Annals of emergency medicine
-
In many institutions it is the "standard of care" to obtain serum chemistries and anticonvulsant levels as part of the emergency department evaluation of seizure patients. To determine the efficacy of such a workup in the ED, 163 seizure patients presenting to an inner-city teaching hospital were studied in a standardized, prospective manner. After the clinical examination all patients had CBC, serum electrolyte, BUN, creatinine, glucose, calcium, magnesium, and if indicated, anticonvulsant drug level determinations performed. ⋯ The clinical examination successfully predicted those abnormalities in all but two cases (one each of hyperglycemia and subdural hematoma). We contend tha routine serum chemistries in patients presenting to the ED are of extremely low yield, and that the clinical examination can predict accurately the need to obtain these studies. CCT scanning is useful in selected patients, and was found to be abnormal in five of 19 (25%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Surveys of current training show that many areas of pediatric emergency medicine are not taught in emergency medicine residencies. Furthermore, published recommendations for minimum pediatric core content in emergency medicine are scant and conflicting. To address this issue we have compiled from a variety of sources a detailed pediatric emergencies curriculum for emergency residency training. This curriculum is complete, and yet may be carried out with currently available resources.
-
Comparative Study
Therapeutic intervention scoring as a measure of performance in a helicopter emergency medical services program.
Helicopter emergency medical services (HEMS), which are both expensive and resource intensive, lack objective measures for system evaluation. We computed the Therapeutic Intervention Scoring System (TISS) score for all patients during six consecutive months of service in a HEMS program to assess the value of this score for measuring the performance of the program. The TISS assigns values ranging from 1 to 4 for 57 medical and surgical interventions to measure the intensity of care during a 24-hour period. ⋯ Thirty-four flights (17%) were thought to be appropriate using the information available at flight time, but not after the diagnostic workup was completed (mean TISS, 10.0). Thirty-six patients (18%) did not appear to require helicopter transport at any time, and had a mean TISS of 9.0. We conclude that TISS is a useful, objective measure of the performance of a HEMS program, and it should be tested in other HEMS programs.
-
In the 1950s, researchers devised the best methods of ventilation. In the 1960s, a method of maintaining circulation and ventilation simultaneously was introduced. In the 1970s, refinements of the understanding of the mechanisms of blood flow during CPR were defined and were accompanied by an aggressive research effort to identify means to improve brain protection during and after cardiac arrest. It is hoped that the fruits of this work will lead to knowledge of better ways to effect resuscitation and will maximize the quality of life in survivors of cardiac arrest.
-
Sudden unexpected death is a traumatic event for surviving family and friends. When the survivors learn of their loss, they react with turmoil and disbelief. ⋯ To provide emergency staff with guidelines, we review the dynamics of grief and discuss intervention in the following six phases: contacting the survivors; arrival of the survivors; notification of death; the grief response; viewing the body; and the concluding process. We conclude with a discussion of intervention with children.