The American journal of emergency medicine
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Multicenter Study
Use of physician extenders and fast tracks in United States emergency departments.
To describe current practice regarding the use of physician extenders (PEs) and the "fast track" (FT) concept in United States emergency departments (EDs), a telephone survey of 250 US health care facilities offering emergency services was conducted. Of the EDs surveyed, 21.6% were using PEs at the time of the survey, and of those not using PEs, 23.5% intended to do so within the next 2 years. Those using PEs had been using them for a mean duration of 3.5 years (the mode was 2 years). ⋯ The mean estimated percentage of ED patients going through FT was 30.1%. The mean number of hours per day of FT operation was 13.4 hours on weekdays and 13.7 hours on weekends (the mode was 12 hours/day both on weekdays and weekends). Of hospitals using PEs in the ED, 56.0% had FT; of hospitals without PEs in the ED, 23.5% had FT.
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Acute traumatic aortic injury (ATAI) results in several characteristic chest radiographic findings, most notably mediastinal widening. This study was based on the hypothesis that blood or fluid in the widened mediastinum might track up into the neck and be detected on lateral cervical radiographs. In a blinded, retrospective, case-control review of radiology files, 13 consecutive adult cases of ATAI were identified and compared with 19 cases of negative aortography (NAO) and 18 multiple trauma victims (MT) without aortography. ⋯ Cervical ST measurements at C3 or at C6 did not correlate with mediastinal-chest width ratios. Mediastinal widening, aortopulmonic window opacification, and blurring of the aortic knob were the most sensitive chest radiography findings in ATAI, although each of these lacked useful specificity and accuracy. Cervical ST swelling is not a useful marker for ATAI.
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Occult infections during sickle cell pain crisis can be associated with significant morbidity. It has been suggested that empiric workup for pneumonia and urinary tract infection (UTI) is required. A study was undertaken to determine whether clinical criteria can be used to exclude such infections as precipitants of pain crisis in adults. ⋯ In patients with sickle cell pain crisis, medical history and physical examination can be useful to predict the absence of pneumonia, but may not be as beneficial in predicting the absence of UTI. These results suggest that empiric chest x-ray may be unnecessary to exclude pneumonia; however, routine urinalysis may be indicated. Because of the low incidence of these infections, larger studies are required to confirm these findings.
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This study surveyed the stool appearance descriptions of 107 inpatient children with intussusception. Fifty-six patients presented with grossly bloody stools (passed spontaneously), 10 of which were determined on chart review to resemble currant jelly. Of the 51 patients without grossly bloody spontaneously passed stools, 35 patients had rectal examination results charted. ⋯ Generic terms such as blood, mucus, burgundy, red, etc, are more objective and sensitive at identifying cases of intussusception. Junior physicians who are taught the classic presentation of intussusception with currant jelly stool should also be taught that intussusception should be considered in the differential diagnosis of children passing any type of bloody stool. As a result, physicians with limited experience will be more likely to appropriately consider the diagnosis of intussusception, permitting a more timely diagnosis and a better outcome.
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Review Multicenter Study
Rapid sequence intubation in adults with elevated intracranial pressure: a survey of emergency medicine residency programs.
A questionnaire entitled "Survey of Protocols for Rapid Sequence Intubation in Previously Healthy Adults with Elevated Intracranial Pressure" was distributed to the program directors of all 100 emergency medicine residency programs listed in the Directory of Graduate Medical Education Programs in February 1995. The medical literature on rapid sequence intubation in patients with suspected intracranial pressure elevations was reviewed. The findings of the review were compared with the survey responses. ⋯ Most of these programs follow the guidelines recommended in the medical literature. The majority of these guidelines, however, are based on statistical data performed in the laboratory or nonemergency environments. Further clinical studies in an emergency medicine environment must be performed to determine the optimal drug regimen for rapid sequence intubation in patients with elevated intracranial pressure.