Annals of emergency medicine
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Algorithm-directed triage by nonprofessionals was used to safely assign care urgency categories to 22,934 walk-in patients under 13 years of age during 1978. Of all patients, 16.7% were categorized as having urgent or potentially urgent problems at triage. Of those patients admitted, 79.12% received these urgency classifications. ⋯ A total of 11.16% of all patients received a routine or non-urgent classification. No patients admitted had been triaged to this non-urgent classification. As determined by review of records of 91 patients admitted from the acute care facility, the system safely identifies both high- and low-risk walk-in populations.
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A 64-year-old man presented with a history of four days of lower abdominal pain and 12 hours of cutaneous discoloration, bullae formation, and swelling of the soft tissues of abdominal wall and right thigh. Myonecrosis of abdominal wall and an adenocarcinoma of the cecum were found at operation. Cultures of blood and fluid from the bullae yielded Clostridium septicum. ⋯ Presumptive diagnosis often can be made by Gram stain of the bullous fluid that reveals gram-positive bacilli and a paucity of leukocytes. Favorable outcome depends on prompt institution of appropriate antimicrobial therapy and surgical debridement of involved soft tissues, as well as correction of the underlying disorder. This disease should be considered to be a medical-surgical emergency.
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Prehospital and interhospital emergency care is moving from the ground to the air, with the realization that such a move will further reduce the morbidity and mortality of the critically ill or injured patient. This move is not without inherent risks, for altitude and take-off further compromise the critical patient. To preclude this risk and improve air ambulance services, Indiana is adopting rules and regulations to govern the operation and administration of air ambulance services. Indiana is the first state to adopt air ambulance standards, although other agencies have established or are attempting to establish similar guidelines.
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An outline of a didactic curriculum from the Core Content in Emergency Medicine is presented. The 430 hours of lecture are distributed over three years. Three new categories have been added to the Core Content as previously defined by the Graduate/Undergraduate Education Committee of the American College of Emergency Physicians: drugs of emergency medicine, laboratory/radiology use in emergency medicine, and resident evaluation series. The benefits of this core curriculum are improved organization in educational format, better defined curricular guidelines for developing residencies, and standardized guidelines for individual topic assessment and review.