Articles: emergency-services.
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Pediatric emergency care · Sep 1990
Rapid intravenous rehydration in the pediatric emergency department.
Children suffering from mild to moderate (3 to 6%) dehydration likely caused by viral gastroenteritis are often hospitalized because they are unable to tolerate oral fluids. We studied 17 such children, aged one to six years, who were otherwise healthy. All had isonatremic dehydration and were treated with 30 ml/kg of 3.3% dextrose and 0.3% saline over a period of three hours in the emergency department before being discharged. ⋯ Only one patient required another course of rapid intravenous rehydration and subsequently improved without hospitalization. Although all our patients experienced vomiting before treatment, 65% had no vomiting after treatment. Rapid intravenous rehydration is an effective treatment, for children with mild to moderate dehydration secondary to presumed viral gastroenteritis, that obviates the need for hospitalization.
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We report on the outcome of major trauma patients brought to the Kent and Canterbury Hospital in 1989 and compare it with 1987. There is an improvement which followed changes in the management of serious injuries.
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The undergraduate medical curriculum does not include supervised training in emergency services. Medical students and residents are expected to acquire skills and experience related to emergency medicine during their clerkships in the clinical wards. Consequently, Israeli medical graduates often have difficulty in coping with common situations in primary care and emergency medicine. ⋯ Both the positive feedback of the trainees and the practical relevance of the program and its feasibility, suggest that it may be a worthwhile addition to the undergraduate and graduate clinical curriculum. However, we have no data for evaluating the outcome. We feel that all aspects of emergency medicine should be included in the teaching programs of the various clinical specialties, and suggest that the emergency room should be used as a teaching setting during the clinical clerkship, the internship and residency training.
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The Casualty Department of the University Hospital of the West Indies (UHWI) has evolved in an ad hoc manner over the last decade, and questions regarding its appropriateness and effectiveness as an Emergency Department persist. This study of 100 systematically-selected patients attempts to assess time utilization during transit, as dictated by the present system of patient management. Time to first contact averaged 2 hr 38 min (158 min). ⋯ Actual contact time with casualty officers averaged only 8.3 min. Referrals to specialist services constituted 11% of the sample, and overall mean waiting time for specialists was 2 hr 16 min (136 min) with a mean contact time of 48 min. Given that the mean total time of 3 hr 46 min is not inordinately long in a public health system such as ours, the recommendation is being made for a modified coding and triage system to reduce time to first contact for more urgent cases.