Annals of emergency medicine
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Improved outcome for trauma patients is closely linked to adequate early resuscitation and timely transfer of selected patients to trauma treatment centers. To document adequacy of early care of patients transferred to a regional trauma center, we analyzed 100 consecutive patients transferred after early care in a licensed emergency department by a medical doctor. Patients were evaluated in four injury categories: 1) neurologic, 2) chest, 3) abdominal, and 4) orthopedic. ⋯ Dangerous levels of noncompliance with accepted standards of trauma care were documented. On the average, major departures from accepted standards of early care were found in more than 70% of cases, particularly in the potentially lethal areas of airway acquisition and volume replacement. Implications of these data and an evaluation of corrective measures are discussed.
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Computer-aided telecommunications provide deaf teletypewriter users with 24-hour toll-free access to emergency services. An interface and software link the deaf caller's teletypewriter (TDD) with a microprocessor by reducing and inverting voltage levels between the two devices. This system facilitates rapid transmission of linguistically controlled triage questions to meet the communication needs of deaf patients.
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Randomized Controlled Trial Clinical Trial
Prophylactic oxacillin in dog bite wounds.
This prospective, double-blind, placebo-controlled study was undertaken to determine the value of prophylactic oxacillin in dog bites. Adult patients with uninfected full-thickness wounds presenting within 24 hours of injury were considered. Management consisted of cleansing, irrigation, debridement, and closure as indicated; no topical antibiotics were applied. ⋯ Two infections of the hand occurred in patients receiving oxacillin; no infections were seen among placebo-treated patients (P = NS). Prophylactic oxacillin was not associated with improved outcome. We do not advise the use of prophylactic antibiotics in dog bite injuries treated within 24 hours of accident.
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We examined satisfaction with burn care in 1,418 patients treated in 20 community hospital emergency departments. Lower levels of satisfaction correlated with a poorer process of care measured by number of physician deviations from burn care algorithms. ⋯ The more satisfied the patient, the greater the compliance with medical regimens and the better the patient outcomes as measured by days lost from work and perceived disability. If better patient attitudes relate to process of care and in turn to increased compliance and better outcome, then patient satisfaction is an important part of an overall evaluation of emergency department care.
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Medical experiences encountered in the activities of an emergency department are important for the development of a well-trained internist. Therefore, a rotation in the emergency department must remain an integral part of any program in internal medicine. ⋯ The faculty attendings provide supervision, immediately available consultation, and an on-going curriculum, including daily lectures and chart review. The results of their programmatic change have been the following: 1) enthusiasm and satisfaction on the part of the housestaff; 2) a 20+ increase in admissions to the hospital from the emergency department; 3) decreased utilization of the observation unit; and 4) fewer patients leaving without being examined.