J Emerg Med
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A case of altered mental status secondary to pneumocephalus as a complication of sinus surgery is presented. The pathophysiology, clinical presentation, diagnosis, and management of pneumocephalus are discussed.
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Application of Continuous Quality Improvement techniques can identify (a) major causes of delay in evaluation and treatment of ambulatory patients in an Emergency Department (ED) and (b) rational solutions to reduce those delays. To confirm this hypothesis, a prospective interventional study was conducted at a tertiary care teaching hospital with 50,000 emergency visits per year. Participants included all patients discharged from the ED in three separate time periods. ⋯ After the intervention, this was reduced to 73 +/- 46 and 67 +/- 31 min in the same two 48-hour samples. Chart generation times were significantly reduced from a mean of 21 +/- 18 min to 8 +/- 6 min. We conclude that the formal application of Continuous Quality Improvement techniques in the Emergency Department can result in appropriate changes in the process of patient flow, leading to measurable and significant reductions in length of stay for Fast-Track patients.
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Emergency departments (ED) are frequently utilized by patients with minor complaints. It has been a long-standing assumption in the medical community that this use was based on the inability of certain subgroups of the population to access primary care providers secondary to inability to pay. ⋯ Our findings suggest that ED utilization for minor complaints is not, as previously believed, higher in patients with the inability to pay primary care providers. Rather, subsidized patients (Medicare/Medicaid) appear to use the ED equally for major and minor complaints, while there is an increased utilization by commercially insured patients for minor illnesses and injuries, and a lower rate in patients who are self-pay.
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This is the 35th article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Vascular and urological complaints are common problems in the emergency department and often lead to consultation with a surgeon. Because an understanding of the principles of surgical diagnosis and treatment is an essential component of the practice of emergency medicine, emergency medicine residents rotating on surgical services require specific goals and objectives to emphasize early patient assessment, identification of the possible need for surgery, and a basic understanding of definitive management. Unique aspects of pediatric surgery are also addressed in this segment.