Annals of emergency medicine
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Practice Guideline Guideline
Trauma care systems quality improvement guidelines. American College of Emergency Physician.
While facility QI has been an important tool in the improvement of the care of the trauma patient, it is essential that system QI also be pursued within each trauma care system. These suggested system QI indicators will provide system medical directors and managers with a valuable tool to facilitate the implementation or improvement of the system QI program. Such a program will allow systems to review their overall function, including management, prehospital, and rehabilitative phases. Through this methodology, both individual providers and the overall trauma system can identify deficiencies and institute appropriate modifications to optimize care of the trauma patient.
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Prehospital medications for congestive heart failure should affect hospital outcomes (survival and length of stay). ⋯ Prehospital medications improve survival in congestive heart failure, especially in critical patients. More than one combination of medications seems effective, and early treatment is associated with improved survival. However, these medications appear to increase mortality in patients misdiagnosed in the field. Factors used in paramedica and medical command assessments require further study.
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To describe the Orange County trauma system's nine-year (July 1980 through June 1989) experience with patient triage. Changes in patterns were sought after the 1983 revisions in triage criteria. ⋯ The growth rate for the total trauma population exceeds that for overall county population growth. These results suggest overtriage. No changes in trends were found after the 1983 revisions in triage criteria. Changes in trends were found in 1986 after the revisions in the Injury Severity Score scoring system.
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Induction of paralysis before intubation is controversial in the aeromedical setting. We reviewed our experience using neuromuscular blockade with nurse/paramedic aeromedical teams to determine effectiveness and outcome. ⋯ Neuromuscular blockade can be used safely and effectively in the field by experienced nurse/paramedic teams. Although problematic intubation was not eliminated, the difficulties encountered were manageable and the overall risk/benefit ratio was acceptable.
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The American College of Surgeons teaches that "trauma occurring above the clavicle should raise a high suspicion for a potential cervical spine injury." In this study, we investigated the association of head, facial, and clavicular trauma with cervical-spine and cord injury. ⋯ Trauma to the head, face, and clavicle is not associated with a higher incidence of cervical-spine or cord injury. Physiologic parameters such as the GCS appear to be more accurate predictors of cervical spine or cord injury than mere evidence of trauma occurring above the clavicle.