Articles: emergency-medical-services.
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A continuous observation time study was used to track 1,568 patients through various stages of emergency department care in order to identify sources of delay. Patients initially were assigned to one of four categories of decreasing acuity, and flow profiles were compared for each category. Patients with lowest acuity level experienced long delays in moving through the ED, although the actual evaluation and treatment time was brief. ⋯ The most critical patients moved most quickly but with a brief evaluation and treatment time due to a rapid disposition from the ED or death. This relationship suggests an emergency care system that is oriented toward the efficient care of high-acuity patients but that is less effective for low-acuity patients. This occurs despite the fact that low-acuity patients comprise the vast majority of the ED census, and represent a group for whom delay is a frequent source of patient dissatisfaction.
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The evolution of selective laparotomy in children sustaining blunt abdominal trauma has been highly controversial. This report describes our experience and policy change during this transitional period. Emergency laparotomies performed in the pediatric age group (less than 14 yr) between 1980 and 1984, based on peritoneal lavage, were reviewed. ⋯ The protocol consisted of: 1) routine peritoneal lavage (DPL) in children at high risk for abdominal injury, 2) immediate laparotomy for DPL positive for blood in conjunction with hemodynamic instability, 3) selective laparotomy for DPL positive for blood in a stable child, additionally evaluated by abdominal CT scan (major mechanism) or liver/spleen scan (minor mechanism), and 4) mandatory laparotomy for DPL effluent positive by criteria other than blood. This policy reduced unnecessary laparotomy, otherwise warranted by DPL, to 18% (2/11); both patients had Grade II splenic injuries. Five children sustaining low-energy trauma were managed nonoperatively following peritoneal aspiration of gross blood with L-S scan confirming minor solid visceral injury.(ABSTRACT TRUNCATED AT 250 WORDS)
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This study is based on a 12 month prospective analysis of 598 paediatric trauma admissions, drawn principally from an urban environment. The spectrum of trauma is described, highlighting the minor nature of most injuries and the rarity of penetrating trauma. A subgroup of seriously injured children was identified and further analysed. ⋯ Of children admitted following pedal cycle accidents, 86% of the total and 91% of seriously injured children were not wearing a helmet. Of passengers in a motor car, 37% of the total number were unrestrained. The results suggest triage in children requires more than a physiological measure (TS) or MOI.(ABSTRACT TRUNCATED AT 250 WORDS)