The American journal of emergency medicine
-
New methods of deciding which patients require trauma center transport continue to be devised. Baxt recently published a Trauma Triage Rule (TTR) using anatomic injury, blood pressure, and elements of the Glascow Coma scale which can be used to identify adult major trauma patients. The purpose of this study was to compare the TTR against three previously published trauma triage instruments; the Triage-Revised Trauma Score, the Prehospital Index, and the CRAMS scale. ⋯ All four instruments identified adult trauma patients who either died or required emergent operations with sensitivities of at least .85. The specificity of the TTR exceeded that of the CRAMS. We conclude that the TTR is an effective means of identifying patients who either die or require emergent operation.
-
Trauma nurse specialists (TNS) have been shown to reduce the burden on house staff and to facilitate patient care on trauma wards. In the authors' facility, this expertise has been extended to the emergency department where TNS contribute to an improved standard of care by (1) nursing assessment and injury recognition and (2) continuity of care. As specially trained individuals, TNS expand upon the role of the emergency department staff nurse. The TNS could be shown to improve compliance with trauma resuscitation room protocol and quality assurance markers of direct patient management at a statistically significant level.
-
The study was conducted to evaluate the usefulness of an esophageal detector device (EDD) to correctly differentiate between esophageal and tracheal intubation. The study was conducted in the emergency department using 10 recently decreased cadavers (nine males, one female, age range 50-72 years). An 8-mm internal diameter endotracheal tube was placed orally into the trachea, and a second 8-mm ID tube was placed orally into the esophagus. ⋯ There were a total of 45 trials performed on the cadavers (median, four evaluations/cadaver, range, one-eight). For the tracheal tube, the EDD inflated immediately in all cases; it was thus 100% correct in identification of tracheal intubation. For the esophageal tube, the EDD did not inflate in 44 cases, and in one case it filled with vomitus; it thus correctly identified esophageal intubation in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Distinguishing patients with uncomplicated ethanol intoxication from intoxicated patients with other causes of mental status depression is a common clinical dilemma. The authors serially tested mental status in a group of ethanol-intoxicated patients to determine the interval over which mental status changes could be attributed to uncomplicated intoxication. Study patients were identified by (1) admission breath ethanol greater than or equal to 100 mg/dL; (2) ethanol-related impairment necessitating further observation or treatment; and (3) not critically ill or exhibiting focal neurologic signs. ⋯ The remaining 71 with uncomplicated ethanol intoxication required (mean +/- SD) 3.2 +/- 3.6 hours to normalize mental status scores. A large proportion, however, took considerably longer to normalize mental status: 15 (21%) took 7 or more hours, and three (4%) took as long as 11 hours. Although patients with ethanol-associated depression of mental status lasting 3 hours after emergency department admission should be carefully evaluated for other causes of mental status abnormalities, the authors' observations indicate considerable individual variation in the duration of mental status depression caused by uncomplicated ethanol intoxication.