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At least 541 records · Page 30Linked to original sources
PubMed2003

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Acute myocardial infarction in cocaine induced chest pain presenting as an emergency.

A short cut review was carried out to establish the incidence of acute myocardial infarction in patients presenting as emergencies with post-cocaine chest pain. Altogether 198 papers were found using the reported search, of which eight 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. A clinical bottom line is stated.

Adult↗
PubMed2006

[Cocaine abuse attended in the emergency department: an emerging pathology].

BACKGROUND AND OBJECTIVE: The consumption of cocaine has increased in Spain in recent years, leading to a probable increase in overdoses. The associated use of other drugs of abuse may be increasing the toxicity of cocaine, and therefore, increasing consultations to the emergency department (ED). PATIENTS AND METHOD: We collected patients seen by the ED of our hospital who reported cocaine consumption in the previous hours. The relationship between cocaine consumption and the reason for attending the ED was analysed. We reviewed the medical records of a sample of overdoses to determine the clinical profile. RESULTS: During the period 2002-2004, 745 patients were detected (average age 31 years, 68% males). The annual distribution was 223 cases in 2002, 232 in 2003, and 290 in 2004. Fifty-three percent of patients attended the ED at the weekend and 53% from 0:00 to 12:00 h. The main drugs associated with cocaine consumption were ethyl alcohol (38%), opiates (14%), cannabis (13%) and amphetamine derivatives (9%). Cocaine was the substance causing clinical symptoms in 70% of cases. The main reasons for attending the ED were anxiety or agitation (48%) and thoracic pain or palpitations (25%). Eleven percent of cases required hospital admission (19 intensive care unit) and 3 patients died. CONCLUSIONS: The consumption of cocaine, almost always associated with other drugs of abuse, has generated an increase in patients attending the ED. Although mortality is low, cocaine consumption generates substantial morbidity and frequent hospital admissions.

Adolescent↗
PubMed2005

What characteristics of applicants to emergency medicine residency programs predict future success as an emergency medicine resident?

OBJECTIVES: Program directors of emergency medicine (EM) residencies attempt to select candidates who will subsequently perform well as residents. This study was undertaken to identify characteristics available at the time of application to an EM residency that predict future success in residency. METHODS: The EM faculty at the University of California San Diego (UCSD) completed a one-time confidential assessment of EM residents on performance in residency at the time of graduation. The faculty member compared the graduate with all residents (both EM and non-EM) with whom the faculty member had previously worked using the five-point scale: > or =90th percentile, 70th-89th percentile, 50th-69th percentile, 30th-49th percentile, or < 30th percentile. Descriptive statistics, ordinal logistic regression (OLR), classification and regression tree (CART) analysis, and multiple additive regression tree (MART) analysis were used to find predictors for each of the outcome variables. RESULTS: Fifty-four graduates were evaluated. The medical school attended (MSA) was the strongest predictor of overall performance in residency in all regression models. OLR showed that MSA and "distinctive factors" (being a championship athlete, medical school officer, etc.) were significant predictors and may deserve greater weighting in the selection process. The most robust MART model demonstrated that MSA, dean's letter of recommendation, and distinctive factors had the most impact on overall performance in an EM residency. CONCLUSIONS: Using regression modeling, it may be possible to predict future resident performance from characteristics contained in residency applications. Applicants from top-tier medical schools and those with distinctive talents were more successful in the UCSD EM residency.

Adult↗
PubMedDate not supplied

Emergency care in California: no emergency?

Glenn Melnick and colleagues' analysis of emergency department (ED) capacity and access in California is fatally flawed because the authors do not consider the operational constraints that severely compromise ED functioning. Simple counts of ED beds and distance to the closest hospital ED are virtually meaningless without considering, for example, the operational impact of loss of inpatient bed capacity, the nurse shortage, declining availability of on-call specialists, lack of access to primary care, and growing numbers of uninsured people. Other surveys indicate that ED overcrowding and ambulance diversion are serious and growing problems-not only in California, but nationwide.

California↗
PubMed2006

Emergency department allies: a controlled trial of two emergency department-based follow-up interventions to improve asthma outcomes in children.

OBJECTIVE: We sought to study the impact of emergency department (ED)-based intensive primary care linkage and initiation of asthma case management on long-term, patient-oriented outcomes for children with an asthma exacerbation. METHODS: Our study was a randomized, 3-arm, parallel-group, single-blind clinical trial. Children aged 2 through 17 years treated in a pediatric ED for acute asthma were randomly assigned to standard care (group 1), including patient education, a written care plan, and instructions to follow up with the primary care provider within 7 days, or 1 of 2 interventions. Group 2 received standard care plus assistance with scheduling follow-up, while group 3 received the above interventions, plus enrollment in a case management program. OUTCOMES: The primary outcome was the proportion of children having an ED visit for asthma within 6 months. Other outcomes included change in quality-of-life score and controller-medication use. RESULTS: Three hundred fifty-two children were enrolled; 78% completed follow-up, 69% were black, and 70% had persistent asthma. Of the children, 37.8% had a subsequent ED visit for asthma, with no difference among the treatment groups (group 1: 38.4%; group 2, 39.2%; group 3, 35.8%). Children in all groups had a substantial, but similar, increase in their quality-of-life score. Controller-medication use increased from 69.4% to 81.4%, with no difference among the groups. CONCLUSION: ED-based attempts to improve primary care linkage or initiate case management are no more effective than our standard ED care in improving subsequent asthma outcomes over a 6-month period.

Adolescent↗
PubMed1996

US emergency department costs: no emergency.

BACKGROUND: Many perceive emergency department (ED) overuse as an important cause of high medical care costs in the United States. Managed care plans and politicians have seen constraints on ED use as an important element of cost control. METHODS: We measured ED-associated and other medical care costs, using the recently released 1987 National Medical Expenditure Survey of approximately 35,000 persons in 14,000 households representative of the US civilian, noninstitutionalized population. RESULTS: In 1987, total ED expenditures were $8.9 billion, or 1.9% of national health expenditures. People with health insurance represented 86% of the population and accounted for 88% of ED spending. The uninsured paid 47% of ED costs themselves; free care covered only 10%. For the uninsured, the cost of hospitalization initiated by ED visits totaled $3.3 billion, including $1.1 billion in free care. Whites accounted for 75% of total ED costs. The ED costs of poor and near-poor individuals accounted for only 0.47% of national health costs. CONCLUSIONS: ED use accounts for a small share of US medical care costs, and cost shifting to the insured to cover free ED care for the uninsured is modest. Constraining ED use cannot generate substantial cost savings but may penalize minorities and the poor, who receive much of their outpatient care in EDs.

Adolescent↗
PubMed2003

Implementation of a point-of-care satellite laboratory in the emergency department of an academic medical center. Impact on test turnaround time and patient emergency department length of stay.

CONTEXT: Emergency department (ED) overcrowding has reached crisis proportions in the United States. Many hospitals are seeking to identify process reengineering efforts to reduce crowding and ED patient length of stay (LOS). OBJECTIVES: To investigate the impact of a point-of-care testing (POCT) satellite laboratory in the ED of a large academic medical center. SETTING: The ED of the Massachusetts General Hospital, Boston, Mass. DESIGN AND OUTCOME MEASURES: Evaluation of physician satisfaction, turnaround time (TAT), and ED LOS before and after implementation of a POCT laboratory. ED LOS was measured by patient chart audits. TAT was assessed by manual and computer audits. Clinician satisfaction surveys measured satisfaction with test TAT and test accuracy. RESULTS: Blood glucose, urine human chorionic gonadotropin, urine dipstick, creatine kinase-MB, and troponin tests were performed in the ED POCT laboratory. Test TAT declined an average of 87% after the institution of POCT. The ED LOS decreased for patients who received pregnancy testing, urine dipstick, and cardiac markers. Although these differences were not significant for individual tests, when the tests were combined, the decreased LOS was, on average, 41.3 minutes (P =.006). Clinician satisfaction surveys documented equivalent satisfaction with test accuracy between the central laboratory and the POCT laboratory. These surveys also documented dissatisfaction with central laboratory TAT and increased satisfaction with TAT of the POCT program (P <.001). CONCLUSIONS: The POCT satellite laboratory decreased test TAT and decreased ED LOS. There was excellent satisfaction with test accuracy and TAT.

Academic Medical Centers↗
PubMed1991

Limiting resuscitation: emerging policy in the emergency medical system.

Patients, families, and physicians frequently decide that a hospitalized patient will forgo cardiopulmonary resuscitation and document this decision with a do-not-resuscitate (DNR) order. In community settings (home, nursing home, hospice), these orders may conflict with paramedics' standing orders to provide cardiopulmonary resuscitation whenever it is medically indicated. We did a nationwide telephone survey of state offices for coordination of emergency medical services (EMS) to see how the states deal with this potential conflict. We identified eight states that have specific policies enabling EMS personnel to accept DNR orders for patients being transported by ambulance. State officials identified administrative complexities and legal concerns as the primary barriers to enacting prehospitalization DNR policies. We also identified 21 local EMS systems that have developed policies for accepting orders to withhold life-sustaining treatment. Four types of policy models, characterized according to procedure for validating DNR orders and telephone accessing the EMS system, show that regulatory reform can address policy barriers in the absence of enabling legislation.

Attitude of Health Personnel↗
PubMed2000

Emergency medicine versus primary care: a case study of three prevalent, costly, and non-emergent diagnoses at a community teaching hospital.

The high cost of emergency department (ED) care is often viewed as an area for achieving cost savings through reduced utilization for inappropriate conditions. The implementation of outpatient prospective payment for Medicare ED patients heightens scrutiny of costs and utilization in the ED versus primary care settings. Data from hospital clinical records, financial records, and a provider survey was used to develop a costing methodology and complete a comparative analysis of the cost of care for three diagnoses by setting. Total costs were significantly higher in the ED due primarily to differences in ancillary tests and prescription drugs ordered.

Accounting↗
PubMed1975

Multiple expanded roles for nurses in urban emergency rooms. 'Emergency room nurse-practitioner'.

The increasing number of patients seeking general medical care in the emergency rooms of urban teaching hospitals creates substantial volume loads, especially in triage and in delivery of primary care. Interns perform these tasks unethusiastically and inefficiently, session physicians indifferently. Selected experienced nurses, after brief but intensive and targeted training, can successfully assume these full responsibilities with a high degree of job satisfaction.

Emergency Service, Hospital↗
PubMed2001

[Emergency diagnosis and emergency care in trauma resuscitation].

Adequate primary and preclinical evaluation of thoracic trauma is the basic for effective therapy. The first intention must be to understand the mechanism of trauma and injury. Severe thoracic trauma is predominantly the result of high energy trauma and mostly combined to multiple injuries (polytrauma). The intention of emergency care medicine is to reduce the number of lethal complications due to trauma. Early intubation and ventilation in preclinical management is accepted as a gold standard. Nevertheless, there is a high percentage of nonintubated and undertreated polytraumatised patients that reach the clinic. To investigate the reason for and problems of undertreatment we have to initiate basic research in accident and polytrauma research.

Adult↗
PubMed2002

[Emergency surgery in Africa (does tropical emergency exist?)].

Most patients admitted to African surgical departments require emergency procedures. Etiologies involve a wide variety of diseases that are only rarely tropical. However the poor general status of patients and underdeveloped sanitary conditions can alter symptomatic presentation and require modified surgical techniques. The adverse conditions under which in the southern hemisphere is now performed will not change without improvement in general living standards and health-care infrastructure of the countries involved.

Africa↗
PubMed2003

The emerging roles of BNP and accelerated cardiac protocols in emergency laboratory medicine.

BACKGROUND: The role of the clinical laboratory in emergency cardiac medicine is rapidly evolving; with recent redefinitions of acute myocardial infarction (AMI) and unstable angina (UA) based on troponin levels, recommended acceleration of cardiac testing protocols, and increased clinical measurement of B-type natriuretic peptide (BNP). We briefly review the background pathophysiology of acute coronary syndromes (ACS) and congestive heart failure (CHF), along with an overview of the biochemistry and physiology of the natriuretic peptides. METHODS: The assay principles and performance characteristics of the rapid BNP assays are discussed. The performance characteristics of troponin assays are at the center of controversy regarding the redefinition of AMI and UA, and will be discussed. RESULTS: We review the rapidly expanding evidence regarding the clinical utility of BNP for CHF patients. While BNP has gained wide acceptance as a rapid diagnostic tool, considerable controversy remains concerning its potential for prognosis, screening, and therapeutic monitoring. Although a thorough discussion of the use of cardiac markers is well beyond the scope of this review, overviews of the redefinitions of AMI and UA, and the trend toward accelerated testing protocols to obtain a quicker diagnosis or ruling-out of AMI are included. In addition to accelerating the retesting of existing markers, a recent test for ischemia modified albumin (IMA) promises another quantum leap in cardiac diagnoses. CONCLUSIONS: The positive impact of these developments on the healthcare costs and overall improvement in the quality of healthcare delivery will be discussed. A brief analysis of the downstream costs of BNP testing is also offered.

Atrial Natriuretic Factor↗
PubMed2004

[Laboratory medicine in the field of emergency medicine and disaster medicine--Old-And-New tools of emergency medical service].

We reviewed the characteristics of the field of laboratory medicine concerning emergency medicine and disaster medicine. Gram's stain was apt to be made light of by clinicians, but it has been reviewed again. A modern sophisticated analysis system is expected for the consequence management of NBC terrorism and mass poisoning, but we would like to emphasize the importance of the basic physical strength of laboratory medicine, such as Gram's stain, to the meaning of old-and-new technology.

Clinical Laboratory Techniques↗
PubMed1992

[The activities of a pediatric emergency department. The emergency problems].

The authors reviewed records of admission at the Fist Ais-Emergency Service of "G. Gaslini" Children's Hospital, data referring both to in and outpatients. First of all we took into account epidemiological data analysing occurrence and types of diseases; at the same time a demographic study, which aimed to show a decrease in the child population in Genova, was performed. Secondly we compared these data with the real number of admitted patients: collected data showed that this service has been used excessively.

Age Factors↗