Annals of emergency medicine
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A device designed to augment venous filling by applying a vacuum to the upper extremity during tourniquet application was evaluated. Ten healthy adult male volunteers with clinical normovolemia were studied for changes in forearm volume and dorsal hand vein turgor during use of an elastic tubing tourniquet, a blood pressure cuff tourniquet, and a vacuum-assisted cuff tourniquet. Use of the device for 30 seconds was not associated with petechia formation and resulted in a significant increase in venous turgor, as measured by an ophthalmologic tonometer, in comparison to the other tourniquet techniques (P less than .005). ⋯ All petechiae resolved in three days. Venous engorgement as reflected by volume displacement was significantly greater for the vacuum device and blood pressure cuff tourniquet combination than other techniques at 30 and 60 seconds of tourniquet application (P less than .005). Brief application of a vacuum to the arm during tourniquet use increases venous turgor and engorgement in normovolemic volunteers.
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A young woman who was seven months pregnant was struck by lightning, resulting in cardiopulmonary arrest. Bystander CPR was begun at the scene. ⋯ The patient was comatose on arrival in the emergency department and fetal death was apparent. The patient's neurological status improved markedly, with a small residual motor deficit.
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We prospectively examined the care provided to 234 elderly patients (age greater than or equal to 65) and an equal number of nonelderly patients visiting the emergency department of an urban teaching hospital. Sociodemographic, treatment, cost, and outcome data were collected through ED record reviews and follow-up telephone interviews. The elderly comprised 19% of the ED population and were often nonwhite (31%), Medicaid recipients (39%), living alone (41%), and multiply and chronically impaired. ⋯ Forty-five percent of old-old patients' visits were for true medical emergencies or urgencies. Compared to the nonelderly, the old-old more often were admitted (47% versus 18%, P = .0001), stayed a longer time in the ED (three hours versus 1.9 hours, P = .0001), and incurred a higher charge ($324 versus $208, P = .0001) Twenty-nine percent of these old-old patients who were not initially admitted returned within 14 days (recidivated). The recidivism rate for nonelderly patients was only half as high (15%) (P = .02).
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Comparative Study
Occupational stress within the paramedic profession: an initial report of stress levels compared to hospital employees.
We report a study of occupational stress in 374 paramedics. Results indicate that this profession experiences a high degree of job-related stress relative to other medical personnel. In a component analysis of this stress the results show that job stress manifests itself as job dissatisfaction, organizational stress, and negative patient attitudes, but not as frequently as somatic distress.
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Emergency medical care at public gatherings is haphazard at best and dangerous at worst. The Arizona chapter of the American College of Emergency Physicians, through the Chapter Grant Program, studied the level of medical care provided at public gatherings in order to develop guidelines for emergency medical care at mass gatherings. The study consisted of a survey of medical care at 15 facilities providing events for the public. ⋯ Based on this survey and a literature review, guidelines for medical care at mass gatherings in Arizona were determined using an objective-oriented approach. It is our position that event organizers have the responsibility of ensuring the availability of emergency medical services for spectators and participants. We recommend that state chapters or National ACEP evaluate the role of emergency medical care at mass gatherings.