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PubMed2004

JUST in time health emergency interventions: an innovative approach to training the citizen for emergency situations using virtual reality techniques and advanced IT tools (the VR Tool).

This paper reports the results of the second of the two systems developed by JUST, a collaborative project supported by the European Union under the Information Society Technologies (IST) Programme. The most innovative content of the project has been the design and development of a complementary training course for non-professional health emergency operators, which supports the traditional learning phase, and which purports to improve the retention capability of the trainees. This was achieved with the use of advanced information technology techniques, which provide adequate support and can help to overcome the present weaknesses of the existing training mechanisms.

Clinical Competence↗
PubMed1990

[An epidemiological study of psychiatric emergencies at the Biella Department of Emergencies and Admissions in the 5 years of 1983-1987].

The psychiatric intervention procedure at the Emergency and Registration Department (ERD) of Biella Hospital is examined. After a short introduction in which some general data are provided regarding Health Unit no. 47 of Biella and Unit no. 48 of Cossato, the data collected by the ERD psychiatric register are analysed. Data on ERD arrival modalities are reviewed and the type of diagnosis attributed by the psychiatrist to patients examined at the ERD is examined. The various types of responses given by the psychiatrist after consultancy are then presented. The time bands in which the request for psychiatric intervention mainly fall are then noted. The paper closes with remarks on the effectiveness over time of psychiatric intervention at the ERD.

Emergencies↗
PubMed1989

[Epidemiology of gyneco-obstetric emergencies (within the framework of emergency medical care)].

The authors studied over a period of four years emergencies in pregnancy. These were seen in patients who were brought in from an outside hospital to a perinatal centre or when transferred from hospitals to a general maternity unit or to a high risk unit for neonatal and maternity care. 382 pregnant women needed to be looked after (293 from outside hospital and 89 transferred from another hospital). Treatment was given especially in the 3rd trimester of the pregnancy to three groups: before labour (60 cases); during labour (211 cases) and; after delivery (30 cases). There were in the same categories 37 cases before labour, 9 cases during labour and 30 cases after labour transferred from one hospital to another. The diagnosis were, in particular, 47 cases with a high risk of premature labour, 5 cases with haemorrhage and placenta praevia, 27 cases of pre-eclampsia, 211 cases in labour of which 120 were outside hospital. There were 14 cases of maternal illness, 3 cases of trauma and 4 cases of cardiac arrest. There was a high risk of prematurity in 33 cases of labour outside a maternity hospital. The neonatal mortality rate for the first six days after delivery was ten times higher than that for all neonates born in the same county in the same period of time as this series took. But the authors noted that pre-eclampsia cases received care at high risk units but premature cases did not necessarily.

Adolescent↗
PubMedDate not supplied

[Emergency and psychiatric emergency at the General Hospital (author's transl)].

First, the author examines the requests made on the consulting psychiatrist (Prof. Luminet Service) within a 1.000 beds' hospital, administered by the Public Assistance and with a university status. He compares data on three months to a similar study done in the same hospital four years ago and lasting for six months. There is an important increase in the number of requests. He examines the reason for the requests, the distribution in age of the patients and their outcome after the psychiatric consultation. The comparison of both studies does not show any improvement in the failure already emphasized in the 1970 study. Secondly, the functioning of the psychiatric emergency unit (11 beds) is examined for a period of four months. The 59 patients in transit in this unit are examined for age, diagnosis, place of origin, length of stay. Some factors in favor and against this type of stay are discussed, in relation to the teaching role of the unit for the students and in relation to the type of hospitalised patients (Acta psychiat. belg., 1977, 77, 639-652).

Adult↗
PubMed1997

[Active compression-decompression resuscitation. Improved survival rate in an emergency medicine system with emergency physician assistance?].

BACKGROUND: Improved cardiopulmonary circulation with active compression-decompression resuscitation (ACD-CPR) has been demonstrated in studies using different animal models and a small number of human in cardiac arrest (CA). However, prehospital studies have shown both positive and no extra benefit of ACD-CPR on survival rates and neurologic outcome. MATERIAL AND METHODS: The aim of our prospective study was to compare standard manual CPR (S-CPR) to ACD-CPR as the initial technique of resuscitating patients with out-of-hospital CA with respect to survival rates and neurological outcome in our two-tiered EMS system with physicians in the field. RESULTS: Patients with out-of-hospital CA treated by emergency medical services (EMS) personnel were randomly assigned to 1 of 2 groups (ACD-CPR versus S-CPR). The treatment groups were similar with respect to age, sex, time interval from collapse to CPR, defibrillation and first epinephrine medication. There was no difference between the ACD group and the standard CPR group in terms of survival rates and neurologic outcome. No differences occurred concerning complications of CPR. CONCLUSION: In our two-tiered EMS system with physician-staffed ambulances ACD-CPR neither improved nor impaired the survival rates and the neurological prognosis in patients with out-of-hospital cardiac arrest. Our results are in accordance with other studies carried out in EMS systems, with first tier call-response intervals between 4 and 6 min.

Adult↗
PubMed2005

[Invasive techniques in emergency medicine. IV. Cricothyrotomy in emergency situations].

Cricothyrotomy is a very invasive technique to secure the airway in an emergency but is irreplacable when less invasive techniques fail or cannot be instigated under the prevailing circumstances. Various techniques have been reported which can be subdivided into anatomical-surgical preparation or puncture techniques. The preferred strategy is mostly oriented towards the departmental standard procedure which will be decided by the clinical situation. Training for each procedure can be carried out in intensive care departments, and using autopsy material or a manekin. Various methods of cricothyrotomy will be discussed here, and additionally an anatomical preparation and two puncture techniques will be demonstrated in detail.

Cricoid Cartilage↗
PubMed2002

Paediatric emergencies: non-traumatic abdominal emergencies.

Presentation with acute abdominal pain or abdominal symptopathology is a very common cause of presentation of children to hospital. The causes are dependent in part on the age of the child, in part on the presence of previous surgery, and can be divided into those that relate to congenital abnormalities at whatever age they present, acquired disease and infection. Children, particularly young children are often poor historians, and therefore the clinical examination and the laboratory investigations are important in helping to come to a diagnosis. Primary imaging of abdominal emergencies in childhood is a radiograph of the abdomen, followed by ultrasound. Further imaging depends on the results of these studies. An ordered review of the abdomen radiograph is important if the salient features on X-ray are not to be missed. Practitioners should be competent with abdominal ultrasound in children and know where to seek the causes of disease, as these are different from those that are obtained in many instances in adults. Familiarity with the likely causes is important. The three commonest causes of acute abdominal pain in childhood are, in young infants, intussusception, appendicitis and mesenteric adenitis. In older children, inflammatory bowel disease and ovarian pathology are also included. This article details the approach to imaging and the salient features of some of the conditions.

Abdomen↗
PubMed2002

Non-traumatic neurological emergencies: emergency neuroradiological interventions.

This article summarizes recent developments in the growing field of interventional neuroradiology for the treatment of acute cerebrovascular disease. We describe the possibilities in endovascular therapy of acute cerebral aneurysms using electrolytically detachable coils combined with trispan neck bridging devices and stent implantation to occlude acute wide neck aneurysms. Techniques and results of local intra-arterial thrombolytic therapy in acute stroke and central retinal artery occlusion are described and we discuss the potential for rapid, large-burden thrombus removal in cases of internal carotid artery thrombosis by rheolytic thrombectomy, percutaneous transluminal angioplasty and stent implantation. Emergency endovascular therapy using the transvenous approach to treat severe intracranial or intraocular hypertension and multifocal haemorrhagic venous infarction due to cerebral sinus thrombosis or dural fistulas is also described. In cases of acute bleeding of head and neck lesions following trauma, tumours after radiotherapy, arteriovenous malformations, epistaxis or from iatrogenic origin, angiography plays a major role in localizing the source of bleeding and occluding the damaged vessel during the same session using the same endovascular approach.

Adolescent↗
PubMed2006

Gray zone BNP levels in heart failure patients in the emergency department: results from the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) multicenter study.

OBJECTIVES: The study purpose was to examine "gray zone" B-type natriuretic peptide (BNP) levels (100-500 pg/mL) in terms of associated clinical factors, perceived severity, and outcomes in patients with established congestive heart failure (CHF). BACKGROUND: Although gray zone BNP levels may have diagnostic ambiguity, the implications of these levels in patients with an established diagnosis of CHF have not been examined. METHODS: REDHOT was a national prospective study in which 464 patients seen in the emergency department with dyspnea had BNP levels drawn. Entrance criteria included a BNP > 100 pg/mL; however, physicians were blinded to the actual BNP level. Patients were followed up for 90 days. RESULTS: Thirty-three percent had gray zone BNP levels. There was no difference in perceived New York Heart Association class (P = .32) or admission rates (P = .76) between the gray zone and non-gray zone groups; 62% of patients with a gray zone BNP were identified as class III or IV CHF. Despite this perceived severity, the 90-day event rate was lower in the gray zone group (19.2% vs 32.9%, respectively, P = .002). Although patients in the gray zone had more symptoms of concomitant pulmonary disease, multivariate analysis could not demonstrate any variable that worsened the prognosis of patients with a gray zone BNP level. CONCLUSIONS: In patients with established CHF, those with gray zone BNP levels have a better prognosis than those with non-gray zone levels despite being perceived by physicians as having New York Heart Association class III or IV CHF.

Aged↗
PubMed2005

From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine--Part II: Challenges in the emergency department.

Part I of this article reviewed the concepts of privacy and confidentiality and described the moral and legal foundations and limits of these values in health care. Part II highlights specific privacy and confidentiality issues encountered in the emergency department (ED). Discussed first are physical privacy issues in the ED, including problems of ED design and crowding, issues of patient and staff safety, the presence of visitors, law enforcement officers, students, and other observers, and filming activities. The article then examines confidentiality issues in the ED, including protecting medical records, the duty to warn, reportable conditions, telephone inquiries, media requests, communication among health care professionals, habitual patient files, the use of patient images, electronic communication, and information about minor patients.

Confidentiality↗
PubMed2004

Major factors affecting the emergence and re-emergence of infectious diseases.

The diversity of infectious disease threats currently facing humanity is unprecedented because of the remarkable emergence and reemergence of pathogens worldwide. Because of population mobility, globalization of commerce and the food supply, and the effects of the HIV/AIDS pandemic, infections in the developing world must be addressed to prevent infections in industrialized countries. Because pathogens do not recognize national boundaries, the rapidity with which individuals can circumnavigate the globe incubating infections makes the control of communicable diseases an enormous challenge for governments as well as for the public and primary health care systems. A global strategy for dealing with infectious disease threats must be developed and implemented as soon as possible.

Communicable Disease Control↗
PubMed1991

The Massachusetts Emergency Medicine Risk Management Program. Massachusetts Chapter of the American College of Emergency Physicians.

Reducing malpractice claims incidence and improving the quality of patient care are the goals of the Massachusetts Emergency Physician Risk Management Program. This innovative program entails computer audit of records in high-risk diagnostic categories. The program focuses on increasing physician awareness of high-risk diagnoses and on medical record documentation of a few critical actions pertinent to each diagnostic area.

Algorithms↗
PubMed1991

The HIV-1 seroprevalence rate of injured patients admitted through California emergency departments. California HIV-1 Emergency Department Seroprevalence Study Group.

STUDY OBJECTIVES: To measure the HIV seroprevalence of injured emergency department patients in a number of California hospitals and to examine the relationship between ED seroprevalence and local AIDS incidence. DESIGN: Prospective blinded testing for HIV-1 antibody was performed on routinely collected blood samples. SETTING: Ten California hospitals; group 1 included three hospitals from counties of high AIDS incidence (more than 40 cases per 100,000 population), group 2 included three hospitals from counties of intermediate AIDS incidence (20 to 40 cases per 100,000 population); and group 3 included four hospitals from counties of low AIDS incidence (less than 20 cases per 100,000 population). TYPE OF PARTICIPANTS: Eligible patients were all adult trauma victims admitted to a participating hospital through the ED during a consecutive three-month period occurring between June and November 1989. MEASUREMENTS: HIV-1 antibody testing was done using enzyme immunoassay confirmed by immunofluorescence assay. Equivocal results were confirmed by Western blot. Mann-Whitney U test, chi 2 test, and multiple logistic regression were used where appropriate. RESULTS: There were 2,264 patients with adequate blood samples for serologic testing. The seroprevalence rates for hospitals in groups 1, 2, and 3 were significantly different (chi 2 = 8.44, P = .02): Group 1, 2.5% (19 of 756: 95% confidence interval [CI], 1.5% to 3.9%); group 2, 0.9% (10 of 1,078; CI, 0.5% to 1.7%); and group 3, 0.5% (two of 430; CI, 0.06% to 1.7%). CONCLUSION: This study suggests that local AIDS incidence rates do not necessarily predict the seroprevalence rates of injured patients who are admitted through local EDs.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Noninvasive ventilation: an emerging supportive technique for the emergency department.

Noninvasive ventilation (NIV) is the provision of ventilatory support to a spontaneously breathing patient without endotracheal intubation. In this review, we detail concerns related to endotracheal intubation and summarize the physiologic effects and clinical application of NIV. We then address the use of NIV in 5 conditions of particular interest to the practitioner of emergency medicine: exacerbated chronic obstructive lung disease, severe asthma, patients who are not candidates for endotracheal intubation, pneumonia, and pulmonary edema.

Clinical Protocols↗
PubMed2002

Hematologic emergencies in the pediatric emergency room.

The complete blood count (CBC) describes the three hematopoietic lineages (i.e., the erythrocytes, leukocytes, and platelets), and it is an essential diagnostic component in numerous clinical situations. The pediatric CBC and hematologic problems in children may significantly differ from that of adults. In this article, special features of pediatric hematologic emergencies are highlighted.

Adolescent↗
PubMed2005

[Emerging or re-emerging infections that can be used for bioterrorism].

USED FOR WARFARE: Bioterrorism is a perfectly foreseeable eventuality. It is defined by the international use, or menace of use, of living organisms whatever their nature, or of substances derived from these organisms, aimed at provoking a disease or the death of human beings, animals or plants. UPDATED COUNTERACTING STRATEGIES: More than 180 infectious agents could be used for terrorist ends. The recent events in the dawn of this twenty-first century have reactivated and notably updated the strategies to counteract such an event. Clinical and therapeutic guidelines have been circulated in many countries. INFECTIONS THAT REQUIRE RECOGNITION: The role of practitioners in the rapid recognition of bioterrorism-related infections is crucial. Hence, updated knowledge on these potentially emerging or reemerging infections is required.

Anthrax↗
PubMed2001

Hot spots in a wired world: WHO surveillance of emerging and re-emerging infectious diseases.

The resurgence of the microbial threat, rooted in several recent trends, has increased the vulnerability of all nations to the risk of infectious diseases, whether newly emerging, well-established, or deliberately caused. Infectious disease intelligence, gleaned through sensitive surveillance, is the best defence. The epidemiological and laboratory techniques needed to detect, investigate, and contain a deliberate outbreak are the same as those used for natural outbreaks. In April 2000, WHO formalised an infrastructure (the Global Outbreak Alert and Response Network) for responding to the heightened need for early awareness of outbreaks and preparedness to respond. The Network, which unites 110 existing networks, is supported by several new mechanisms and a computer-driven tool for real time gathering of disease intelligence. The procedure for outbreak alert and response has four phases: systematic detection, outbreak verification, real time alerts, and rapid response. For response, the framework uses different strategies for combating known risks and unexpected events, and for improving both global and national preparedness. New forces at work in an electronically interconnected world are beginning to break down the traditional reluctance of countries to report outbreaks due to fear of the negative impact on trade and tourism. About 65% of the world's first news about infectious disease events now comes from informal sources, including press reports and the internet.

Communicable Disease Control↗