Articles: emergency-services.
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Pediatric emergency care · Jun 1991
Toxic exposures and ingestions in Honolulu: I. A prospective pediatric ED cohort; II. A prospective poison center cohort.
Poisonings and toxic exposures are a frequent cause of preventable morbidity in children requiring emergency care. Ingestions and toxic substance exposures were studied in two prospective cohorts in Hawaii to examine the epidemiology of these events in this community in order to assess the effectiveness of current poison prevention practices and to identify additional measures to further prevent and reduce morbidity and mortality. During a 12-month period ending on 11/30/88, data were collected on 286 pediatric patients visiting a pediatric ED with an ingestion or a toxic substance exposure. ⋯ Although ipecac is widely recommended as a pre-hospital intervention, it use is limited owing to unavailability in the home and the short period of time during which it must be given. Since the dispensing of pharmaceuticals in limited quantities and in childproof containers began, it appears that other measures to further reduce morbidity and mortality owing to poisonings have had less additional effect. It appears that serious morbidity and mortality from poisonings in this cohort were uncommon.
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To evaluate whether the capillary refill test can correctly differentiate between hypovolemic and euvolemic emergency department patients. ⋯ Capillary refill does not appear to be a useful test for detecting mild-to-moderate hypovolemia in adults.
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Four per cent of patients attend the Accident and Emergency Department (A&E) present with chest pain. In this prospective study of 297 patients the value of chest radiography is assessed. ⋯ Twenty-nine per cent of CXRs were misinterpreted by Casualty Officers but resulted in the mismanagement of only six patients (3.3%). Potentially serious errors were averted by early CXR audit by a Radiologist.
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To describe the clinical and ECG features of cocaine abusers evaluated in the emergency department and admitted to the medical coronary care unit with chest pain consistent with myocardial ischemia. ⋯ Our findings confirm a small but significant incidence of myocardial infarction in cocaine abusers presenting to the ED with chest pain. The chronicity of cocaine abuse, the persistence of ECG abnormalities, and the variable temporal relationship of chest pain to cocaine abuse suggest possible chronic myocardial changes as etiologies of ischemia.
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The eye care provided by an Accident and Emergency (A&E) Department was prospectively studied over a 2-month period. Six out of a total of 506 patients were deemed to have been treated unsatisfactorily by the A&E Department. None of these patients suffered serious sequelae. Approximately one in three of those patients seen solely by A&E staff failed to have their visual acuity recorded.