European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
The aim of this study was to describe the possibility of influencing components of hospital delay time within the emergency department (ED) among patients with ST-elevation on the initial electrocardiogram (ECG). Nurses recorded seven patient time points: (1) ED admission; (2) ECG recording; (3) decision by nurse/ED physician; (4) cardiologist ED arrival; (5) decision of coronary care unit (CCU) admission; (6) ED departure; (7) CCU arrival. After special training in ECG, nurses in the ED were subsequently delegated to send patients directly to the CCU if showing ST-elevation on the admission ECG without contacting either the physician in ED or the cardiologist on call (intervention). ⋯ Among patients receiving thrombolysis, the median delay time from hospital admission to CCU admission was reduced from 40 minutes during the 9 months prior to start of the intervention (nurses sending patients directly to the CCU) to 22 minutes during the 6 months thereafter (p = 0.02). The largest proportion of hospital delay components for acute coronary syndrome patients occurred between the cardiologist's decision to admit to the CCU and departure from the ED, and the interval following the decision by the nurse or physician to the cardiologist ED arrival. When nurses were delegated to transfer patients with ST-elevation on admission directly to the CCU without contacting a physician, the delay time from ED admission to CCU admission was reduced by nearly 50%.
-
To determine the rate of inappropriate use of the ambulance service a prospective study of patients brought to a Dublin accident and emergency (A&E) department by ambulance was performed over a 78-day period--358 cases were analysed representing 37% of the ambulance case load. The receiving A&E physician deemed 43.3% of cases to have a definite indication for calling an ambulance, 36.9% a relative indication and 19.8% to have no indication. A strong correlation was shown between a definite indication for transport by ambulance and admission to hospital. ⋯ When a general practitioner requests the ambulance only 7.4% of cases had no indication for the action. Approximately one-third (31%) of 999 calls were made because the patient had no transport alternative. The problem of ambulance misuse is multifactorial and a variety of strategies are required to address the issue.
-
The diagnosis of elder abuse and neglect is difficult to accomplish, making intervention elusive, primarily because to date there is no set definition of either abuse or neglect. This paper, written primarily from the American viewpoint, addresses definitions; assessment and diagnosis; aetiology of abuse; intervention; prevention and management; ethical and legal considerations; elder abuse and the emergency physician; and future goals.
-
Comparative Study Clinical Trial
Non-invasive continuous positive airway pressure in acute hypoxaemic respiratory failure--experience of an emergency department.
Non-invasive continuous positive airway pressure (CPAP) seems to decrease the need for intubation in patients with severe cardiogenic pulmonary oedema (CPO) in the intensive care unit. The goals of our study were to delineate indications for CPAP in the emergency department, and to confirm its usefulness in such a setting. We retrospectively assess the evolution of all patients ventilated under CPAP for an acute hypoxaemic respiratory failure over a 1-year period (n = 64 patients). ⋯ No side effects were reported. In conclusion, CPAP is a useful and easy-to-use ventilatory device in the emergency department. It is now one of our first line treatments during prehospital and emergency care of patients with CPO.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Flumazenil for hepatic coma in patients with liver cirrhosis: an Italian multicentre double-blind, placebo-controlled, crossover study.
Several factors suggest that endogenous benzodiazepines and gamma-amino-butyric acid may be involved in pathophysiology of hepatic encephalopathy (HE). Contrasting opinions exist on the therapeutic efficacy of flumazenil in the treatment of HE. This study was planned to assess the efficacy of flumazenil by a double-blind, placebo-controlled, crossover design in a large and selected population of cirrhotic patients in stage 4a HE admitted to intensive care units over a 4-year period. ⋯ The presence of benzodiazepines was detected in the serum of three responders and in two non-responders. The presence of diazepam and NN-desmethyl diazepam was documented in two responders; prior intake of synthetic diazepam was later confirmed in these patients. The results of our study suggest that flumazenil is beneficial only in a selected subset of cirrhotic patients with severe HE; the applicability of this treatment to unselected patients with hepatic coma or to cirrhotic patients with less severe HE still remains to be determined.