Annals of emergency medicine
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To determine whether omitting neuroimaging in the primary assessment of patients with minor head injuries in the emergency department is safe. ⋯ We found it safe to exclude neuroimaging in the primary assessment of patients with minor head injuries in the ED, and to rely instead on clinical criteria.
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Comparative Study
Evaluation of SaO2 as a predictor of outcome in 280 children presenting with acute asthma.
To evaluate the initial measurement of arterial oxygen saturation (SaO2) as a predictor of outcome in acute childhood asthma compared with other factors of past and present asthma history. ⋯ We have shown that in acute childhood asthma, the initial level of SaO2 reflects severity as it predicts the likelihood of poor outcome. This predictive quality of SaO2 is independent of current or past clinical factors.
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To delineate the diagnoses of children who required emergency intubation, to ascertain which medications were used, and to describe the complications of intubation and their association with the choice of medications. DESIGN, SETTING, AND TYPE OF PARTICIPANTS: Three-year retrospective study of 60 intubations of critically ill pediatric patients by pediatric emergency physicians in the emergency department setting. ⋯ Rapid-sequence protocols with paralysis facilitate intubations in the complex pediatric patient in the ED setting.
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Previous studies, conducted mainly in ICUs, have shown low compliance with hand-washing recommendations, with failure rates approaching 60%. Hand washing in the emergency department has not been studied. We examined the frequency and duration of hand washing in one ED and the effects of three variables: level of training, type of patient contact (clean, dirty, or gloved), and years of staff clinical experience. ⋯ Compliance with hand washing recommendations was low in this ED. Nurses washed their hands significantly more often than either staff physicians or resident physicians, but the average hand-washing duration was less than recommended for all groups. Poor compliance in the ED may be due to the large number of patient contacts, simultaneous management of multiple patients, high illness acuity, and severe time constraints. Strategies for improving compliance with this fundamental method of infection control need to be explored because simple educational interventions have been unsuccessful in other health care settings.
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Spontaneous cervical epidural hematoma is a rare cause of neck pain. We present the case of a 64-year-old woman who presented to the emergency department with neck pain from a partial Brown-Sequard syndrome secondary to spontaneous cervical epidural hematoma. The prompt recognition of this entity resulted in a favorable outcome.