Articles: emergency-services.
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Recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for the triage and resuscitation of critically ill patients during the 'golden hour' in the emergency department. Vital signs, shock index and invasive monitoring of mean arterial pressure and central venous pressure have limited roles in evaluating cumulative oxygen debt and systemic oxygen balance in an acute critical illness. ⋯ Organ-specific oxygenation indices such as gastric tonometry and renal function can supplement indicators of systemic oxygen balance to detect ischaemia-hypoxia of non-vital organs. Systemic oxygenation and organ-specific indices can guide the choice of therapy to optimize resuscitation of the macro- and microcirculation in critically ill patients in the emergency department.
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Emergency department patients who leave without seeing a physician: the Toronto Hospital experience.
To determine why emergency department patients leave without being seen by a physician and whether they receive alternate medical care. ⋯ The majority of survey respondents had a low acuity rating and left because of prolonged waiting times. Most of these patients sought alternate medical care through their personal physician or other EDs.
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To determine the rate and cause of death of patients who were evaluated in the emergency department and discharged and how the cause of death related to the ED visit. ⋯ Death after discharge from the ED is uncommon. The most common cause of unexpected, directly related death is ruptured aortic aneurysm.
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To assess factors related to emergency department use in the Ontario population. ⋯ Our study estimated that approximately one in five Ontario residents had reported one or more visits to the ED in the past 12 months. There were identifiable subgroups in the population with increased ED usage even after adjustment for health needs factors.