J Emerg Med
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Comparative Study
Base deficit level indicating major injury is increased with ethanol.
Analyses were performed to determine whether ethanol increases base deficit, independent of major injury, in blunt trauma patients from two Level I trauma centers. In 2140 Baltimore patients, base deficit was significantly higher in ethanol-positive patients (blood level > or =0.01%), independent of blood pressure (BP), Injury Severity Score (ISS), and blood loss. In 139 Youngstown, Ohio, patients, base deficit was significantly higher in ethanol-positive patients, independent of ISS and RBC units given. ⋯ A base deficit < or =-4.1 for ethanol-positive and < or =-1.1 for ethanol-negative patients had higher rates of major injury (odds ratio 3.2 and 2.1, respectively) and abdominal trauma (odds ratio 3.6 and 3.2, respectively). In blunt trauma patients, base deficit is increased with ethanol, independent of major injury. A base deficit of < or =-4.1 for ethanol-positive and < or =-1.1 for ethanol-negative awake patients may be an early warning for occult injury and suggest the need for an abdominal computed tomography (CT) scan or ultrasound.
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Comparative Study
"Medical clearance" of psychiatric patients without medical complaints in the Emergency Department.
This study was conducted to evaluate the benefit of comprehensive "medical clearance" (history, physical examination, vital signs, laboratory, radiography) in patients presenting to the Emergency Department (ED) with isolated psychiatric complaints. All patients 16 years and older who presented with a psychiatric complaint and required a psychiatric evaluation before discharge from the ED were included in the study. Data, obtained in a 5-month consecutive, retrospective chart review, included patient age, sex, initial complaint, past medical and psychiatric history, initial vital sign measurement, physical examination findings, laboratory analysis (electrolytes, complete blood count, toxicology screen), chest X-ray study results, and final disposition. ⋯ The remaining 132 patients (62%) presented to the ED with medically based chief complaints or past medical history requiring further evaluation in the ED before discharge. The initial complaints of these patients correlated directly with the need for laboratory and radiographic "medical clearance" in the ED. Patients with a primary psychiatric complaint coupled with a documented past psychiatric history, negative physical findings, and stable vital signs who deny current medical problems may be referred to psychiatric services without the use of ancillary testing in the ED.