Articles: hospital-emergency-service.
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Review
Accuracy of interpretations of emergency department radiographs: effect of confidence levels.
We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. ⋯ No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist.
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Our approach to the management of fear and pain in the pediatric emergency department is presented. Tricks to attempt the gaining of rapport with frightened children in pain are noted, with emphasis on a developmental approach. The use of analgesic medications, local anesthetics, ketamine, and nitrous oxide as appropriate to emergency situations is outlined. Lastly, the guidelines of the American Academy of Pediatrics for outpatient sedation are reviewed.
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Thirty-nine emergency cricothyrotomies were reviewed from the emergency department of Hennepin County Medical Center during the 4-year period ending December 1985. Due to technical changes in airway management and a desire to assess their impact, this experience was compared with a previously reported series of 38 emergency cricothyrotomies from the same department. Technical changes include the use of paralyzing agents, transtracheal needle ventilation, and the use of only vertical skin incisions and #4 Shiley tubes when cricothyrotomy is performed. ⋯ However, the tube was in the trachea in all cases, and acceptable ventilation was achieved. No patient developed a clinically significant hematoma or hemorrhage from cricothyrotomy. It is concluded that our technical changes in airway management have helped to decrease both the relative frequency of cricothyrotomy and the complication rate.
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Review Case Reports
The assessment and treatment of pain in the emergency room.
A broad spectrum of painful conditions presents to the modern emergency center (EC). The three most common categories are acute, self-limited disorders; chronic medical or surgical syndromes with acute exacerbation; and psychic pain syndromes in which the etiology cannot be easily ascertained. Many factors may differentiate pain from suffering, and physicians should educate patients not only about the nature of their condition and its prognosis, but also about anticipated discomfort. ⋯ Two special groups of patients, those with psychic pain syndromes and those with drug-seeking behavior, can create problems for the physician. Patients with chronic pain syndromes need special follow-up but do not benefit from additional analgesic drug therapy. Patients who seek and abuse drugs can be difficult to identify, may have true underlying medical pathology, and should not be given narcotic prescriptions.
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J Health Soc Policy · Jan 1989
ReviewMedical indigency and inner city hospital care: patient dumping, emergency care and public policy.
This paper discusses the growing lack of private for-profit hospital care for the medically indigent. The issues of patient dumping and emergency care are examined from both judicial and public policy perspectives. The paper concludes by noting that dumping may be viewed as a most serious form of neglect and more comprehensive laws and court decisions are needed to require all hospitals, regardless of ownership, to treat all patients who arrive at their doors if they have the appropriate medical staff and facilities.