Articles: emergency-services.
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The initial electrocardiogram is crucial in accurately selecting patients with chest pain for thrombolytic therapy. An electrocardiogram with a large amount of ST-segment elevation and depression is "visually alarming," and therefore, may influence the efficiency of patient treatment with thrombolytic therapy. It was hypothesized that the amount of ST-segment deviation present on the initial electrocardiogram was an important variable in determining the time to initiation of thrombolysis in the emergency department. ⋯ Regression analysis of multiple clinical variables revealed that ST-segment sum was the only variable that significantly influenced the time to thrombolysis (r = -0.42; p < 0.001). For patients treated in < or = 30 minutes, the average ST-segment sum was 21.1 +/- 13.5 vs 11.5 +/- 11.4 mm for those treated in > or = 60 minutes (p = 0.01). In 10 patients mistakenly treated with thrombolytic therapy, the electrocardiographic processes responsible for ST-segment elevation included the early repolarization variant, left ventricular hypertrophy, old anterior AMI with persistent ST-segment elevation, and conduction delay.(ABSTRACT TRUNCATED AT 250 WORDS)
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To improve understanding of the patterns of injury morbidity and mortality in an urban African-American population. ⋯ Interpersonal intentional injury occurs frequently in this population. More attention needs to be paid to prevention and intervention to reduce the toll of this violence. The high prevalence of injury in certain age strata may make general, population-based efforts for injury prevention more efficient than efforts targeted to subgroups.
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The objective of this study was to describe the characteristics and clinical course of patients who receive emergency department (ED) migraine treatment and their association with frequent ED visits. All migraine patient records during a 42-month period were reviewed retrospectively at an urban teaching hospital ED. One hundred eighty-five migraine patients had 339 total visits; 133 had a single visit; 31 had two visits; and 21 patients had three or more ED visits (range, 3 to 26 visits). ⋯ A small group (11.4%) of patients accounted for 42.5% of all ED visits. Given the nature of severe, frequent migraines and the current lack of consistently effective therapy, this may be a common ED phenomenon. More effective management strategies and therapy that will enable patients to reduce their dependence on the ED for treatment would be useful for patients with multiple ED visits.
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The objective of this study was to evaluate the characteristics of the patient population of an urban emergency department (ED) in The People's Republic of China. A prospective observational study was conducted at a university-affiliated hospital adult ED medical unit and included all patients visiting the medical unit of the ED during a 2-week period. A data collection log was designed and placed in the ED. ⋯ These data offer emergency physicians a preliminary understanding of the clinic presentations and diagnoses of patients seen in a university-affiliated urban hospital ED in China. The number and length of time patients were held in observation unit point out the shortage of in-hospital beds. This study is useful for describing and understanding characteristics of the patient encounter and for improving the delivery of emergency care in China.