The American journal of emergency medicine
-
We describe the prevalence of cognitive impairment in a population aged 65 and older requiring urgent medical services and to propose global evaluation, involving cognitive, functional and social aspects, during the emergency department (ED) visit to define an individualized care protocol. A total of 150 patients aged 65 and older attended at the ED were screened for cognitive impairment using the Mini-Mental State Examination (MMSE). ⋯ In no case of mild impairment had a cognitive deficit already been diagnosed. The functional and socioeconomic profile enabled proposing a strategy for better management of the patients discharged by the ED.
-
A prospective study involving 179 patients with cranial and orbital stab wounds was undertaken to evaluate the incidence and relationship of clinical findings, radiographs, and computed tomography (CT) findings and treatment decision. Indications for a CT scanning of the head are a of loss of consciousness, convulsions, any neurological deficit, palpable or visible fracture on the skull X-ray film after an attack with a sharp instrument, presence of an impaling weapon. A CT scan and plain radiography were performed in 179 patients. ⋯ Approximately 80% of all cranial injuries would remain undetected if the diagnosis would be based on a visible fracture. Fifty percent of patients had an admission GCS of 15/15. The importance of a CT scan and the limited benefit of plain radiography alone in stab injuries to the head is discussed.
-
The objective was to describe patterns of analgesic use for trauma patients treated in our emergency department (ED). We reviewed analgesic use in consecutive patients meeting American College of Surgeons (ACS) Trauma Center Guidelines. A comprehensive database was abstracted from this institution's Trauma Registry and medical records of each patient. ⋯ Patients with head trauma and those admitted to the intensive care unit were least likely to receive analgesics. Morphine was the most frequent analgesic used with an average total dose of 14 milligrams. A majority of patients meeting ACS Trauma Center Guidelines did not receive analgesics in the ED.
-
Medical care for the sick and injured on a variety of sea-faring vessels throughout the world represents a challenging area of medical care. The scope is extremely broad and unique in terms of the problems encountered at sea, logistical difficulties in assessment and treatment of patients, as well as the provision of definitive care. The problems of sparse resources availability, great distances, isolation, communications, accessibility, and weather are also very real. ⋯ In 1980, the accident and emergency department at Singapore General Hospital took over this responsibility. This report analyzes 2,320 calls received over a period of 21 years (January 1980 to December 2000). It highlights the common consultations, modes of communications, treatment and management prescribed, training requirements, as well as the challenges for the future.