Articles: emergency-services.
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Routine pelvic radiography is carried out in all blunt trauma patients referred to our Emergency Department according to advanced trauma life support protocols. In this retrospective study, we questioned whether it is cost-effective to obtain 'routine' pelvic X-ray films. The notes and X-rays of all consecutive patients with blunt trauma who were referred to the Emergency Department of Dokuz Eylül University Hospital, Izmir, Turkey, between August and December, 1993 were re-evaluated. ⋯ The difference between the groups were statistically significant (p < 0.001). As a result, we concluded that 'routine' pelvic radiography should be performed in the setting of blunt trauma only if the patient is: (a) unconscious, uncooperative or intoxicated, or (b) conscious, fully orientated and cooperative and complaining of pain both in the history and on pelvic examination. These limitations would allow us to decrease the amount of irradiation received, render more cost-effective treatment, and reduce the workload of emergency and radiology departments.
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To describe emergency department quality assurance (QA)/improvement (QI) practices for pediatric patients. ⋯ The bulk of pediatric emergency patients are cared for in a general ED. Most ACEP members surveyed reported the use of separate QA indicators to monitor the care of pediatric patients seen in the ED. This survey provides the first description of QA/QI practices for pediatric patients by EDs nationwide.
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To examine whether well-trained paramedics can perform emergent, successful, uncomplicated, endotracheal intubations during in-hospital cardiopulmonary resuscitation (CPR). ⋯ Paramedics can successfully, and without undue difficulty or complications, place endotracheal tubes during in-hospital CPR. Appropriately trained paramedics may be incorporated into hospital-based CPR teams in two contexts: (1) to provide an acceptable, long-term solution to the scarcity of personnel highly skilled in endotracheal tube placement during in-hospital CPR, and (2) to fulfill the need for hospitals to have on-site, qualified professionals to perform emergent endotracheal intubation during CPR. In the latter situation, personnel skilled in airway management could supplement the paramedics on demand. Further investigation in this area could be fruitful in view of the small sample size covered in this study.
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Diabetes mellitus accounts for 5.8% of the total health care costs of citizens of the United States. Hospitalization expenses produce 40.5% of these costs. We sought to determine the public expenditure and major precipitators of admissions for uninsured diabetic hyperglycemic emergencies at a large public hospital. ⋯ The uninsured patients were younger and had relatively mild disease in comparison to the insured patients. These patients identified a primary physician in only 6% of the cases and had a higher incidence of admissions associated with lack of medications. We conclude that public funds to provide access to primary care and enhancement of employer-sponsored health insurance programs may decrease the numbers and costs of hospitalizations due to hyperglycemic emergencies in uninsured patients with diabetes mellitus.