J Emerg Med
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An essential feature of the trauma center concept is the rapid delivery of patients with complicated injuries to a regional trauma center directly from the site of injury. A variety of triage instruments have been proposed to aid the prehospital personnel in making this difficult triage decision. We used a combination of prospective and retrospective analysis to evaluate and compare the performance of 11 recommended triage instruments on the same trauma population. ⋯ Of the triage instruments with a sensitivity greater than 70%, the respiratory/systolic pressure/Glasgow Coma Scale (RSG) score provided the largest improvement in odds for needing a trauma center when the triage instrument is positive. Although no triage instrument performed ideally, the patients missed by the triage instruments having a sensitivity greater than 70% were hemodynamically stable. Transfer of such patients to a trauma center following determination of the extent of underlying injury at a referring emergency department should be possible.
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Significant ECG findings frequently accompany blunt chest trauma. Surface ECG in conjunction with creatinine phosphokinase (CPK) isoenzyme assay, has been an accepted standard for diagnosis of posttraumatic cardiac dysfunction, or "cardiac contusion." Studies employing recently developed noninvasive cardiac imaging techniques have called this practice into question and have shed new light on the pathophysiology of this clinical entity. As a result, it is appropriate to review the ECG manifestations of blunt chest trauma and to reappraise the utility of the ECG in its evaluation. This article will concern itself solely with nonpenetrating cardiac injuries not requiring initial surgical management, since clinical presentation, course, and prognosis differ when operative therapy is indicated.
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There continues to be a debate on the indications for and value of emergency department thoracotomy, especially with regard to thoracotomies performed by emergency physicians. The current literature does not deal specifically with thoracotomies performed by an emergency physician on trauma patients in full cardiopulmonary arrest in a setting with no immediate surgical backup. This paper reports the results of 6 years of experience by one emergency physician in such a setting involving 80 patients, with a 6% overall survival rate, including two patients who survived blunt traumatic cardiac arrests. This lends support to emergency-physician-performed thoracotomies on trauma patients in "extremis," even in the setting of a hospital with no immediate surgical backup.
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All emergency departments face the possibility of having insufficient personnel to provide adequate care for patients. Such occasions may present an emergency department with several severely injured patients or merely an unusually large number of that emergency department's usual patient profile. ⋯ In addition, emergency department directors have an obligation to consider their particular staffing and usage patterns in order to try to devise the most efficient back-up policy prior to need. Finally, assessment of the success with which such back-up policies are used is discussed.
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To assess the moon's perceived impact on emergency medicine, a survey was conducted using a modified Belief in Lunar Effects (BILE) scale. Eighty percent of the respondent emergency department nurses and 64% of the emergency physicians believe that the moon affects patients. Of these nurses, 92% find lunar shifts more stressful and indicated lunar pay differentials are warranted. Medical, social, and administrative strategies to deal with lunacy are presented.