Annals of emergency medicine
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To determine the hospital characteristics associated with patients leaving emergency departments prior to physician evaluation. ⋯ More than 4% of patients who seek care at EDs in Los Angeles County leave without being seen by a physician. A greater proportion of patients leave without medical evaluation from EDs with long waiting times for ambulatory patients and from those that serve uninsured populations. These findings should be interpreted in light of existing data on the health consequences faced by patients who leave hospital EDs without treatment.
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Time series analysis can provide accurate predictions of emergency department volume, length of stay, and acuity. ⋯ Time series analysis can provide powerful, accurate short-range forecasts of future ED volume. Simpler models performed best in this study. Time series forecasts of length of stay and patient acuity are not likely to contribute additional useful information for staffing and resource allocation decisions.
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Randomized Controlled Trial Comparative Study Clinical Trial
Indomethacin suppositories versus intravenously titrated morphine for the treatment of ureteral colic.
To develop a protocol for the blinded IV titration of morphine and to compare the analgesic efficacy and side effect profile of indomethacin suppositories versus IV morphine in the treatment of acute ureteral colic. ⋯ IV morphine produced more rapid analgesia than rectally administered indomethacin. There were no significant differences in vital sign changes or number of side effects between the two treatment groups. This study is the first to compare an NSAID with morphine administered by IV titration, considered by many to be the "gold standard" for relief of acute, severe pain. Future studies could evaluate the simultaneous administration of an opioid combined with an NSAID or compare an IV titrated opioid with an IV NSAID.
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Randomized Controlled Trial Comparative Study Clinical Trial
Suprapubic bladder aspiration versus urethral catheterization in ill infants: success, efficiency and complication rates.
To compare success rates, complications, and efficiency of suprapubic bladder aspiration with urethral catheterization in ill infants. ⋯ Both suprapubic bladder aspiration and urethral catheterization afford the emergency physician low-risk access to uncontaminated urine in ill infants. Suprapubic bladder aspiration is less efficient in that it requires physician participation and failure rates are higher. These data suggest that successful suprapubic bladder aspiration is primarily dependent on the volume of urine in the bladder; thus, in the ill or febrile ED infant who may be dehydrated, the likelihood of success decreases. The authors recommend that ED nursing and physician staff become comfortable with performing urethral catheterization on infants.
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Sedation and analgesia are essential components of the ED management of pediatric patients. Used appropriately, there are a number of medications and techniques that can be used safely in the emergency care of infants and children. Emergency physicians should be competent in the use of multiple sedatives and analgesics. Adequate equipment and monitoring, staff training, discharge instructions and continuous quality management should be an integral part of the ED use of these agents.