Articles: emergency-services.
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Many studies have drawn attention to deficiencies in the management of major trauma, both in the UK and elsewhere. One area that has received little attention is the documentation of such cases in the Emergency Room. When outcome may be sub-optimal, documentation assumes greater importance if advances are to be made in the organisation of trauma care. ⋯ It unifies the recording of vital signs, whilst acting as an assessment and resuscitation template. By ensuring no life-threatening illness is missed it is likely to improve patient survival. The document can act as a basis for teaching and a medico-legal record, whilst providing the necessary data for quality assurance and outcome audit.
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Pediatric emergency care · Oct 1992
Follow-up of patients with occult bacteremia in pediatric emergency departments.
Blood cultures are frequently obtained in pediatric emergency departments (EDs) from febrile young children at risk for bacteremia and subsequent development of serious bacterial infections. This study of 105 children with occult bacteremia treated in two large urban pediatric EDs describes the follow-up of these patients and the impact that positive blood culture results have on the detection of serious illness. Seventy-seven percent of patients had a follow-up visit in the ED, 8% had follow-up by telephone alone, and 15% were not contacted. ⋯ Ten children (9.6%), five of whom had been notified of the positive blood culture, returned with serious illnesses. Patients whose diagnosis of serious illness was facilitated by blood culture results had shorter delay in identifying cultures as positive than did patients notified of positive results who did not develop serious illness (16.2 vs 31.6 hours; P < 0.05). The delay in follow-up of children with occult bacteremia limits the usefulness of blood cultures in the early detection of serious illness.(ABSTRACT TRUNCATED AT 250 WORDS)
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Lack of a comprehensive health care system in the United States has resulted in a series of legal cases that have expanded the common-law right to care in the hospital emergency department, thereby bringing increased pressure on hospitals to provide care under an ever-widening variety of nonemergency conditions. Health care legislation at the state and federal level during the 1980s expanded the concept of physician duty to include women in labor as well as any condition that could reasonably be expected to lead to serious impairment to bodily functions or serious dysfunction of any bodily organ or part. ⋯ The United States needs a national health care solution that does not rely on the ED as the locus of care for general medical practice. Failure to act will jeopardize the ability of hospital EDs to provide the highly specialized care that only they can provide and will put more hospitals at financial risk as they struggle to comply with state and federal law while serving a growing population of uninsured and underinsured patients.
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To assess the timing of key decisions and clinical events in the treatment of acute myocardial infarction with thrombolytic therapy. ⋯ Thrombolytics should be stocked and started in the ED. Emergency physicians should generally make the decision to administer thrombolytic therapy with reference to accepted protocols without awaiting an ED consultation from either private attendings or cardiologists.
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Use of emergency outpatient services is described for a 34-bed rural hospital in Alberta. One in 10 outpatients was classified as having serious and extreme emergencies. Less than 3% were transferred to a higher level of care; 10% were admitted to the local hospital. Recommendations are made for staffing, training, inventory, and funding of small rural hospital emergency departments.