The American journal of emergency medicine
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Pulse oximetry and capnography are widely used in clinical practice. They provide quick and noninvasive methods to estimate arterial oxygen saturation and carbon dioxide tension in different situations including emergency departments, intensive care units, and during procedures. This article reviews the principles of surgery, accuracy, limitations, and clinical applications of these instruments.
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The purpose of this study to determine predictors of revisit, hospital admission, or death among older patients discharged from the emergency department (ED). We performed a prospective study of patients aged 65 or older in an urban ED. The primary outcomes were ED revisit, hospital admission, or death 30 or 90 days after discharge from an index ED visit. ⋯ Poor physical functioning, missing mini-mental state examination, comorbidity, and ambulance transport to the initial ED visit predicted 90-day outcome. Problems with physical functioning, mental health and supplemental insurance are potentially remediable precursors of early morbidity among older patients after ED discharge. Future research should examine whether addressing these issues among the elderly population will lessen ED return visits, hospitalization, and mortality.
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Comparative Study
Diagnosis of appendicitis in the ED: comparison of surgical and nonsurgical residents.
The purpose of this study was to evaluate the impact of a surgery-based (SB) versus nonsurgery-based (NSB) training background of residents on the diagnosis of acute appendicitis in the emergency department (ED). The medical records of 641 adult patients who had undergone an appendectomy during a 3-year period (July 1996 to June 1999) were reviewed. All the patients were divided into NSB-in charge (n = 367) and SB-in charge (n = 274) groups, and demographic and clinical data recorded. ⋯ With the application of a CT scan, the negative appendectomy rate was reduced significantly from 23% to 12%. We concluded that under the supervision of board-certified emergency physicians, the NSB residents had capabilities similar to SB residents in making correct diagnoses of acute appendicitis. In addition, close observation of equivocal cases in the ED did not necessarily increase the perforation rate.
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Injury to rear-seat occupants (RSOs) has received little systematic study in the literature. Past studies have focused on patterns of injury presented to the emergency department, various aspects of restraint usage and injury, or specific populations of RSOs. This is the first systematic analysis of injury severity to RSOs. ⋯ In our rural population, RSOs sustain less severe injuries than FSOs. Restraint usage and sober drivers provide a greater protective effect however. Seat location does not replace restraint usage or sobriety.
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The study objective was to evaluate the capability and the consistency of the triage nurse to categorize correctly emergency patients and its impact on the waiting time for physician examination over a period of 3 years. The study was performed at the emergency department of the Barzilai Medical Center, Ashkelon, Israel. A retrospective review of the medical records was performed. ⋯ The rates of incorrect classification, deterioration, and delay of treatment of patients because of incorrect triage are very low. Most of the patients were examined by the physician within the expected time. Triage nurse predicted correctly the urgency category of patients with chest in most of the cases and the rate of missing acute coronary events was very low.