The American journal of emergency medicine
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Twenty-three chapters of the American Red Cross located in the Northeast participated in this study of achievement in adult cardiopulmonary resuscitation (CPR) classes. Sixty-eight classes offered to the public were studied by a pencil-and-paper survey and a specially developed written test. This study locates student, instructor, and course factors associated with achievement in CPR classes. ⋯ The only instructor factor to predict student achievement was training within the 12 months prior to teaching the studied class. Showing a videotape to the class and distributing workbooks before the class also had a significant positive effect on student achievement. The addition of material by the instructor decreased achievement.
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Bacterial tracheitis is an uncommon cause of acute respiratory distress in children. The authors present a case of bacterial tracheitis in a 6-year-old girl caused by an unusual pathogen, Streptococcus pneumoniae. ⋯ Management of this case involved endotracheal intubation, although a review of the literature suggests that airway management can vary with age and size of the tracheal lumen. The microbiology of bacterial tracheitis shows a predominance of Staphylococcus and Streptococcus reported previously, with only three prior reported cases of Pneumococcus.
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Subungual hematoma is a commonly encountered problem in the emergency department. We designed a prospective, observational study to determine if treatment of simple subungual hematomas (SUH) by nail trephination alone is without cosmetic or infectious complications. Over a 2-year study period, 48 patients met inclusion criteria. ⋯ By patient history, average time for the nail to grow back was 4.0 +/- 2.6 months. No complications of infection, osteomyelitis, or major nail deformities occurred in any patients treated by nail trephination, regardless of SUH size or presence of fracture. In simple SUH, regardless of size, nail removal with suture repair of the nail bed, as suggested in previous studies, is unnecessary.
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This article describes the National Park Service wilderness emergency medical services (EMS) system, as implemented at Sequoia-Kings Canyon National Park. EMS records on all 434 patients in the period from August 1, 1986, to July 31, 1987, were reviewed. Most patients had minor problems. ⋯ Differences between the times and problems with skills maintenance. Differences between the patients treated by a wilderness system and those seen in most urban systems may make it appropriate to release a greater portion of patients without ambulance transport. In a system with long response and transport times, use of personnel with different training than in the urban setting becomes necessary.
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Prompt treatment of the chest pain patient in the emergency department (ED) is crucial. To ensure prompt treatment, identification of factors that delay flow of these patients through the department is essential. To identify factors that delay patient flow through the ED, the authors conducted a prospective study of all chest pain patients, using a time-flow analysis. ⋯ Additional findings confirmed the efficacy and role of the triage nurse in patient flow. Nursing and medical education and staffing needs were addressed. The use of the community's emergency medical services was examined by analyzing the disposition of patients arriving at the ED by ambulance.