European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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An intravascular access line for the administration of life support drugs and volume expanders may be particularly difficult, especially in very small premature babies. We report on the successful use of an intraosseous accessline in an 800 grams preterm infant for the administration of drugs and fluid. The use and technique of an intraosseous access is an important emergency alternative which may be lifesaving, even in very preterm babies, when other methods fail.
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To determine the rate of inappropriate use of the ambulance service a prospective study of patients brought to a Dublin accident and emergency (A&E) department by ambulance was performed over a 78-day period--358 cases were analysed representing 37% of the ambulance case load. The receiving A&E physician deemed 43.3% of cases to have a definite indication for calling an ambulance, 36.9% a relative indication and 19.8% to have no indication. A strong correlation was shown between a definite indication for transport by ambulance and admission to hospital. ⋯ When a general practitioner requests the ambulance only 7.4% of cases had no indication for the action. Approximately one-third (31%) of 999 calls were made because the patient had no transport alternative. The problem of ambulance misuse is multifactorial and a variety of strategies are required to address the issue.
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The diagnosis of elder abuse and neglect is difficult to accomplish, making intervention elusive, primarily because to date there is no set definition of either abuse or neglect. This paper, written primarily from the American viewpoint, addresses definitions; assessment and diagnosis; aetiology of abuse; intervention; prevention and management; ethical and legal considerations; elder abuse and the emergency physician; and future goals.
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Comparative Study Clinical Trial
Non-invasive continuous positive airway pressure in acute hypoxaemic respiratory failure--experience of an emergency department.
Non-invasive continuous positive airway pressure (CPAP) seems to decrease the need for intubation in patients with severe cardiogenic pulmonary oedema (CPO) in the intensive care unit. The goals of our study were to delineate indications for CPAP in the emergency department, and to confirm its usefulness in such a setting. We retrospectively assess the evolution of all patients ventilated under CPAP for an acute hypoxaemic respiratory failure over a 1-year period (n = 64 patients). ⋯ No side effects were reported. In conclusion, CPAP is a useful and easy-to-use ventilatory device in the emergency department. It is now one of our first line treatments during prehospital and emergency care of patients with CPO.
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Because acute myocardial infarction causes significant morbidity and mortality, a correct diagnosis in the accident and emergency department is important so that early treatment including thrombolytic therapy can be given. The aim of this study was to evaluate the reasons for missed diagnosis of acute myocardial infarction in the accident and emergency department, and the implications. All patients admitted to our coronary care unit in 1995 with the confirmed diagnosis of acute myocardial infarction were analysed retrospectively. ⋯ About one-third (34.9%) of missed diagnosis patients (vs. 6.0% in correct diagnosis, p < 0.01) did not receive thrombolytic therapy because of delayed diagnosis. In the missed diagnosis group, 34.8% of them might be avoidable, if electrocardiogram interpretation was more accurate. More education and training of the involved medical personnel might improve the overall situation.