Articles: hospital-emergency-service.
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The emergency nurse practitioner (ENP) is a rapidly developing role within emergency health care provision in the United Kingdom (UK). This paper explores some of the available literature concerning the development of the role in the context of major accident and emergency departments. The professional and legal implications of this shift in role boundaries are discussed. ⋯ The relative plethora of rigorous evaluation studies of ENP role effectiveness in North America, is contrasted with the current paucity of empirical data available in the UK. A number of methodological issues concerning the evaluation of ENP services are identified. The need for research in this area, alongside a programme of continuing local audit to guide and inform evidence-based practice, is emphasized.
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As the 21st century approaches, the United States is moving, toward a more pluralistic society with regard to race, ethnicity, and national origin. With this increase in diversity has come a resurgence of hate crime violence. Scant information is available in the medical literature about hate crime violence, hate groups, hate crime violence legislation, or the physical and psychologic sequelae of hate crime violence on the individual and its effects on the community. Guidelines for the treatment of victims of hate crime violence in the prehospital care setting, ED, and inpatient setting are proposed.
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This article provides brief updates, pearls, and pitfalls on aspects of emergency practice that are dealt with routinely, including the application of diagnostic testing in the emergency department, ruling out subarachnoid hemorrhage, and the use of tympanic temperatures. Physician-patient and physician-physician communication skills are addressed. Finally, medicolegal and administrative topics, such as EMTALA, writing admitting orders, treating minors in the emergency department, and blood product therapy in Jehovah's Witnesses are also discussed.
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The evaluation of chest pain in the emergency setting should be systematic, risk based, and goal driven. An effective program must be able to evaluate all patients with equal thoroughness under the assumption that any patient with chest pain could potentially be having an MI. The initial evaluation is based on the history, a focused physical examination, and the ECG. ⋯ These strategies should include additional methods of identifying acute coronary syndromes in patients initially appearing as at moderate or low risk to assure that no unstable patients are discharged. All patients should be followed up closely until the cardiovascular evaluation is completed and, when possible, a definitive diagnosis is determined. Finally, this must be done efficiently, cost-effectively, and in a manner that will result in an overall improvement in patient care.
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Patients who attend Accident and Emergency (A & E) departments with problems that could be dealt with by their general practitioners (GPs) use time and resources of the department that could be otherwise used for patients with more appropriate needs. Definitions used for inappropriate attendance are drawn from the literature, and the usefulness of the term is discussed in the light of evidence that these patients have logical reasons for attending. ⋯ The reluctance of GPs to treat minor injuries in their surgeries is noted. The implications of changing the service provided in A & E to accommodate or deter patients with primary care problems are discussed.