J Emerg Med
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The study objectives were to ascertain historical and clinical criteria differentiating intracranial injury (ICI) in elderly patients with minor head trauma (MHT), and determine applicability of current head computed tomography (CT) scan indications in this population. A 12-month retrospective chart review was performed at a community teaching hospital with 34,000 annual Emergency Department (ED) visits. Included were patients > or = 65 years old sustaining MHT with a Glasgow Coma Scale (GCS) score of 13-15 who had a CT scan performed during their hospital stay. ⋯ In this study, no useful clinical predictors of intracranial injury in elderly patients with MHT were found. Current protocols based on clinical findings may miss 30% of elderly ICI patients. Head CT scan is recommended on all elderly patients with MHT.
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The objective of this study was to derive a simple equation to convert distances between air miles traveled by a helicopter and ground miles traveled by an ambulance. We performed a retrospective analysis of a convenience sampling of 245 "lights and sirens" ground ambulance transports between 1993 and 1997. Ground distances were recorded from odometer miles for each transport. ⋯ The approximation equation yielded an answer within 1 mile of the regression equation for distances up to 40 air miles. It is concluded that in a mixed rural and urban EMS system, one may convert air and ground mileage estimates by using the simple relationship: Ground miles = 1.3 (air miles). This conversion coefficient may prove useful for EMS personnel in designing reasonable helicopter utilization policies, making accurate transport decisions and conducting research.
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A 46-year-old woman presented to the Emergency Department with lethargy and respiratory depression after ingesting methadone. Initial oxygen saturation of 61% on room air did not improve with supplemental oxygenation. As venous access was initially unobtainable, naloxone was administered by nebulizer. ⋯ The patient did not develop severe withdrawal symptoms. Naloxone hydrochloride has been administered by various routes to treat opioid toxicity. Our report describes the successful use of nebulized naloxone for methadone toxicity.
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This study identifies factors associated with mode of transport to rural hospitals. We evaluated 11,541 trauma patient visits that came by ground ambulance or private vehicle to the Emergency Department of one of six northwest Iowa rural hospitals. We performed univariate analyses and logistic regression analyses to identify factors associated with mode of transport for each severity level (fatal, major and minor). ⋯ We conclude that for major/fatal injuries, older persons, those injured from high velocity causes, and those with hip fractures are more likely to use an ambulance. Emergency Medical Services may improve the community's ambulance utilization by providing public education (e.g., proper use of 911 and injury severity recognition), and by collaborating with dispatch, the local community and health care providers. Further study of the community's and individuals' decision-making factors determining mode of transportation is needed.