Articles: hospital-emergency-service.
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This study was conducted to determine whether hospital emergency department (ED) use has been affected by the presence of freestanding emergency centers (FECs) in hospitals' service areas. A sample of FECs was drawn and hospitals in their service areas identified. ED visits to those hospitals from 1970 to 1980 were compared with those of a comparison group of hospitals not studied. ⋯ Because of the relative newness of FEC development, future studies of this type should be conducted. This study could not answer the question of whether FECs caused the growth of hospital ED visits to slow. It did not attempt to measure the impact FECs have on private medical practices or determine whether FECs attract currently underserved patient groups.
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The results of emergency room thoracotomy (ERT) and cardiorrhaphy for 91 patients with penetrating cardiac injuries admitted in extremis to Lincoln Medical and Mental Health Center from 1963 to 1981 are reviewed to determine criteria for selection of patients for this procedure. Four groups were defined based on the severity of the effects of their injuries. The survival rates were 32.1 and 33.3%, respectively, for Group I ('fatal') and Group II ('agonal') patients. ⋯ A.') patients for whom ERT is a fruitless procedure. Survival in Group III ('profound shock') patients was only 40%, which might have been improved if ERT had been performed without delay. We conclude that ERT is essential for patients with 'fatal' and 'agonal' wounds and advise prompt ERT for patients in 'profound shock' who do not respond immediately to rapid volume infusion.
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Transcutaneous oxygen sensor values reflect peripheral oxygen tensions. During shock and resuscitation, transcutaneous oxygen sensor values depend on peripheral blood flow, and, therefore, reflect cardiac output and oxygen delivery. Transcutaneous oxygen sensor monitoring, therefore, should be quite useful when caring for acutely ill patients; data from 20 surgical emergency department patients support this hypothesis. ⋯ In addition, transcutaneous oxygen sensor was useful for continuous monitoring during resuscitation. Successful correction of hypoxia and perfusion deficits results in increased transcutaneous oxygen sensor values. Failure of the transcutaneous oxygen sensor value to increase during resuscitation implies ongoing deficits of tissue oxygenation.