Articles: emergency-services.
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Patients generally have the right to refuse medical care, a right based on certain legal precedents. Its application in the emergency department leads to difficult decisions for the emergency physician. ⋯ These include psychiatric patients, narcotics abusers, alcoholics, "street people," and some patients with migraine headaches. They represent some of our most difficult decisions because the treatment required for the patient is often clear and the patient refuses care or demands inappropriate care.
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Hosp Community Psychiatry · Dec 1990
Characteristics of psychiatric emergency room patients with alcohol- or drug-induced disorders.
Although emergency room psychiatrists are often faced with evaluating and planning treatment for patients who abuse substances, there is limited information about the characteristics of emergency room patients with alcohol- or drug-induced disorders. The authors describe the demographic and clinical characteristics of 343 consecutive patients referred to a general hospital's emergency psychiatry service. ⋯ They also demonstrated increased suicidality. Alcohol was the predominant substance that contributed to psychiatric emergencies, but a surprising number of patients were diagnosed as having amphetamine-induced disorders, possibly representing an important trend.
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Emergency center (ER) trauma evaluations often include leukocyte count (LC), serum amylase (SA), electrolytes (EL), and urine analysis. We reviewed records of 100 pediatric ER patients to determine utility of these tests in management of blunt injury. SA was evaluated in 65 patients and ranged from 30-146 U/L (mean 50.6 U/L); 14 patients with normal CT scans had SA from 30-68 U/L (mean 49.1 U/L). ⋯ DA predicted injury with sensitivity 60.0 per cent (specificity 79.2%). DA accurately represented LA results (sensitivity 100%, specificity of 94.5%). DA is a rapid and effective replacement of LA in evaluation of trauma patients in the emergency center.
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Comparative Study
Do trauma centers improve outcome over non-trauma centers: the evaluation of regional trauma care using discharge abstract data and patient management categories.
Development of regional medical care systems to treat patients who sustain major accidental injuries (trauma victims) has been based on autopsy studies which demonstrate that hospitals that meet certain accepted criteria of readiness (trauma centers) can prevent needless deaths of trauma victims. However, since only autopsy data have been available from non-trauma centers, it has not previously been possible to compare morbidity data between trauma centers and non-trauma hospitals. This study examines discharge abstract data and a new patient classification system called patient management categories (PMC) which are generated from this abstract data to evaluate length of stay (LOS), complications, and death to compare morbidity and mortality data from trauma centers and non-trauma centers. ⋯ Patients treated in trauma centers had significantly fewer complications (21% vs. 33%; p less than 0.001) and lower mortality rates (p less than 0.05) than those treated in non-trauma centers. Associated injuries, age, complications, and/or delay in time to OR significantly increased intensity and length of stay in both trauma and non-trauma centers. This significantly increased the cost of care provided to these patients in both types of centers.(ABSTRACT TRUNCATED AT 250 WORDS)