The American journal of emergency medicine
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Infection control for health care workers caring for critically injured patients: a national survey.
Prevention of transmission of bloodborne pathogens to health care workers (HCWs) involved in resuscitation of critically injured patients presents special challenges. As a step toward creation of a standard, a telephone survey of the infection control practices in this setting of the 100 busiest EDs in the United States (US) was performed. Departmental staff who were knowledgeable about ED infection prevention protocols were questioned about general policy, barrier protection measures, sharps management, and educational programs directed to HCWs. ⋯ Only 59 EDs (72%) reported that sharp containers were always within arm's reach of HCWs with material to discard. Specially adapted equipment included self-sheathing intravenous catheters (21, 26%) and needle/syringe combinations (16, 20%). Considerable variation exists in infection control practices in busy US EDs during resuscitation of critically injured patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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The authors' observation of an apparent increased incidence of patients presenting with spontaneous subarachnoid hemorrhage (SAH) during stormy weather prompted them to retrospectively review admissions data during an 18-month period to look for an association between SAH and changes in barometric pressure (BMP). Of the 39,049 cases examined, 76 had confirmed SAH. Continuous graphs of BMP were used to categorize days as being "flat" days (change in BMP < or = 0.15; dpHg) or "change" days (change in BMP > 0.15; dpHg). ⋯ The correlation of SAH with change in BMP did not hold if these summer months were examined alone. The risk ratio of having an SAH on an inclement day during the winter months was 1.99 (95% confidence interval, 1.11 to 3.60). The reason for this association is not clear at this time.
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Train accidents involving motor vehicles and pedestrians can be devastating. Approximately 1,234 fatalities were recorded in the United States in 1989. The literature from the United States is sparse, prompting a 7-year review of 23 consecutive train accident victims. ⋯ Three (14%) patients died. Although alcohol use occurred in 16 (70%), there was no significance between alcohol use and amputation. Thus, non-railroad employed pedestrians, because of a lack of protection, are more prone to traumatic amputations, primarily of the lower extremities, than those involved in motor vehicle accidents.