Can J Emerg Med
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Cutaneous infestation by the human botfly, Dermatobia hominis, results in furuncular myiasis. This condition is endemic to the forested areas of Mexico, Central and South America. However, because of widespread travel, furuncular myiasis has become more common in North America. ⋯ To our knowledge, there is only a single report of botfly myiasis in the recent emergency medicine literature, which is surprising since the emergency department is likely to be the place many patients with this condition first seek attention. We present and discuss the case of a 50-year-old man with furuncular myiasis acquired in Belize. Parasitic infestation should be included in the differential diagnosis of a new skin lesion in patients who have travelled to endemic areas.
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Emergency department (ED) triage prioritizes patients based on urgency of care, and the Canadian Triage and Acuity Scale (CTAS) is the national standard. We describe the inter-rater agreement and manual overrides of nurses using a CTAS-compliant web-based triage tool (eTRIAGE) for 2 different intensities of staff training. ⋯ Agreement between study nurses and duty triage nurses, both using eTRIAGE, was moderate to good, with a trend toward improvement with additional training. Triage overrides were infrequent. Continued attempts to refine the triage process and training appear warranted.
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US emergency personnel cared for 106% more patients in 1990 than they did in 1980, and national emergency department census data show that 60%-80% of those patients presented with non-urgent or minor medical problems. The hiring of nurse practitioners (NPs) is one proposed solution to the ongoing overcrowding and physician shortage facing emergency departments (EDs). ⋯ The medical community should further explore the use of NPs, particularly in fast track areas for high volume departments. In rural areas, NPs could supplement overextended physicians and allow health centres to remain open when they might otherwise have to close. These strategies could improve access to care and patient satisfaction for selected urban and rural populations as well as make the best use of limited medical resources.