The American journal of emergency medicine
-
Trauma nurse specialists (TNS) have been shown to reduce the burden on house staff and to facilitate patient care on trauma wards. In the authors' facility, this expertise has been extended to the emergency department where TNS contribute to an improved standard of care by (1) nursing assessment and injury recognition and (2) continuity of care. As specially trained individuals, TNS expand upon the role of the emergency department staff nurse. The TNS could be shown to improve compliance with trauma resuscitation room protocol and quality assurance markers of direct patient management at a statistically significant level.
-
The study was conducted to evaluate the usefulness of an esophageal detector device (EDD) to correctly differentiate between esophageal and tracheal intubation. The study was conducted in the emergency department using 10 recently decreased cadavers (nine males, one female, age range 50-72 years). An 8-mm internal diameter endotracheal tube was placed orally into the trachea, and a second 8-mm ID tube was placed orally into the esophagus. ⋯ There were a total of 45 trials performed on the cadavers (median, four evaluations/cadaver, range, one-eight). For the tracheal tube, the EDD inflated immediately in all cases; it was thus 100% correct in identification of tracheal intubation. For the esophageal tube, the EDD did not inflate in 44 cases, and in one case it filled with vomitus; it thus correctly identified esophageal intubation in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Distinguishing patients with uncomplicated ethanol intoxication from intoxicated patients with other causes of mental status depression is a common clinical dilemma. The authors serially tested mental status in a group of ethanol-intoxicated patients to determine the interval over which mental status changes could be attributed to uncomplicated intoxication. Study patients were identified by (1) admission breath ethanol greater than or equal to 100 mg/dL; (2) ethanol-related impairment necessitating further observation or treatment; and (3) not critically ill or exhibiting focal neurologic signs. ⋯ The remaining 71 with uncomplicated ethanol intoxication required (mean +/- SD) 3.2 +/- 3.6 hours to normalize mental status scores. A large proportion, however, took considerably longer to normalize mental status: 15 (21%) took 7 or more hours, and three (4%) took as long as 11 hours. Although patients with ethanol-associated depression of mental status lasting 3 hours after emergency department admission should be carefully evaluated for other causes of mental status abnormalities, the authors' observations indicate considerable individual variation in the duration of mental status depression caused by uncomplicated ethanol intoxication.
-
Because of severe emergency department (ED) overcrowding, the authors initiated a program of referring certain patients who were assessed as not needing emergency care away from the ED. A selected group of patients who presented to a busy university ED were refused treatment and triaged away following a medical screening examination performed by a nurse. In this 3-year study 136,794 patients presented to the triage area in the ED, of which 21,069 (15%) were refused care and referred elsewhere. ⋯ Responses from this survey indicated that 42% of persons received care elsewhere the same day, 37% within 2 days, and 22% decided not to seek medical care. A group of 1.6% sought care at other hospital EDs for minor complaints. The authors concluded that a group of patients can be selectively triaged out of the ED without significant adverse outcomes, which may offer one approach to the problem of ED overcrowding.
-
The purpose of this study was to determine the effectiveness of a protocol for the outpatient management of laryngotracheitis (croup) using racemic epinephrine and steroids. The authors retrospectively reviewed fifty consecutive charts of children with croup who were treated under this protocol in the Scottish Rite Children's Medical Center Emergency Department (Atlanta, GA) and discharged to home after 2 hours of observation. Forty-seven of the 50 children had stridor at rest and/or retracting at rest on presentation to the emergency department. ⋯ One patient required another emergency visit and additional treatment with racemic epinephrine. Two patients were lost to follow-up. This study suggests that selected children presenting with croup and significant distress may be effectively treated with racemic epinephrine and steroids, observed for at least 2 hours, and safely discharged home.