The American journal of emergency medicine
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Alteration of mental status secondary to medical illness may occasionally be incorrectly attributed to a psychiatric problem. The cases of 64 patients with unrecognized medical emergencies inappropriately admitted to psychiatric units from emergency departments were reviewed to determine the cause of the misdiagnoses. ⋯ Other common causes of misdiagnosis included inadequate physical examination (43.8%), failure to obtain indicated laboratory studies (34.4%), and failure to obtain available history (34.4%). A systematic approach is required for patients with altered mental status, including those with psychiatric presentations.
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The objective was to compare the accuracy of abdominal sonography performed by emergency physicians in the diagnosis of acute appendicitis with that of the surgeons' clinical impression. Three hundred-seventeen patients with right lower abdominal pain admitted to the Department of Emergency Medicine at National Taiwan University Hospital in Taipei, Taiwan were prospectively included in this study. Patients were divided into two groups according to the time of day they visited the emergency department. ⋯ The definitive diagnosis of acute appendicitis was confirmed by the pathological reports. In the diagnosis of acute appendicitis, group I had a sensitivity of 96.4%, a specificity of 67.6%, a positive predictive value of 89.8%, a negative predictive value of 86.2%, and an accuracy of 89.1%, and group II had a sensitivity of 86.2%, a specificity of 37.0%, a positive predictive value of 74.6%, a negative predictive value of 55.6%, and an accuracy of 70.6%. The overall accuracy of sonography performed by emergency physicians in the diagnosis of acute appendicitis was superior to that of the surgeons' clinical impression.
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Previous studies have reported inadequate pain control in the emergency department (ED). The primary purpose of this study was to determine the proportion of ED patients with acute fractures who actually wanted pain medication given in the ED. A convenience sample of 107 adults with acute long-bone fractures seen in a community hospital ED were surveyed on the pain level they had on ED presentation, the pain level desired at ED discharge, and their preferences for administration of analgesia in the ED. ⋯ Sixty-nine percent were comfortable with a nurse administering pain medication before physician evaluation. Seventy percent wanted pain control without being sedated and 25% wanted complete pain relief even if sedation was necessary to achieve it. Sixty percent were either slightly concerned or not concerned about potential medication side effects.
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We investigated predictors of patient satisfaction in a large, municipal emergency department (ED). Patients were telephoned 10 days postvisit, and satisfaction was assessed using a structured survey with 22 items measuring several domains, as well as the estimated length of stay. The dependent variables consisted of ratings of overall satisfaction and likelihood of recommending the ED to others. ⋯ Likelihood to recommend was associated with (P < .05): degree to which staff cared for the patient as a person, understandability of discharge instructions, perceptions of safety, age, and insurance status. Patients' perceptions of care, rather than demographics and visit characteristics, most consistently predicted satisfaction. However, differences were observed between the specific predictors for overall satisfaction and likelihood to recommend, providing a possible explanation for inconsistencies observed in the literature.
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The purpose of this study was to examine the emergency department (ED) management of hypothermic cardiac arrest and its outcome. The medical records of all patients with hypothermic cardiac arrest treated in the ED from January 1, 1988 to January 31, 1999 were retrospectively reviewed. Data collected included initial body temperature, serum potassium, methods of rewarming, return of perfusing rhythm, and morbidity and mortality. ⋯ In two of these patients a perfusing rhythm had been established after thoracotomy in the ED and before transport to the operating room for cardiac bypass. Only one of seven (14.3%) patients who arrested prehospital survived versus four of four (100%) who arrested in the ED. ED thoracotomy with internal cardiac massage and mediastinal irrigation rewarming is effective in the management of hypothermic cardiac arrest.