emerge. No currently available antimicrobial is consistently effective against certain strains of VRE and the potential emergence of VRSA. Orthopaedic surgeons soon may be in the undesirable position of having to eradicate organisms resistant to all available antibiotics. Several new antibiotics show promising activity and may be useful against these multidrug-resistant bacteria. However, as the history of bacterial resistance has taught us, it likely only will be a matter of time until these organisms adapt mechanisms of resistance to these new drugs. The key then lies, as it always has, in preventive measures. Surgeons, and all physicians, must adhere to the precautionary guidelines recently set forth by the CDC and HICPAC. Chief among these guidelines is the elimination of inappropriate antibiotic usage, especially inappropriate vancomycin use.

Cross Infection↗

PubMed2001

Objective standards for the emergency services: emergency admission to hospital.

The primary objectives of the emergency services are to minimize early mortality and complications, although longer-term morbidity, quality of life and late mortality may also be influenced by early actions. Evaluation of the emergency services and demonstration of quality need to reflect these objectives by appropriate choice of outcome measures. This brief review of leading measures of quality in emergency admissions discusses population-based 30-day mortality, after examining some limitations of 'hospital mortality', incidences of complications, which can be more sensitive measures of quality of care when mortality rates are low, and a role for audit and management, when relationships between process and outcome are clear. As an example, the UK study of urgent admission to hospital, on behalf of the Clinical Standards Advisory Group, showed wide variation between sampled hospitals in timeliness of early clinical actions and a statistically significant association between timeliness and 30-day survival. The review also discusses capacity, a necessary requirement for a quality service, and operations research/queuing theory to facilitate management of capacity/resources to meet fluctuating demands. The NHS should be able to plan for seasonal needs.

Emergency Service, Hospital↗

PubMedDate not supplied

[Glypressin and emergency sclerotherapy, deferred emergency shunt (Warren, portacaval, mesocaval): new tactics in the treatment of severe hemorrhage by esophagogastric varices in cirrhotic patients].

Transplenic decompression of esophageal varices by distal splenorenal shunt according to Warren (DSRS) aims to a selective detention of the esophago-gastric varices, also assuring an adequate portal perfusion and hypertensive state of the porto-mesenteric district. The DSRS though, should and must not be performed in emergency as a high mortality rate is registered in all cases of emergency porto-systemic derivations. A mortality risk is reported even during endoscopic sclerosis if performed in emergency compared to the elective procedure. The scope of our study was to test the validity of a new approach of the hemorrhagic cirrhotic patient: the end point was to stop the bleeding with Glypressin and deferred sclerotherapy, associating a selective shunt at 40-60 days. Out of 32 patients with esophago-gastric variceal bleeding, 8 were selected also for derivative surgery. Results show Glypressin as the first and best therapeutic approach. The drug in many cases stops bleeding or at least reduces the blood loss allowing an easier endoscopic sclerosis. Further sclerosis and/or surgical therapy may assure variceal eradication.

Adult↗

PubMedDate not supplied

Preparation for neonatal emergencies: a neonatal emergency medication sheet.

Safe and timely administration of emergency medications and infusions is crucial when caring for critically ill neonates. A neonatal emergency medication sheet can enhance preparation, calculation, and administration of medications during emergency situations in neonatal intensive care units (NICUs).

Drug Therapy↗

PubMedDate not supplied

Emergency nursing scope of practice. Emergency Nurses Association (ENA).

The intent of this document is to conceptualize practice and provide direction to practitioners, educators, researchers, and administrators, and to inform other health professions, legislators, and the public about the participation in, and contribution to, health care by emergency nursing. Through articulation of the elements of core, dimensions, boundaries, and intersections, the Emergency Nursing Scope of Practice document defines the specialty practice of emergency nursing.

Emergency Medical Services↗

PubMed1983

[Medical performance record of emergency physicians' mobile unit and emergency aid helicopter].

A large amount of data and information has accumulated in the course of the ever-increasing rate of first-aid relief by emergency physicians. These data have either not been documented so far or, if so, in a rather perfunctory manner. For this reason, the authors developed for the Mannheim emergency physician's mobile car unit and for the first-aid relief helicopter Christoph 5, a record of performance (logbook) of primary-care cases for the purpose of data acquisition and computer-assisted medical documentation and statistics via EDP. An example of an E-605 intoxication serves to illustrate the advantages of this logbook, which has already been applied to more than 200 emergency cases.

Adult↗

PubMed1982

[Cardiovascular emergencies--endocrine and metabolic crises. Practical hints for the physician in emergency service].

50% of hospitalized medical emergency cases are cardiological and respiratory emergencies. Myocardial infarction, cardiogenic shock, ventricular arrhythmias and left ventricular failure often cause sudden death occurring within 1 or 2 hours. Therefore immediate management is necessary already in the prehospital phase of cardiovascular events. This does also apply for acute respiratory failure due to obstructive ventilatory disorders. Acute exacerbations of chronic obstructive pulmonary disease frequently are masked and may be misinterpreted as encephalopathy or alcohol withdrawal syndrome. Sedation may be dangerous. Also neuroglucopenic syndrome and hyperosmolar coma are occasionally interpreted wrongly. Thyrotoxic crisis, adrenal crisis and hypercalcemia are characterized by lethargy, mental disturbance and weakness, by dehydration, myopathy, nausea, constipation, diarrhea or tenesms or arrhythmias. In this situation of varied symptoms the most important action is to think of endocrine emergency, which may have multiple etiologies.

Airway Obstruction↗

PubMed1994

[Pulmonary emergency medicine at Okinawa Chubu Hospital, including care of patients with primary, secondary, and tertiary emergency problems].

In the emergency department of Okinawa Chubu Hospital, 32,088 patients were seen between November 1992 and October 1993. Of these patients, 19,306 were over 16 years old. About 20% of the patients seen in the emergency department had pulmonary diseases. In decreasing order of frequency, the five most commonly seen conditions were: upper respiratory tract infections (19%), bacterial pneumonia (12%), acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease, and chest trauma. Medical (i.e. nonsurgical) treatment was required by 10,034 patients. Thirty five percent of those had pulmonary disorders, and the mortality rate was 0.9%. A total of 747 patients were hospitalized, and 65 were admitted to the intensive care unit. Of those admitted to the intensive care unit, 9% died of respiratory problems. Surgical treatment was required by 5587 patients. Only 5.1% of them had pulmonary problems, and the mortality rate was 3.5%. However, the mortality rate among the 25 patients admitted to the intensive care unit for surgical pulmonary problems was 8%. Among patients with medical problems who were hospitalized via the emergency department, 36% had pulmonary disorders (mainly pneumonias, asthmatic attacks, acute bacterial bronchitis, and acute exacerbation of chronic obstructive pulmonary disease), but only 7% of patients with surgical problems had chest trauma (mainly due to traffic accidents of falls).

Adolescent↗

PubMed1995

[Emergency service course manual--a contribution to quality assurance in emergency medicine education].

For the purpose of comparison and quality control for the acquisition of the subspeciality in emergency medicine, a committee of experts in the area of emergency medicine developed the first curriculum (course book Emergency medicine) valid in all states of Germany. The requirements for the development of this curriculum were derived from the experts' experiences and from the requirements of the medical society for the quality of medical training.

Curriculum↗

PubMed1998

The effect of a dedicated emergency theatre facility on emergency operating patterns.

Following the introduction of a dedicated 24-hour emergency theatre facility in a 500-bed district general hospital, the total amount of emergency general surgery performed after 22.00 hours has been reduced from 37.2 to 13.1%, with a concomitant increase in emergency day-time operating from 22.1 to 51.2%. The majority of the workload was previously performed by the junior grades, and this has remained unchanged. Operative experience has not been diminished with the reduction in night-time surgery, and senior supervision has been enhanced. There has been no significant difference in mortality or morbidity with the changes in operating patterns. Utilization of the theatre staff and time during the night has been improved.

Emergency Treatment↗

PubMed1997

[Organization of emergency medicine based on the frequency and severity of emergency conditions].

The spontaneous development of the organization and practice of emergency medicine created a number of types of emergency medicine units. Long time, these units were developed in out-hospital institutions such as health centres. Together with these services, all acute hospitals have had full day,s emergency services for definite care of urgent conditions. The authors give principles of this activity organization in the light of expected incidence and severity of urgent conditions related to the number of population which gravitate to particular hospital or other health services. Starting from the assumption that expected frequency of urgent conditions per 100 persons in 24 hours is between 0.50-0.75, the authors present the model of health care organization of such cases including family doctor, health station, health centre, hospital.

Bosnia and Herzegovina↗

PubMed2004

The emerging role of the emergency care practitioner.

OBJECTIVES: To examine the emerging role of the emergency care practitioner (ECP) with comparisons to paramedic practice. Key activities were identified of newly appointed ECPs using qualitative methodology and a qualitative and quantitative comparison of patient treatment was made. METHOD: A constructivist methodology taking account of stakeholder input and drawing upon the constant comparisons of different group's construction of reality. Four practitioners completed reflective patient case studies and adapted patient report forms, which were compared with a second case group of 11 paramedics. In addition individual and focus groups interviews were performed with key stakeholders. RESULTS: In the comparison between ECP and paramedic roles, 331 paramedic incidents were compared with 170 ECP reports. ECPs treated 28% of patients on scene compared with 18% by paramedics (p = 0.007). Fifty per cent of ECPs patients were conveyed compared with 64% of paramedics (p = 0.000). Analysis of the 269 reflective reports and 14 stakeholder interviews revealed four key themes. Firstly, ECPs had a beneficial impact on the deployment of resources, especially relating to non-conveyance. Secondly, their training and education improved their decision making repertoire and developed their confidence for a leadership role. Thirdly, inter-agency collaboration and cooperation was improved, and finally, care benefits were increased especially relating to immediacy of treatment and referral mechanisms. CONCLUSIONS: The results indicate that an investment in the ECP role could be beneficial, however, more work is required to evaluate the development of practice, the quality of care, and cost benefits.

Adolescent↗

PubMed2006

Patient- and family-centered care and the role of the emergency physician providing care to a child in the emergency department.

Patient- and family-centered care (PFCC) is an approach to health care that recognizes the role of the family in providing medical care, encourages collaboration between the patient, family, and health care professionals; and honors individual and family strengths, cultures, traditions, and expertise. Although there are many opportunities for providing PFCC in the emergency department, there are also challenges to doing so. The American Academy of Pediatrics and American College of Emergency Physicians support the following: promoting patient dignity, comfort, and autonomy; recognizing the patient and family as key decision makers in the patient's medical care; recognizing the patient's experience and perspective in a culturally sensitive manner; acknowledging the interdependence of child and parent as well as the pediatric patient's evolving independence; encouraging family member presence; providing information to the family during interventions; encouraging collaboration with other health care professionals; acknowledging the importance of the patient's medical home; and encouraging institutional policies for PFCC.

Child↗