Articles: emergency-services.
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It is still a common practice to continue unsuccessful field resuscitations in the emergency department (ED) even after prolonged estimated down times. The authors studied patients who arrested in the field and did not regain a pulse before their arrival in the ED to determine if any ever leave the hospital neurologically intact. All cardiac arrests in the urban St Louis area that were brought to our facility over a 2 1/2-year period by advanced life support units (excluding all patients with hypothermia, drug overdose, near drowning, and traumatic cardiac arrest) were reviewed. ⋯ Eighteen of these patients were admitted but only one was discharged neurologically intact. The only survivor in the group without a pulse arrested while en route to the ED. It is concluded that cardiac arrest victims who arrive in the ED without a pulse on arrival or en route have almost no chance of functional recovery.
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Pediatric emergency care · Mar 1990
Pediatric critical care transport survey: team composition and training, mobilization time, and mode of transportation.
A survey was conducted to determine the current standard of care with regard to team composition and training, mobilization time, and vehicle use for pediatric critical care transport. An evaluation of 30 pediatric referral centers revealed that 60% provide a critical care transport team. Of those teams, the mean number of transports per year was 304. ⋯ All teams included a physician all or most of the time; 100% of teams included a critical care nurse, and 50% always included a respiratory therapist. Ambulances alone are used in 28% of systems, with the remainder using combinations of ambulances, helicopters, and fixed wing aircraft. A proposal is presented for future standards in pediatric critical care transport with regard to the factors discussed.
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In a prospective study lasting 6 months, all missed injuries in patients visiting the casualty department or admitted to the orthopaedic department of Aarhus Amtssygehus were registered and analysed. A total of 15,806 patients attended the casualty department and 783 patients were admitted to the orthopaedic department. ⋯ Twenty-three injuries were missed in 17 patients in the orthopaedic department making a missed injury rate of 2.2 per cent. Re-examination of all patients and matching radiographs reduced the number of missed injuries significantly.
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We evaluated the frequency with which blood alcohol concentrations were obtained in emergency department patients with presumed alcohol impairment, whether physicians counseled impaired patients not to drive, and whether safe transportation was available. ⋯ Presumed alcohol-impaired patients seen in emergency departments frequently have blood alcohol concentrations measured. Despite documented evidence of driving impairment there is little evidence that such patients are counseled not to drive or that safe transportation home is available.
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The AIDS epidemic is having an increasing impact on the practice of emergency medicine. In inner-city emergency departments, significant numbers of patients have unrecognized human immunodeficiency virus (HIV) infection. Transmission of HIV in the health care setting has been predominantly from exposure to patients' infected blood, but most of the exposures (80%) are due to injuries from sharp instruments. ⋯ However, due to methodologic limitations, these figures may be underestimations. The effectiveness of azidothymidine for postexposure prophylaxis has not been shown. Currently, the best protection against HIV and other blood-borne pathogens remains use of universal precautions.