Emergency medicine

Article Abstract:

Physicians who practice emergency medicine deal with a heterogeneous patient group and commonly manage several different cases simultaneously. The specialty itself functions on a 24-hour-a-day basis, in both prehospital (community) and hospital settings. Cardiac and cerebral resuscitation are important functions of emergency personnel. Success of cardiopulmonary resuscitation (CPR, the use of artificial respiration and external heart massage) can now be monitored using end-tidal CO2 content (content of carbon dioxide in expired air). Electromechanical disturbances of the heart are not amenable to treatment with CPR. Consequences of cardiac arrest (sudden cessation of heart activity) or stroke (loss of blood supply to the brain due to hemorrhage or blood clot) include cellular lactic acidosis, a condition in which cells are damaged by the build-up of lactic acid. Several approaches may be used to treating hemorrhagic shock (shock resulting from excessive blood loss). Patients who have taken overdoses of drugs, including cocaine, may not need gastric decontamination (stomach pumping) if their symptoms are minimal. Patient awareness of the warning signs of certain conditions, such as myocardial infarction (heart attack), is necessary so that minimum time is lost before evaluation by health care personnel. Physician-developed protocols (standard procedures) for managing critically ill patients outside the hospital are preferable to individual case discussions between prehospital personnel and physicians during patient transport. Decision making is critical in effective emergency medicine, and it takes on a special importance as insurers become more selective regarding the treatments they will reimburse. A cost-effective alternative to discharging patients immediately from the emergency room is placing them in an observation unit, where they can be monitored. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Management, CPR (First aid), Cardiopulmonary resuscitation, Emergency physicians

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Emergency medicine

Article Abstract:

Advances in the practice of emergency medicine, including prehospital services and emergency room interventions, are discussed. Emergency medicine is benefitting from an increase in the quality and types of services rendered to patients before they arrive at a hospital. Injury prevention is another field in which advances can lead to increased survival rates for patients. Development of effective public health strategies can be aided by analysis of demographic characteristics of accidents and illnesses. Technical advances in the detection of acute myocardial infarctions include monitoring levels of enzymes in the blood and using artificial neural networks. Though high-dose epinephrine (HDE) was originally thought to be more effective in managing heart attack patients, recent research comparing survival rates of patients who received HDE with those who received standard doses of epinephrine found no difference in survival rates.

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Adequacy of hospital discharge status as a measure of outcome among injured patients

Article Abstract:

Analyzing mortality rates among injured patients at the time of discharge may not be the best way to evaluate trauma care. Researchers analyzed the medical records of 90,048 injured patients treated in the state of Washington from 1991 to 1993. The overall mortality rate at hospital discharge was 12.1 per 100,000 directly due to trauma and 9.1 per 100,000 due to non-traumatic causes. When mortality rates within 30 days of discharge were included, these rates rose to 14.1 per 100,000 and 21.3 per 100,000, respectively.

Patient outcomes, Mortality, Wounds and injuries, Injuries, Hospital patients, Hospitals, Hospital admission and discharge

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