Articles: hospital-emergency-service.
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For 8 years biweekly ambulance critique review sessions have evaluated performance and discussed management of cases brought to our hospital by ambulance. Over 500 cases reviewed have centered primarily on evaluation and care at the scene and its possible relation to outcome. Problems which have recurred on the scene include whether the patient would have benefited from less time in stabilization and immobilization; manipulation of deformed fractures for splinting; use of tourniquets; techniques of airway maintenance; and management of infrequently seen problems such as hypothermia and drowning. ⋯ Improved outcome needs to be assessed in a carefully controlled study. The enthusiasm and attendance of ER staff and ambulance personnel has grown and endured over 8 years. The review sessions have spread to other area hospitals with some success.
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Reports of advancements in emergency department operative resuscitative skills have included craniotomy, thoracotomy, cardiorrhaphy and even cardiopulmonary bypass. The efficacy and advisability of laparotomy in the emergency department remain in question. Between July, 1972, and July, 1977, adhering to an established protocol, resuscitative laparotomy was performed on 51 patients in the emergency department. ⋯ Control of exsanguinating hemorrhage with precise application of vascular clamps was possible in all but 15 patients. Because of extensive multiple injuries and inability to achieve cardiovascular stability, only 11 patients reached the operating room, and none survived to leave the hospital. Although technically possible, laparotomy in the emergency center did not alter the fatal outcome of moribund patients in this series.
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Med Malpract Cost Containment J · Apr 1979
Emergency hospital care: issues of treatment and liability.
Increased utilization of hospital emergency rooms, and a departure from traditional physician-patient relationships, have resulted in increased litigation. Risks to hospitals can be minimized if certain policies are pursued.