Articles: emergency-services.
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In the last ten years, many emergency medicine specialists have studied animal bite wounds. The majority of these studies have addressed the controversies of prescribing prophylactic antibiotics or suturing wounds. This study was undertaken to determine risk factors for cat bite wound infections. ⋯ In this study, wound type and wound depth were the most important factors in determining the likelihood of developing wound infection regardless of whether the patient was prescribed prophylactic oral antibiotics.
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To assess the extent and distribution of hospital and emergency department crowding nationally. ⋯ Our study strongly suggests that ED crowding is not an isolated phenomenon; ED crowding and its attendant problems appear to affect hospitals with similar adverse effects regardless of ownership. Although our results suggest that ED crowding is concentrated in metropolitan areas and in a smaller subset of hospitals, we found instances of crowding among hospitals nationwide.
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To determine the sensitivity, specificity, and predictive values of a new rapid creatine kinase-MB (R-CK-MB) assay compared with a standard CK-MB (S-CK-MB) assay and to determine its potential use in the evaluation of emergency department patients with possible myocardial infarction. ⋯ The R-CK-MB assay demonstrated high sensitivity and specificity compared with the S-CK-MB assay. When used for patients in whom a cardiac care unit admission is not considered, the rapid assay may identify some patients with unsuspected myocardial infarction and prevent inadvertent discharge or admission to unmonitored beds.
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Widespread application of thrombolytic therapy has increased the importance of rapid triage and intervention for the patient who seeks treatment in the emergency department (ED) for suspected acute myocardial infarction. It has been suggested that all patients with acute myocardial infarction who might benefit from thrombolytic therapy should receive treatment within the first "golden hour" of arrival at the hospital ED. Busy urban medical centers, particularly public hospitals serving a large proportion of indigent patients, face special challenges in attempting to meet this goal. ⋯ Hospital administrators must recognize the unique problems created in the ED when inpatient beds are unavailable. The hospital must also have efficient bed turnover and a community-wide plan for dealing with patients when the ED "closes" to incoming ambulance traffic. Governmental entities must recognize the consequences of their actions in curtailing health care benefits for those who cannot afford care in private hospitals.
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Ann R Coll Surg Engl · Sep 1991
Assessment of burn injury in the accident and emergency department: a review of 100 referrals to a regional burns unit.
Accurate assessment of the extent of thermal injury in the accident and emergency (A&E) department is essential if appropriate resuscitation and referral to a specialist unit is to occur. However, review of 100 referrals to a regional burns unit confirms that assessment is often inaccurate, and usually undertaken by no one more senior than a casualty officer, leading to suboptimal treatment and referral. Severe thermal injury should be assessed by a team of senior doctors, according to the major trauma protocol, and casualty officers should receive better training in the assessment of less extensive burns.