Articles: emergency-services.
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Thirty-nine emergency cricothyrotomies were reviewed from the emergency department of Hennepin County Medical Center during the 4-year period ending December 1985. Due to technical changes in airway management and a desire to assess their impact, this experience was compared with a previously reported series of 38 emergency cricothyrotomies from the same department. Technical changes include the use of paralyzing agents, transtracheal needle ventilation, and the use of only vertical skin incisions and #4 Shiley tubes when cricothyrotomy is performed. ⋯ However, the tube was in the trachea in all cases, and acceptable ventilation was achieved. No patient developed a clinically significant hematoma or hemorrhage from cricothyrotomy. It is concluded that our technical changes in airway management have helped to decrease both the relative frequency of cricothyrotomy and the complication rate.
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We have reviewed the 130 patients presenting to an accident and emergency (A & E) department with a headache, followed up for 2 years. These are infrequent attenders but we have found that there is a high incidence of serious neurological pathology (16%) in this group of patients. We suggest that patients presenting to the A & E department with headache should be thoroughly examined and investigated and in the absence of a definite benign diagnosis should at least be admitted for a period of observation.
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We evaluated the nature and significance of seizure problems in an emergency department (ED) by studying seizures in an urban community hospital. In 6 months, there were 29,131 ED visits; of these, 200 (0.7%) were for diagnosed seizures. Among these 200 seizure visits, were 69 (34.5%) new-onset seizures, 30 (15%) febrile seizures, and 92 (46%) seizures in epilepsy patients with prescribed antiepileptic drugs (AEDs). ⋯ A hospital ED is a major source for epilepsy and seizure care, but this care is not always optimum. EDs need to be prepared to manage common acute seizure problems. However, EDs must also place greater emphasis on significant nonemergency aspects of seizure care such as AED compliance, associated psychosocial problems, and effective communication with primary care providers.
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The demand for home attention in the special emergency service of L'Hospitalet and Cornella de Llobregat (Barcelona) was evaluated. The data from a sample of 2046 requests for home attention were assessed, corresponding to the period between July 1st, 1985, and June 30th, 1986. This sample was randomly selected from overall 28385 home visits carried out during this period. ⋯ The most common group of diseases were the respiratory conditions. 83% of patients received some type of therapy. In 12% of cases, admission to a hospital was indicated; the most common cause of admission to a hospital was indicated; the most common cause of admission was cardiovascular disease. Emphasis is made on the importance of the coordination between primary care groups and special emergency services, as well as on the need for continuing education of professionals with specialties related to the care of emergencies and pediatrics.
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Overcrowding in emergency departments presents serious problems to both patients and hospital staff. At Scarborough (Ontario) General Hospital this problem was becoming potentially dangerous until a hospital committee instituted a series of changes that dramatically improved the situation. A geriatrician was appointed to assess and care for the increasing number of elderly and chronic care patients. ⋯ Surgeons agreed to perform more surgery on an outpatient basis, and the Short-Stay and Ambulatory Procedures units were expanded to handle more procedures. In addition, the implementation of a physician-managed admission system ensured the appropriate admission of patients. The entire system is monitored, and the committee meets regularly to deal with any problems.