Articles: emergency-medical-services.
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Practice Guideline Guideline
Trauma care systems quality improvement guidelines. American College of Emergency Physician.
While facility QI has been an important tool in the improvement of the care of the trauma patient, it is essential that system QI also be pursued within each trauma care system. These suggested system QI indicators will provide system medical directors and managers with a valuable tool to facilitate the implementation or improvement of the system QI program. Such a program will allow systems to review their overall function, including management, prehospital, and rehabilitative phases. Through this methodology, both individual providers and the overall trauma system can identify deficiencies and institute appropriate modifications to optimize care of the trauma patient.
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Prehospital medications for congestive heart failure should affect hospital outcomes (survival and length of stay). ⋯ Prehospital medications improve survival in congestive heart failure, especially in critical patients. More than one combination of medications seems effective, and early treatment is associated with improved survival. However, these medications appear to increase mortality in patients misdiagnosed in the field. Factors used in paramedica and medical command assessments require further study.
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The outcome of patients transported by coastguard helicopter to the Lewis Hospital, Stornoway was studied for the first 30 months of the service. Although undoubtedly life-saving in some cases, some patients were transferred for trivial reasons. Feedback between the hospital and ships' captains and owners may reduce possible abuse of this service. Most patients were uplifted entirely appropriately.
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Emergency thoracotomy is a standard procedure in the management of cardiac arrest in patients sustaining severe trauma. We examined the records of 463 moribund trauma patients treated at our institution from 1980 to 1990 to refine indications for emergency thoracotomy. Patients underwent thoracotomy either in the emergency department (ED) (n = 424) or in the operating room (OR) (n = 39) as a component of continuing resuscitation after hospital arrival. ⋯ Patients with penetrating trauma and in profound shock (BP less than 60 mm Hg) or mild shock (BP 60-90 mm Hg) with subsequent cardiac arrest had survival rates of 64% (27 of 42) and 56% (30 of 54), respectively. None of the patients with absent signs of life, defined as full cardiopulmonary arrest with absent reflexes (n = 215), on initial assessment by paramedics in the field, survived. We conclude that (1) no emergency thoracotomy should be performed if no signs of life are present on the initial prehospital field assessment; (2) emergency thoracotomy is an indicated procedure in most patients sustaining penetrating trauma; (3) blunt traumatic cardiac arrest is a relative contraindication to emergency thoracotomy.
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To determine the extent of supervision necessary for emergency medicine residents practicing in the emergency department. ⋯ Supervision is required for all patients managed by second-year emergency medicine residents, regardless of complaints. This evaluation should include a direct patient interview and examination by the emergency medicine attending and should not be limited to a case discussion or ED record cosignature.