The American journal of emergency medicine
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Review Case Reports
Midgut volvulus: an unusual case of adolescent abdominal pain.
Rotational gut abnormalities are generally considered a disease process of the neonatal and pediatric populations. However, they may first become manifest in teenagers and adults, often with disastrous outcomes. ⋯ At surgery, he was found to have a midgut volvulus. A differential diagnosis is discussed, as well as an anatomical review and typical symptomatology associated with midgut abnormalities.
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In a retrospective case review of inpatient and emergency department (ED) records during a 55-month period, 155 hospitalizations for Kawasaki syndrome (KS) were identified, of which 44 were seen in the ED. In 16 cases, KS was already suspected by their private physicians and confirmed in the ED by a KS specialist. In the remaining 28, patients presented initially to the ED. ⋯ In four instances, patients were hospitalized for other reasons. In all cases in which the diagnosis of KS was not made in the ED, viral infections or sepsis were suspected. One child presented to the ED in respiratory arrest and severe bradycardia.
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The objective of this study was to evaluate the characteristics of the patient population of an urban emergency department (ED) in The People's Republic of China. A prospective observational study was conducted at a university-affiliated hospital adult ED medical unit and included all patients visiting the medical unit of the ED during a 2-week period. A data collection log was designed and placed in the ED. ⋯ These data offer emergency physicians a preliminary understanding of the clinic presentations and diagnoses of patients seen in a university-affiliated urban hospital ED in China. The number and length of time patients were held in observation unit point out the shortage of in-hospital beds. This study is useful for describing and understanding characteristics of the patient encounter and for improving the delivery of emergency care in China.
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To determine current practices regarding security measures in the emergency department (ED), a random sample of 250 hospitals with EDs was surveyed by telephone. Security issues addressed included personnel (in-house security, contract guards, or police), hours of staffing in the ED, how security is armed, whether ED doors are locked at off-hours, and whether alarm buttons, direct phone lines, a paging code, closed circuit surveillance, metal detectors, and seclusion rooms are used. This information was stratified according to hospital size, ED census, rural/suburban/urban setting, teaching/nonteaching status, and region. ⋯ Small, rural hospitals are more likely to lock the ED doors at off-hours, whereas the use of security codes does not clearly follow demographic trends. Larger hospitals in suburban and urban settings and having a teaching status are more likely to have secure/detention rooms and closed circuit surveillance. The use of alarm buttons and/or direct telephone lines varies widely, but is generally more common in larger, teaching hospitals, located in urban and suburban settings.
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To determine whether age and other readily obtainable clinical and laboratory variables could be used to predict illness severity in febrile adults, data were collected on 39 patients presenting to an emergency department (ED) with rectal temperature > or = 37.8 degrees C (100 degrees F). Serious illness was defined as (1) need for emergency surgery; (2) intubation; (3) hypotension requiring treatment; (4) bacteremia requiring antibiotics; or (5) death. Six variables were associated with serious illness in the univariate analysis. ⋯ Optimal partitioning of these two variables showed that febrile adults younger than 50 years of age with leukocyte counts of less than 15 E9/L have a 5% incidence of serious illness (95% confidence interval [CI], 3% to 8%). In contrast, those who are > or = 50 years of age with leukocyte counts > or = 15 E9/L have a 36% incidence of serious illness (95% CI, 22% to 52%). Patients in this latter category should be carefully examined and considered for hospitalization before concluding that they may be safely discharged from the ED.