Articles: emergency-services.
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Emerg. Med. Clin. North Am. · Feb 1991
ReviewEvaluation of behavioral and cognitive changes: the mental status examination.
Patients who present to the Emergency Department with a behavioral or cognitive disorder should be treated in an organized fashion. The most important element of their care is determining the etiology of their abnormality, whether organic or functional. ⋯ It must be focused and brief. By focusing on seven major areas (affect, attention, language, orientation, memory, visual-spatial ability, and conceptualization), a quick and thorough examination of the patient's mental status can be performed.
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Short-term psychiatric hospitalization, developed during the past 2 decades, needs thorough evaluation with regard to its advantages. It is important to be able to identify those patients who might be aided by such treatment. Therefore the psychiatric emergency room physician should have at hand a model which would enable quick and relatively accurate decisions in identifying such patients. ⋯ This data may aid the physician during the initial interview in the psychiatric emergency room in deciding on further treatment. We also found that psychiatric emergency room diagnoses are usually reliable; and that those whose only diagnosis was "for observation" had a fair chance of a successful result after short-term hospitalization (discharge directly from the emergency room unit). We therefore presume that a sharper characterization of patients referred to the psychiatric emergency room may aid in tailoring the most suitable treatment for any particular patient, thus reserving short-term hospitalization only for those who would benefit the most.(ABSTRACT TRUNCATED AT 250 WORDS)
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Occult bacteremia, which precedes many serious infections in children, is most often due Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, or Salmonella species. Diagnosis on the basis of clinical judgment is unreliable, although the presence of certain risk factors may suggest the diagnosis. ⋯ Although results are delayed, a culture of blood is the only definitive test. Studies suggest that treatment with various antibiotics may be helpful, but that some drugs, particularly orally administered amoxicillin, should not be relied on to eliminate occult bacteremia or prevent its most serious sequela, meningitis.