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At least 145 records · Page 8Linked to original sources
PubMed1998

[Psychiatric emergencies from the viewpoint of the emergency physician].

OBJECTIVE: In the German physician-based emergency medical system (EMS) psychiatric emergency situations (PES) rank on third place contradictory to it's importance during emergency physician training program. The aim of our study was to examine the relevance of PES and the stress which PES imposes upon EMS physicians. Further, the interest of training programs on that issue was determined. Knowledge about PES was investigated by a short test. METHODS: 952 emergency physicians were sent a questionnaire about following: demographic data, frequency of PES, strain by PES, own knowledge, interest about training programs. Further five typical PES were presented for diagnostic and therapeutic judgement. RESULTS: 222 responded (183 men/37 women/2 without gender data, average age: 40.1 +/- 6.7, qualification as emergency physician: 9.6 +/- 5.1 years, most frequent subspeciality in-hospital physicians: anaesthesiology 67.5%, in-practice physicians: general medicine 72.1%). PES frequence was estimated at 9.4%, personal knowledge judged only by 13% as sufficient, 14.2 felt incapable by PES. 73% saw importance of training, especially expressed by the more experienced (P < 0.05). Test presented 65% correct diagnoses, 33% correct therapy, 26% incorrect decision of hospital admission. CONCLUSION: PES are a frequent problem of pre-hospital patient care for emergency physicians. As personal knowledge was estimated to be insufficient, the interest for courses concerning PES issues is high.

Adult↗
PubMed2003

The role of the emergency physician in emergency medical services for children.

Emergency physicians have a duty to advance the care of pediatric patients in the emergency medical services (EMS) system. This policy resource and education paper, designed to support the American College of Emergency Physicians policy paper "The Role of the Emergency Physician in Emergency Medical Services for Children," describes the development of the federal EMS for Children Program, the importance of the integration of EMS for children into EMS systems, and the role of the emergency physician in EMS for children.

Child↗
PubMed2002

Office emergencies and emergency kits.

Preparedness to recognize and appropriately manage medical emergencies in the dental environment includes the following: current BLS certification for all office staff; didactic and clinical courses in emergency medicine; periodic office emergency drills; telephone numbers of EMS or other appropriately trained health care providers; emergency drug kit and equipment, and the knowledge to properly use all items. This update on office emergencies and emergency kits replaces the previous Association report, prepared in 1980 by the Council on Dental Therapeutics.

Cardiopulmonary Resuscitation↗
PubMed1994

Prospective randomized trial of emergency portacaval shunt and emergency medical therapy in unselected cirrhotic patients with bleeding varices.

A prospective randomized trial was conducted in unselected, consecutive patients with bleeding esophageal varices resulting from cirrhosis comparing (1) emergency portacaval shunt performed within 8 hr of initial contact (21 patients) with (2) emergency medical therapy (intravenous vasopressin and esophageal balloon tamponade) followed in 9 to 30 days by elective portacaval shunt in survivors (22 patients). All patients underwent the same diagnostic workup within 3 to 6 hr of initial contact, and received identical supportive therapy initially. All patients were followed up for at least 10 yr. The protocol contained no escape or cross-over provisions. There were no statistically significant differences between the two treatment groups in the incidence of any of the clinical variables, results of laboratory tests or degree of portal hypertension. Child's risk classes in the shunt group were A-2 patients, B-8 patients and C-11 patients, whereas in the medical group they were A-10 patients, B-5 patients, and C-7 patients, a significant difference (p < 0.01) that might have favored emergency medical treatment. Bleeding was controlled initially and permanently by emergency shunt in every patient, but by medical therapy in only 45% (p < 0.001). Mean requirement for blood transfusion was 7.1 +/- 2.6 units in the shunt group and 21.4 +/- 2.6 units in the medical group (p < 0.001). Eighty-one percent of the patients in the shunt group were discharged alive compared with 45% in the medical group (p = 0.027). Five- and 10-yr observed survival rates were 67% and 57%, respectively, after emergency shunt compared with 18% and 18%, respectively, after the combination of emergency medical therapy and elective shunt (p < 0.01). These survival rates produced by emergency shunt performed within 8 hr of initial contact confirm the effectiveness of this procedure observed in our previous unrandomized studies.

Adult↗
PubMedDate not supplied

Objectives to direct the training of emergency medicine residents in pediatric emergency medicine.

This article outlines the objectives for a resident rotation on a pediatric emergency medicine service that is geographically separate from adult-oriented facilities. In this setting, pediatric emergency department care is considered an off service. However, these objectives incorporate key pediatric knowledge and techniques in a practical format for emergency medicine trainees who have no separate pediatric emergency department experience. The content of the pediatric emergency department educational exposure can be attained in a concentrated 2-month exposure at a pediatric facility or extracted throughout the course of multiple pediatric encounters at a general emergency department. These objectives are a part of a continuing series on the goals and objectives to direct emergency medicine resident training on off-service rotations.

Curriculum↗
PubMed1990

The role of the emergency physician in providing pediatric emergency care--a membership survey.

A survey of the membership of the American College of Emergency Physicians (ACEP) was undertaken to identify members with special interest or expertise in pediatric emergency medicine. A questionnaire was published in the August 1988 issue of ACEP News, which was distributed to 12,079 members. One hundred seventy-one responses were returned, revealing a subset of the membership (1.42%) with a special interest or expertise in pediatric emergency care. This group was characterized as to type of residency training, board certification (completed or planned), practice location, and percentage of practice composed of children. Opinions were sought regarding subspecialty certification, continuing medical education needs, and quality and quantity of pediatric emergency medical training in pediatric and emergency medicine residency programs. More than 200 physicians were identified as resources in pediatric emergency medicine for ACEP. The majority of the respondents favored subspecialty board certification. Continuing education needs are generally being met, but there is a need for better geographical distribution of courses. Minifellowships and more pediatric rotations for emergency medicine residents were suggested.

Certification↗
PubMed1994

Proposed core content for pediatric emergency medicine fellowship training of emergency medicine graduates.

The establishment of pediatric emergency medicine as a subspecialty of emergency medicine has engendered the need for closer examination and development of guidelines for fellowship training. Core content and curriculum documents pertaining to fellowship training in pediatric emergency medicine for pediatric graduates have been published previously. However, the educational needs of emergency medicine graduates for such training are significantly different from those of pediatric graduates in several important respects. We believe that emergency physicians should take an active role in the creation and refinement of educational guidelines for fellowship training in pediatric emergency medicine for emergency medicine graduates. For this reason, we present a proposed core content outline in the hope that it will serve to foster this process.

Curriculum↗
PubMed2004

[Emergency contraception: user's profile in primary care emergency services].

OBJECTIVES: To establish the emergency contraception (EC) users profile and whether she perceives this type of contraception as an emergency. Design. Cross sectorial study (over one year period: March 2002-March 2003). SETTING: Emergency Services in Primary Care. Usera and Carabanchel; 11th Area; Madrid. PARTICIPANTS: Women requesting EC in these centres. MAIN OUTCOME MEASURES: A questionary was filled out for all participants with their age, how many hours had spent since sexual intercourse took place (within 24 h), usual method of contraception used, previous use of EC, level of education, and reason for this request. RESULTS: 89 women. Drops out: 0. Average age: 23.7+/-48 years (range: 16-40 years). 79.8% of them came to medical emergency services in less than 24 h after sexual intercourse. Usual anticonceptive method was the condom (88.8%), 2.2% used hormones, 9% no contraceptive method at all and none of them had used the intrauterine device. 34.8% were previous users of EC. Education levels: 2.2% of women only could read and write, elementary school (37.1%), secondary school (34.8%) and high school (25.8%). Reasons for requesting EC: 91% condom failure, 7.9% not to have used any contraceptive method, and 1.1% wrong use of natural birth control methods. Among the women who had went to the emergency services within the 24 h of the sexual intercourse the 77.4% of all of them had requested EC previously and the 93% of those had requested EC for the first time (P=.032). Likewise all of them with high school level and who could write and read, the 93.9% with elementary school level, and the 71% with secondary studies went to the emergency services within the 24 h of the non protected sexual intercourse (P=.05). CONCLUSIONS: Most of the women were young, they perceived the unprotected sexual intercourses as an emergency, the condom was the most frequently used anticonceptive method, they requested EC due to condom breakage. In 1/3 of the cases the EC had been requested previously and this group and the young women with secondary studies one were who requested it later.

Adolescent↗
PubMed2003

International report: current state and development of health insurance and emergency medicine in Germany. The influence of health insurance laws on the practice of emergency medicine in a European country.

Germany has a comprehensive health insurance system, with only 0.183% of the population being uninsured. Access to office-based medicine and to hospitals is easy and convenient. Due to enormous financial pressures, Germany is currently decreasing the number of beds in hospitals, introducing the Diagnosis Related Groups (DRG), and restricting accessibility to specialists. In contrast to Anglo-American countries, Germany follows the concept of bringing the physician to the patient in the prehospital setting, with Emergency Medical Services (EMS) physicians responding to all Advanced Life Support (ALS) calls. Despite a mature EMS system with sophisticated medical equipment and technology, both in the prehospital and hospital setting, logistical issues such as a single emergency telephone number or multidisciplinary Emergency Departments have yet to be established. Within the hospital, this "Franco-German model" considers Emergency Medicine a practice model that does not merit specialty status. Spending restrictions in the health care system, with less access to hospital beds and office-based physicians, will increase the demand for hospital-based emergency care when patients experience problems accessing the medical system. Currently, the German hospital system is unprepared to care for greater numbers of emergency patients. This may call for changes in the German health care system as well as the medical education system, with the introduction of hospital-based Emergency Medicine as its own specialty, similar to Anglo-American countries.

Emergency Medicine↗
PubMed1997

Nontraumatic dental emergencies in a pediatric emergency department.

The objectives of this study were to describe nontraumatic dental emergencies among children treated in a pediatric emergency department. The children studied received emergency treatment for a nontraumatic dental problem from December 1992 through November 1993. Among the 1,459 children treated for dental emergencies, 949 had a nontraumatic emergency (65%) and were enrolled in this study. Patients ranged in age from 1 month to 19 years, with a mean age of 6.9 years. Fifty-two percent of patients were male. The teeth were involved in 99% of cases. An abscess was present in 33% of patients; and among these patients, 26% also had a fistula. Pericoronitis was seen in 4% of patients, primary viral stomatitis in 1%, and an eruption hematoma in 0.5%. Caries is the etiology of the problem prompting the emergency department visit in 73% of patients, and baby bottle caries accounted for 18% of all cases of caries. Other etiologies included the late effects of trauma (8%), iatrogenic (7%), idiopathic (3%), and periodontal processes (2%). Tooth extraction was performed in 45% of patients. Findings of this large consecutive series provide a better understanding of this type of visit to the pediatric emergency department.

Adolescent↗
PubMed2006

The Society for Academic Emergency Medicine's 2004-2005 emergency medicine faculty salary and benefit survey.

OBJECTIVES: To report on the sixth survey of the Society for Academic Emergency Medicine (SAEM) of emergency medicine faculty salaries, benefits, work hours, and department demographics for all programs accredited by the Residency Review Committee for Emergency Medicine (RRC-EM). METHODS: Data represent compensation paid for the 2004-2005 academic year. Responses were collected by SAEM, and blinded program and individual faculty data were entered into a customized version of a relational database program with a built-in statistical package. Salary data were sorted by criteria such as program region, faculty title, American Board of Emergency Medicine certification, academic rank, years since completing residency, program size, and whether data were reported to the American Association of Medical Colleges (AAMC). Demographic data were analyzed with regard to numerous criteria including department staffing levels, emergency department (ED) volumes, ED length of stay, department income sources, salary incentive components, research funding, and specific type and value of fringe benefits offered. Data were compared with previous SAEM studies. RESULTS: Sixty-one of 132 (46%) accredited programs responded, yielding data on 1,213 full-time faculty from all four AAMC regions. Mean salaries were reported as follows: all faculty, 189,848 dollars; first-year faculty, 153,855 dollars; programs reporting data to AAMC, 183,605 dollars; programs not reporting data to AAMC, 204,383 dollars; core faculty, 197,259 dollars; and noncore faculty, 164,215 dollars. Mean salaries as reported by AAMC region were as follows: Northeast, 192,864 dollars; South, 182,768 dollars; Midwest, 192,224 dollars; and West, 195,732 dollars. Full-time emergency medicine residency program faculty are reported to be working an average of 1,032 total clinical hours per year. Workweeks average 22 clinical hours per week and 22 nonclinical hours per week, with 5.1 weeks of time off per year. CONCLUSIONS: Reported salaries for full-time emergency medicine residency faculty continue to rise overall but fell for the first time in one region (the Midwest). Academic rank continues to correlate directly with salary. Fellowship training continues to show a negative correlation with salary. Significant regional differences in salaries have been present in all six SAEM surveys.

Emergency Medicine↗
PubMed2006

Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system.

Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue.

Aged↗
PubMed2005

Emergency contraception in emergency departments in Oregon, 2003.

OBJECTIVES: We sought to learn about access to emergency contraception (EC) in Oregon emergency departments, both for women who are rape patients and for women who have had consensual unprotected sexual intercourse ("nonrape patients"). METHODS: We interviewed emergency department staff in 54 of Oregon's 57 licensed emergency departments in February-March 2003 (response rate = 94.7%). RESULTS: Only 61.1% of Oregon emergency departments routinely offered EC to rape patients. Catholic hospitals were as likely as non-Catholic hospitals to routinely offer EC to rape patients. The hospitals most likely to routinely offer EC to rape patients had a written protocol for the care of rape patients that included offering EC (P = .02) and access to staff with specialized sexual assault training (P=.002). For nonrape patients, 46.3% of emergency departments discouraged the prescribing of EC. Catholic hospitals were significantly less likely than non-Catholic hospitals to provide access to EC for nonrape patients (P=.05). CONCLUSIONS: Oregon emergency departments do not routinely offer EC to women who have been raped or to women who have had consensual unprotected sexual intercourse.

Adult↗
PubMedDate not supplied

An emergency pursuit game: a method for teaching emergency decision-making skills.

Continuing education programs are used to enhance nurses' emergency decision-making knowledge and skills. Often, these programs are viewed as necessary but boring. An Emergency Pursuit game was developed to provide a novel, challenging, motivating, and cost-effective teaching/learning method. The game is played by teams of nurses who compete for points by answering questions concerning emergency drugs, cardiac arrhythmias, emergency policies and procedures, and non-arrest medical emergencies. Many benefits are realized from a continuing educational program using the Emergency Pursuit game. Of greatest importance is the improved proficiency and performance by nurses during clinical emergency situations.

Decision Making↗
PubMed2002

Clinical and demographic characteristics of psychiatric inpatients admitted via emergency and non-emergency routes at a university hospital in Pakistan.

OBJECTIVE: To examine the differences in the demographic and clinical characteristics of patients admitted through emergency versus non-emergency routes and see if these two groups of patients were significantly different from each other with respect to criteria mentioned in the title. METHODS: Retrospective data was analysed in all 2576 patient records were reviewed and these patients were divided in two groups with respect to their mode of admission (emergency vs non emergency). These groups were then compared with respect to sex, age, length of stay, discharge status and diagnostic categories. Statistical package for social sciences version 8.0 (SPSS 8.0) was used to analyze the data. SETTING: The study was conducted at the Aga Khan University Hospital, is a private tertiary care hospital with a 13 bed psychiatric facility. RESULTS: When these two groups were compared, significant differences were found, with ER patients having a shorter length of stay and youngest mean age, proportion of females admitted via ER was greater than those in non-ER group. There were significantly more women in each group who were married. The percentage of patients who left against medical advice was greater in the ER group. In both the groups mood disorders including Bipolar disorder and major depressive disorders was the most prevalent category with psychotic disorders to follow. The percentage of patients in both these categories was greater in the non-ER group where as percentage of patients with conversion disorder was higher in the ER group. CONCLUSION: Significant differences were found in the patient characteristics admitted via ER versus Non ER. Shorter length of stay in ER group might indicate an acute episode resolving quickly. Studies need to be done prospectively to determine the difference in the two groups thus ascertaining the level of care needed for each group. Lastly, the high proportion of patients coming through the ER also indicates that there exists a need for primary care involvement in mental health care thus reducing the need for emergency room usage. Clinical and Demographic Characteristics of inpatients admitted via emergency and non-emergency routes at a university hospital in Pakistan.

Adult↗
PubMed1990

[The demand for emergency services at pediatric hospitals: a study of 4,858 cases treated at the emergency department of a pediatric hospital].

Given the rise in hospital emergencies, a detailed study of the demand for emergency pediatric care is a must. We compiled 4,858 medical records elected at random and gathered data about global activity in the emergency department of pediatric hospital. The demand for emergency pediatric care grows faster than the corresponding population. The higher and lower patient influxes were on Sunday and Wednesday respectively. The peak rate of influx was attained at 8 pm, whereas the low happened at 6 am. Pediatric emergencies diminish with age and are less frequent in girls than in boys. Only 15.86% of the patients had been referred by a physician. Fever and accidents were the most frequent reason for consultation. Ear, nose and throat diseases are at the top and double in frequency the bronchopulmonary sickness. Analyses were done in 12% of the cases, radiographs were taken in 23% of the patients and 68.58% of the casualties were taken were care of without any of these means. The visit was finished in a mean of 1.99 hours, a swift performance. Of all the cases studied, 93.4% were discharged and 5.3% were admitted to the same hospital. Our data confirm and complete the one published fragmentarily in the Spanish literature. We emphasize that a primary pediatrician could have spared the emergency department a lot of work. We conclude that accessible continuous care must be offered in order to transcend patchwork in following growth and development through pediatric emergency rooms.

Child↗
PubMed1997

[Emergency medical care--an important factor in prehospital emergency medicine].

When looking at Emergency Medical Service as an example of emergency medicine in BiH, the authors present the following concept: that the management of medical emergencies in the prehospital phase of medical emergencies is the responsibility of EMS. The modern conception of EMS is examined in a comprehensive fashion, exploring the evolution of the discipline from its inception to the present, the conditions necessary for the EMS to function effectively (equipment, education and organisation), and examples are cited from foreign countries demonstrating the best results in the field of emergency medicine. The recommendations for EMS in BiH are made based upon the original conception of emergency service, with significant influence from US and German systems respectively. The article makes the case for EMS to be the only provider of prehospital medical care, and examines possibilities for further improvements in organisational structures, and the conclusions drawn reflect the fact that EMS is the institution capable (and responsible) for health care in prehospital phase of medical emergencies. This is found to be a rational assessment of the countries needs within the context of actual capacities.

Bosnia and Herzegovina↗
PubMed2007

What general emergency nurses want to know about mental health patients presenting to their emergency department.

This paper presents the findings of a qualitative project conducted to investigate the education and training requirements that non-mental health trained emergency nurses need to enable them to effectively care for psychiatric patients presenting to a West Australian emergency department. Non-mental health trained nurses are ill-equipped in their psychiatric knowledge, assessment and communication skills to provide best possible care to the one in ten patients presenting to the emergency department with a complex mental health issue. The area of assessment and management of mental health patients in the emergency department is a complex one and staff are required to assess, triage and manage these patients appropriately. Furthermore, with aggression and violence increasing, emergency department nurses are concerned about their safety in the workplace. Focus groups with emergency nurses and semi-structured interviews with subject matter experts were conducted at one West Australian teaching hospital. The findings of the project demonstrated that these nurses considered that customer focus, workplace aggression and violence, psychiatric theory, mental health assessment and chemical dependence as key learning areas. These findings will form a platform for further education and training for ED staff.

Attitude of Health Personnel↗