International journal of emergency medicine
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Early use of continuous positive airway pressure (CPAP) has been shown to be beneficial within the setting of acute cardiogenic pulmonary edema (ACPE). The Boussignac CPAP system (BCPAP) was therefore introduced into the protocols of emergency medical services (EMS) in a large urban region. This study evaluates the implementation, practical use and complications of this prehospital treatment. ⋯ A significant portion of patients with clinical signs of acute cardiogenic pulmonary edema in the prehospital setting is not treated according to protocol using BCPAP. Based on the small group of patients that actually received BCPAP treatment, the facial mask seems feasible and effective for the treatment of acute cardiogenic pulmonary edema in the prehospital setting.
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It is not known whether lack of recognition of organ failure explains the low compliance with the "Surviving Sepsis Campaign" (SSC) guidelines. We evaluated whether compliance was higher in emergency department (ED) sepsis patients with clinically recognizable signs of organ failure compared to patients with only laboratory signs of organ failure. ⋯ The presence of clinically evident compared to biochemical signs of organ failure was associated with increased compliance with a SSC-based resuscitation bundle and admission to the ICU, suggesting that recognition of severe sepsis is an important barrier for successful implementation of quality improvement programs for septic patients. In septic ED patients admitted to the ICU, the time to antibiotics was shorter compared to patients admitted to a normal ward.
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The incidence of delayed emergency calls and the outcome of out-of-hospital cardiac arrest (OHCA) may differ among public facilities when emergency calls are placed by institutional staff. The purpose of this study was to identify the actions prescribed in the rules and/or manuals of public facilities and to clarify whether the incidence of delayed emergency call placement and the outcome of OHCA differ among these facilities. ⋯ Manuals or rules for making emergency calls in our public facilities may contain incorrect information, and emergency calls may be delayed owing to correctable human factors. Such manuals should be checked and revised.
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Emergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland. ⋯ Swiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care.
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Increase in waiting time often results in patients leaving the emergency department (ED) without being seen, ultimately decreasing patient satisfaction. We surveyed low-acuity patients in the ED waiting room to understand their preferences and expectations. ⋯ Contrary to popular belief, at our ED a large proportion of low-acuity patients has a PCP and is medically insured. Providing patients with appropriate reasons for the wait, an accurate estimate of waiting time and creating separate areas to examine minor illness/injuries would increase patient satisfaction within our population subset.