The American journal of emergency medicine
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Little is known about the extent of critical care delivered to patients in the emergency department (ED) and its impact on ED lengths of stay or patient outcomes. The purpose of this study was to characterize the timing of care for critically ill patients, both medical and surgical, in the ED. The design was a retrospective review. ⋯ The timing of these procedures indicates that they are performed when necessary for patient care regardless of ED or ICU setting. Thus, ICU care is often initiated and maintained in the ED setting. EDs must be staffed adequately with appropriately trained personnel to care for these patients.
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Comparative Study
The use of TRISS methodology to validate prehospital intubation by urban EMS providers.
The purpose of this study was to determine the impact of field orotracheal intubation (OI) by urban emergency medical technician-paramedics (EMT-Ps) on outcome compared with trauma score and injury severity score (TRISS) expectations. The records of all trauma patients intubated by EMT-Ps or hospital personnel were abstracted for OI attempts/ successes, use of neuromuscular blockade (NMB), scene time, discharge neurological status, and hospital survival compared with TRISS. EMT-Ps attempted 43% of all intubations; 81% were successful versus 98% by hospital staff (P < .05). ⋯ Sixty percent of patients intubated by EMS versus 68% by hospital staff had good/moderate discharge neurological status. Survival for patients intubated by EMS versus hospital staff was 11% and 40%, respectively, compared with 2% and 45% expected by TRISS. Field OI by urban EMT-Ps has a favorable impact on survival with good neurological outcome (P < .05).
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This study examined whether emergency medical technicians (EMTs) withhold oxygen from hypothetical patients whom emergency physicians would treat with high-flow oxygen, particularly chronic obstructive pulmonary disease (COPD) patients. A survey describing 12 hypothetical patients was distributed to 33 emergency physicians, 30 newly trained EMTs, and 27 experienced EMTs. ⋯ Newly trained EMTs were significantly more likely than physicians to administer high-flow oxygen to patients with COPD who were not receiving home oxygen. Otherwise, the oxygen administration practices of EMTs were not inconsistent with those of emergency physicians.
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Based on the hypothesis that managing pediatric death--particularly, communicating with survivors--is extremely difficult for most emergency physicians, 122 general emergency physicians at a written board review course were surveyed to assess their attitudes toward pediatric death. Sixty-six percent reported that communicating with the family of a child who had died was the most difficult experience in emergency medicine. ⋯ Only 8% of physicians were aware of published guidelines regarding managing pediatric emergency department (ED) deaths, and only 14% of physicians had ever had any training in death notification. Ninety-two percent of physicians responded that a course directed toward managing the family of a child who had died in the ED would be helpful in dealing with this difficult situation.
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Historical Article
Legal history of emergency medicine from medieval common law to the AIDS epidemic.
The early development of legal obligation in emergency medicine is traced through medieval English common law to the first stages of American law after Independence. An identifiable set of legal principles in the nineteenth and early twentieth centuries is described. ⋯ In the modern era, there has been a substantial legal and ethical change to a requirement of extensive duties to operate open-admission emergency services in virtually all acute-care hospitals. The AIDS epidemic is utilized as a case example of expanded legal and ethical duties to offer emergency care in a nondiscriminatory manner to all patients presenting at hospital emergency departments.