Annals of emergency medicine
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Because asthmatics have the highest utilization rate (11%) kin our emergency department (ED) observation unit (OU), we conducted a study correlating predictors of the need for OU therapy to initial disposition (ID) and final disposition (FD) using chart audit of treated asthmatics. Twenty-four clinical variables. (historical, physiological, laboratory, therapy response) were examined utilizing chi-square and Student's t tests. Forty-six asthmatics were treated during a four-month period in 1980. ⋯ Clinical variables correlating significantly with definitive therapy based on ID and FD were historical; symptoms greater than 24 hours, prior OU admissions, and prior hospitalizations. We conclude that the OU is appropriate, safe, and less expensive than admission; is not used for procrastination in decision making and decreases the hospitalization rate. Historical data correlated significantly with both ID and FD, while clinical variables were of little predictive value.
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Patients treated for pneumococcal bacteremia were prospectively evaluated over a 21-month period. Of 2,610 blood cultures obtained, 79 (3%) were positive for Streptococcus pneumoniae. Of these, 37 patients (47%) initially had a focus of infection, and 73 (92%) were reevaluated after the results of the blood culture were known. ⋯ Six demonstrated persistence of the original disease, nine showed no focus of infection, seven developed a focus of infection, and one developed a second focus of infection. No patients with temperatures less than 37.4 C developed significant disease. A regimen for management of patients with pneumococcemia is given.
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Pediatric triage algorithms which were prospectively and retrospectively validated in a pediatric acute care facility serve as the basis for the development of a simplified pediatric triage checklist. This checklist is used by minimally trained nonprofessionals to assign safely the care urgency categories of the chief complaints of pediatric "walk-in" patients. This article describes the background of the pediatric triage checklist and its adaptation to a computerized triage system. This system not only allows for safe triage, but also creates a mechanism for rapid, organized retrieval of data from individual and group patient triage encounters that is useful for the study and planning of health care delivery.
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Ventricular fibrillation was induced in nine dogs weighing 18 to 22 kg. CPR was performed with a mechanical chest compressor. Mean carotid flow during CPR was 7.9 +/- 1.5 ml/min. ⋯ One liver laceration and two gallbladder contusions were noted at autopsy. MAST inflation apparently augments carotid flow an systolic pressure. Variations in intrapleural pressure do not seem to have a significant influence on CPR.