Articles: emergency-services.
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To determine whether the length of a queue at a public hospital emergency department was associated with increased likelihood of patients' leaving without being seen by a physician and whether leaving adversely affected patients' health or affected their subsequent use of health care services. ⋯ Many patients can appropriately decide whether their problem is truly urgent and make alternative plans in the face of long waits, but the health of some patients may be jeopardized by long queues for emergency care.
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To determine whether patients who sought care at a public hospital emergency department and left without being seen by a physician needed immediate medical attention and whether they obtained care after leaving. ⋯ Overcrowding in this public hospital's emergency department restricts access to needed ambulatory medical care for the poor and uninsured.
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The results of 163 patients (49 SWs, 85 GSWs, 29 blunt trauma) who had resuscitative thoracotomy in the emergency room (ERT) were reviewed to reassess the indications for the procedure. The Revised Trauma Score (RTS) of the patients ranged from 0 to 3 in 138, 4 to 8 in 21, and greater than 8 in four. No patient with blunt trauma survived. ⋯ Two of the five patients (40%) with extremity vascular injuries survived after ERT was successful in restoring a cardiac rhythm. These data suggest that in patients without vital signs, ERT "directed" at potential cardiac injury based on thoracic penetration is an important prognostic prerequisite for survival. Emergency room thoracotomy is not beneficial in blunt trauma and its role in penetrating abdominal injuries remains unproven.
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Accurate patient triage to provide early identification of potentially seriously ill or high-risk infants and children is an important part of any emergency care system. Use of the SAVE-A-CHILD mnemonic in a busy ED setting provides systematic organization of important clinical observations that may serve as markers of serious disease. Early recognition of the high-risk patient will reduce morbidity and mortality. The discussion included may be helpful to emergency physicians in training their staff to provide a safe triage environment.