The American journal of emergency medicine
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Although depression is the most common psychiatric disorder in the elderly, it is often unrecognized by physicians. The objective of the study was to assess the utility of a 3-question screening instrument (ED-DSI) to detect depression among elderly emergency department (ED) patients. We used a prospective convenience sample of English-speaking ED patients >or=65yr. ⋯ GDS identified 33 patients (32%) as depressed. Of these, 26 were correctly identified by ED-DSI giving an ED-DSI sensitivity of 79% (95%CI (65%, 93%)) specificity of 66% (95%CI (54%, 78%)) and a negative predictive value of 87% (95%CI (79%, 95%)). The 3-question ED-DSI is a useful tool to detect depression in this population of ED patients.
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The objective of the present study was to evaluate the stability of diazepam rectal gel (Diastat) in various conditions of temperature and light exposure as might be found in ambulances. Three lots of Diastat (Xcel Pharmaceuticals, San Diego, CA) in various fill/syringe configurations were evaluated in controlled conditions of a freeze-thaw cycle, hard freeze (-30 degrees C for 72 hours), extreme light exposure (1,000 ft candles for 1 month), and long-term evaluation at either 30 degrees C or 40 degrees C. ⋯ The estimated shelf-life at 30 degrees C exceeds 48 months. Based on the results of the present study, the restocking frequency of Diastat in ambient storage conditions (eg, ambulances), could be up to 48 months in nonfreezing environments, as long as this does not exceed the labeled expiration date on the product.
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The objective of the study was to evaluate our experience with esophageal foreign body (EFB) removal comparing the use of ketamine-midazolam (K-M) and fentanyl-midazolam (F-M) in the emergency department (ED), to admission and general anesthesia (GA) in the operating room (OR). A retrospective review of all children undergoing EFB removal at our institution during a 2-year period was conducted. A total of 93 patients were identified: K-M 57/93 (61.2%), F-M 28/93 (30.1%), GA 5/93 (5.4%), and 3/93 (3.2%) by other means. ⋯ Transient hypoxemia occurred in 10.7% of K-M and 15.4% of F-M. Removal of EFBs in the ED may obviate the need for admission. In our experience, the use of K-M is associated with fewer airway complications, shorter removal times, and an overall shorter LOS.
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The emergency care system in Bulgaria is evolving as a hybrid of the former "Soviet-style" health service and western-style emergency medicine. Bulgaria like other "Eastern bloc" Communist nations has undergone a sweeping socioeconomic transformation during the past 10 years. These changes have had profound consequences including the development of emergency services and the recognition of emergency medicine as a specialty in Bulgaria.
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The objective of the study was to describe parenteral analgesic and sedative (PAS) use among patients treated in US emergency departments (EDs). Data representing 6 consecutive years (1992-1997) from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined and analyzed. Patients were identified as having received PAS if they received fentanyl, ketamine, meperidine, methohexital, midazolam, morphine, nitrous oxide, or propofol. ⋯ A total of 43,725 pediatric and 114,207 adult ED encounters were analyzed and represented a weighted sample of 555.3 million ED visits. For patients with orthopedic fractures, African American children covered by Medicaid insurance were the least likely to receive PAS (OR 0.2, 95% confidence interval 0.1-0.6). These results suggest that variations may be occurring among ED patients receiving PAS.