Articles: emergency-services.
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With improved rapid transportation systems, an increasing number of children may arrive at the emergency room (ER) without detectable vital signs and may undergo vigorous resuscitation, including emergency room thoracotomy, aortic cross clamping, and open cardiac massage. Of 1,287 pediatric trauma admissions between 1980 and 1985, 101 deaths were recorded. Fifty (50%) of the deaths occurred in the ER. ⋯ Despite maximal conventional resuscitation and ER thoracotomy, none of the 17 patients survived. In this group of pediatric blunt trauma victims who appear initially salvageable, and present in the ER with no detectable vital signs, ER resuscitative thoracotomy did not influence survival. ER thoracotomy in children, therefore, should be reserved for patients presenting with penetrating thoracic injuries or blunt injuries associated with detectable vital signs and deterioration despite maximal conventional therapy.
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We present a method for a microcomputer-assisted emergency department daily chart audit using a spreadsheet format. Computer technology allows the extraction of a large amount of information from audit data with a minimum of clerical time. The software automatically tabulates, sorts, and updates audit data, and depicts physician performance in a quantitative manner. ⋯ The spreadsheet model is flexible, and can be adapted to the needs of various emergency departments or quality assurance activities. The audit has a rapid turnaround time, with charts audited and returned to physicians for feedback within 24 hours of the patient being discharged. Individual physician confidentiality is maintained throughout.
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All emergency departments face the possibility of having insufficient personnel to provide adequate care for patients. Such occasions may present an emergency department with several severely injured patients or merely an unusually large number of that emergency department's usual patient profile. ⋯ In addition, emergency department directors have an obligation to consider their particular staffing and usage patterns in order to try to devise the most efficient back-up policy prior to need. Finally, assessment of the success with which such back-up policies are used is discussed.
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Social science & medicine · Jan 1987
Historical ArticlePsychiatric emergency services: evolution, adaptation and proliferation.
This paper traces the dramatic rise of psychiatric emergency services (PES) and crisis intervention services over recent decades. It examines three processes--the evolution of such services, their adaptation to diverse settings, and the striking increase both in the number of programs and their utilization. PES first evolved along three disparate lines--makeshift psychiatric emergency care in the emergency room of the general hospital, ad hoc after-care services in the psychiatric hospital, and the community mental health movement. ⋯ Although PES were initially visualized as resources for acute mental health care and continue to serve as such, they have become increasingly chronicized, consequent on the deinstitutionalized abandonment of many chronically ill persons. Changes are also occurring in the social and demographic characteristics of persons utilizing PES and in the ways in which the services are perceived and utilized. The early development of unlabeled and makeshift psychiatric emergency care in the general hospital's emergency room and the psychiatric hospital were instances of 'evolutionary planning'.(ABSTRACT TRUNCATED AT 250 WORDS)
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Exsanguination may be presumed in pale, mottled, unresponsive trauma victims with no palpable pulse nor spontaneous respirations with noncranial penetrating wounds. Under ideal circumstances, those victims initially witnessed to have some signs of life can be successfully revived in 5 to 25% of cases. ⋯ After confirming the witnessed cardiopulmonary arrest from presumed exsanguination, the four phases of resuscitation are restoring central oxygenation, controlling internal hemorrhage, re-establishing spontaneous cardiac function, and definitively repairing the injury. Regardless of the type or location of the noncranial penetrating injury, these phases must be accomplished sequentially to minimize the risks of cerebral and cardiac anoxia.