The American journal of emergency medicine
-
A review of the charts of 198 patients who were admitted through the emergency department with a variety of acutely painful medical and surgical conditions revealed that 56% received no analgesic medication while in the emergency department. In the 44% of patients who received pain medication, 69% waited more than 1 hour while 42% waited more than 2 hours before narcotic analgesia was administered. In addition, 32% initially received less than an optimal equianalgesic dose of narcotic when compared with morphine. This study demonstrates that narcotic misues, in the form of oligoanalgesia, is prevalent and is the shared responsibility of both emergency physicians and housestaff consultants.
-
A severe, premature snow storm resulted in widespread loss of power, communications, and transportation in a populous region of the Northeast. Staff in hospital emergency departments centered in the path of the storm reported a large number of injuries and many unexpected health effects related to the storm. A retrospective survey of the five major hospital emergency departments serving the most heavily affected urban and suburban areas was undertaken to determine the emergency health impact of the storm and resulting operational problems. ⋯ Unexpected findings include a large number of carbon monoxide poisonings and disposition and staffing problems created by caring for many patients who lost access to customary home health care services. Emergency department staff are encouraged to engage in public education efforts that may reduce serious illness or injury related to severe weather and its aftermath. Moreover, traditional disaster plans may need to be supplemented in anticipation of the disposition and staffing problems created by a growing population of elderly patients who will be cut off from vital home health care services by severe weather.
-
Demographic data and blood samples were collected from 278 patients seen at two District of Columbia emergency departments, and tetanus antitoxin assays by hemagglutination were performed at the Centers for Disease Control. Twenty-seven patients (10%) had antibody levels below the 0.01 U/mL considered protective. Four demographic characteristics were different in the patients with inadequate immunity (in decreasing order of significance): advanced age, fewer years of education, female sex, and non-US origin. ⋯ Of the 84 patients who reported their immunization histories, five reported no complete series of tetanus shots but had adequate antibody levels, while three reported a complete series but had inadequate levels. Twenty-two patients with inadequate immunity were not offered immunization in the emergency department because they did not have wounds. Patient recall of immunization history is not a reliable guide to tetanus immunization in the emergency department, but patients in certain demographic groups, such as older women, are more likely to have inadequate immunity.
-
A retrospective study was conducted to examine whether emergency physicians can perform accurate ultrasonography that influences the diagnosis and treatment of selected disorders in the emergency department (ED). The physicians acquired a moderate level of expertise in sonography using a series of practical demonstrations and lectures. Patients with symptoms suggestive of cardiac, gynecologic, biliary tract, and abdominal vascular disease periodically underwent ED sonography. ⋯ The accuracy of positive sonographic findings was assessed by confirmatory testing, formal review, or confirmatory clinical course. Emergency physicians were able to diagnose correctly (1) the presence and approximate size of pericardial effusions, (2) the presence or absence of organized cardiac activity in patient with clinical electrical mechanical dissociation, (3) the presence or absence of intrauterine pregnancy in pregnant patients with lower abdominal/pelvic complaints, (4) the position of intrauterine devices in patients with suspected uterine perforation, (5) the presence of gallstones in patients with suspected biliary tract disease, and (6) the presence and size of abdominal aortic aneurysms in patients with pulsatile masses or unexplained abdominal pain. It was concluded that reliable sonography which influences diagnosis and therapy can be performed by emergency physicians and that sonography should become a standard procedure in EDs.