The American journal of emergency medicine
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Medical care for the sick and injured on a variety of sea-faring vessels throughout the world represents a challenging area of medical care. The scope is extremely broad and unique in terms of the problems encountered at sea, logistical difficulties in assessment and treatment of patients, as well as the provision of definitive care. The problems of sparse resources availability, great distances, isolation, communications, accessibility, and weather are also very real. ⋯ In 1980, the accident and emergency department at Singapore General Hospital took over this responsibility. This report analyzes 2,320 calls received over a period of 21 years (January 1980 to December 2000). It highlights the common consultations, modes of communications, treatment and management prescribed, training requirements, as well as the challenges for the future.
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Multicenter Study
Reliability and validity of a visual analog scale for acute abdominal pain in the ED.
The objective of the study was to assess the validity and reliability of the visual analog scale (VAS) in the measurement of acute abdominal pain, and to identify the minimum clinically significant difference in VAS scores among patients with acute abdominal pain. The study was undertaken in preparation for a randomized clinical trial of opioid use in acute abdominal pain. A prospective, observational cohort study of a convenience sample of patients presenting to 2 urban EDs with the chief complaint of acute abdominal pain was conducted. ⋯ VAS measures of acute abdominal pain are valid and reliable. The 95% CI surrounding the minimum clinically significant difference of approximately 16 mm overlaps with the 95% CI of minimum clinically significant difference of approximately 13 mm reported previously in traumatic and other types of acute pain. We conclude that the VAS is a methodologically sound instrument for quantitative assessment of acute abdominal pain and for detecting clinically important changes in such pain.
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Clinical Trial Controlled Clinical Trial
The effects of a physician-nurse patient care team on patient satisfaction in an academic ED.
The objectives were to investigate the effects of a RN/MD patient care team operational change on ED patient satisfaction. In period 1, RNs had standard room assignments and MDs evaluated patients based upon physician availability and perceived patient load. In period 2, RNs and MDs were organized into 2 patient care "teams" and patients were assigned to teams on an alternating basis. ⋯ Satisfaction with waiting time to see the physician also improved from the 25th to the 62nd percentile (67.6 +/- 32.2% v 73.4 +/- 28.5%, P
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Case Reports
Dissection of the proximal thoracic aorta: a new ultrasonographic sign in the subxiphoid view.
Dissection of the thoracic aorta is a life-threatening event that presents with some regularity to emergency departments (EDs). Despite often nonspecific symptoms, it is critical to catch this disease process early, especially when the proximal aorta is involved because dissections involving the aortic root can lead to myocardial infarction and failure of the aortic valve resulting in death. ⋯ Although not as accurate as transesophageal echocardiography, transthoracic echocardiography (TTE) can be used to detect aortic dissection as well. We present a previously undescribed echocardiographic finding associated with proximal dissection of the thoracic aorta in 7 cases.