The American journal of emergency medicine
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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.
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The objective of this retrospective study was to identify factors affecting the accuracy of pulse oximetry in the ED. Over a 3-year period, 664 consecutive emergency department (ED) patients had simultaneous arterial blood gas (ABG) and pulse oximeter readings taken. Pulse oximeter saturations (SpO2) were compared with ABG CO-oximeter saturations (SaO2) for accuracy. ⋯ If COHb is > or =2%, sensitivity is 0.74 and specificity is 0.84. For patients likely to have a COHb < 2, pulse oximetry is an effective screening tool for detecting hypoxia. However, more caution must be exercised when using pulse oximetry in patients likely to have a COHb > or = 2%.
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The study objective was to determine the impact on quality of care, resource use, and outcomes by developing an emergency department (ED)-based asthma-specific care plan. The design was a time based, prospective cohort and set at an urban university/trauma center, EM residency site, combined adult/pediatric department. Best practice was defined prospectively for ED asthma patients, leading to an asthma care plan (ACP). ⋯ ACP+ group had more timely beta agonist treatment (93% versus 74%, P < .01), shorter LOS (3.29 +/- 1.90 vs. 3.53 +/- 1.86 hrs, P < 0.5) more appropriate steroid dosages (67% versus 41%, P < .01), and fewer tests (41% versus 59%, P < .05). No improvements were noted in admission or relapse rates. In conclusion, care plans can improve quality of care and decrease LOS, but may have limited impact on outcomes of admission/discharge or relapse rates.