Articles: emergency-services.
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Offentl Gesundheitswes · Aug 1989
[Emergency services for crisis intervention--8 years' experience of a social psychiatry service in a rural area].
This is a report on a special around-the-clock service for psychiatric crisis intervention, maintained by social workers of a Sociopsychiatric Service (SpD) in cooperation with a psychiatrist. Only in a few number of cases it is necessary to make use of Federal German psychiatric legislation ("Psych-KG"). ⋯ The introduction of this sociopsychiatric concept which stresses the importance of familiar community environment, has clearly changed quality and quantity of compulsory admission in rural areas also. Only half of the work of this special service for crisis intervention is called for during regular working hours.
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Our approach to the management of fear and pain in the pediatric emergency department is presented. Tricks to attempt the gaining of rapport with frightened children in pain are noted, with emphasis on a developmental approach. The use of analgesic medications, local anesthetics, ketamine, and nitrous oxide as appropriate to emergency situations is outlined. Lastly, the guidelines of the American Academy of Pediatrics for outpatient sedation are reviewed.
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Review
Accuracy of interpretations of emergency department radiographs: effect of confidence levels.
We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. ⋯ No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist.