Accuracy of emergency radiograph interpretation by emergency physicians

The incidence of abnormalities in 1,869 sets of radiographs was recorded, and the accuracy of the interpretation of these films by emergency physicians was assessed. Abnormalities were most frequent in hip/femur (52.5%), thoracic spine (46.7%), and shoulder (44.8%) films and least frequent in skull (5.7%), cervical spine (14.9%), and foot (15.7%) films. The accuracy of interpretation by emergency physicians for all categories of films was 93.6%, with 1.8% false positives and 4.6% false negatives. Overreading of abnormalities occurred most often in thoracic spine (12.5%) and hip/femur radiographs (9.1%). The incidence of missing existing pathology was highest for abdomen (40.0%) and knee (31.6%) films. The overall accuracy of the emergency physicians in interpretation of emergency films was excellent. Increased didactics in particular areas of interpretive inaccuracies should be considered.     

2009年自贡市急救中心院前急救反应能力分析

目的通过客观指标评估2009年自贡市急救中心院前急救反应能力。方法回顾性分析自贡市急救中心2009年所有院前急救数据库,计算接警受理时间、出车准备时间、应急反应时间、急救半径,并与2007年应急反应时间、急救半径比较,分析其可能的影响因素。结果全年院前出诊病例共4588例,接警受理时间为（41.92±10.76）秒,出车准备时间为（2.03±1.11）分钟,白班出车准备时间比夜班短（P（0.05）,急救半径为（10.39±11.24）km;应急反应时间为（20.31±19.61）分钟,与出诊范围、昼夜分布有关（P（0.05）;急救半径及应急反应时间较2007年增加（P（0.05）。结论进一步普及急救知识,提高急诊队伍急救能力,加强急救网络标准化建设,不断提高急救反应能力,方能满足人民群众对急救资源需求的增加。     

A late shift in accident and emergency accident emergency

The Accident and Emergency (A & E) department at Harrogate District Hospital in North Yorkshire, UK, serves a population of 142 000 in a catchment area that covers Harrogate, Knaresborough, Ripon, Nidderdale, part of Wetherby, and occasionally Ilkley and Otley.In 1994, 29 884 new patients attended the department, and 6760 return visits were made.There are large fluctuations in the workload of the department that are difficult to predict.This account of a late shift demonstrates particular problems that are associated with a split site hospital, the transfer of acutely ill and injured patients to specialised units, and how the nursing workforce is depleted by 25% if one nurse is absent due to sickness.     

急救护理流程再造在急诊抢救中的应用

[目的]对急诊病人的抢救护理流程进行再造,以提高急诊抢救质量。[方法]将151例急诊抢救病人随机分为对照组(73例)和实验组(78例),对照组采用原有急救护理流程,实验组采用新构造的急救护理流程,观察两组病人抢救成功率、病人满意度、医生对护士满意度。[结果]实验组病人抢救成功率、病人满意度、医生对护士满意度优于对照组,差异有统计学意义(P<0.05或P<0.01)。[结论]新构造的急救护理流程采用连续无缝隙抢救,为病人提供全程护理,不仅提高了急救护理质量,而且减少了护患矛盾。     

应急管理路径在急诊手术护理中的应用

目的 运用应急管理路径,提升急诊手术护理水平,提高急救护理质量.方法 调查分析手术室急诊护理中的相关危险因素,制定科学的应急管理路径,启动专项应急管理,观察与评价急诊手术的护理质量.结果 实施与应用各种应急管理路径后,手术室护士急救意识提高,应急应变能力增强,急救护理质量明显提高.结论 应急管理路径的实施有助于提高手术...     

Application of emergency severity index in pediatric emergency department

BACKGROUND:

The purpose of triage is to identify patients needing immediate resuscitation, to assign patients to a pre-designed patient care area, and to initiate diagnostic/therapeutic measures as appropriate. This study aimed to use emergency severity index (ESI) in a pediatric emergency room.

METHODS:

From July 2006 to August 2010, a total of 21 904 patients visited the International Department of Beijing Children’s Hospital. The ESI was measured by nurses and physicians, and compared using SPSS.

RESULTS:

Nurses of the hospital took approximately 2 minutes for triage. The results of triage made by nurses were similar to those made by doctors for ESI in levels 1-3 patients. This finding indicated that the nurses are able to identify severe pediatric cases.

CONCLUSION:

In pediatric emergency rooms, ESI is a suitable tool for identifying severe cases and then immediate interventions can be performed accordingly.KEY WORDS: Pediatrics, Emergency Department, Triage, Emergency severity index     

Patients' emergency contraception comprehension, usage, and view of the emergency department role for emergency contraception

Female Emergency Department (ED) patients were surveyed to determine their comprehension of the concept of emergency contraception (EC), to assess how often they had used EC in comparison to other forms of contraception, and to learn which patients want the ED to provide EC services. Most of the 761 respondents were aged < 35 years (62.1%), never married (42.9%), had been pregnant at least once (70.2%), had never had an abortion (76.1%), had never used EC (90.6%), and had sex with a man within the past month (70.7%). Respondents were 2.5 times more likely to have had an abortion than to have used EC; 85.3% could not correctly answer two questions that assessed comprehension of the concept of EC; 43.1% wanted the ED to offer EC, 55.6% to provide information about EC, and 52.6% to refer patients for EC. Younger patients, those who attended religious services infrequently, patients who had ever used EC, and those at risk of pregnancy were more likely to want the ED to provide EC services.     

急诊危重度指数在儿科急诊中的应用

目的 例证急诊危重度指数(ESI)在儿科急诊室的应用.方法 通过收集2006年7月至2010年8月,北京儿童医院国际部急诊21 904人次患儿的ESI分级资料,应用x2检验方法,回顾性对比分析医生和护士的分诊结果.结果 ESI容易掌握,护士分诊结果与医生矫正分诊结果有较好一致性.结论 ESI分诊系统适合儿科急诊分诊,能够迅速分检危重病例,有效利用临床资源.     

急诊快速病情严重程度评估--一种新的急诊病情评估方法

目的应用年龄、意识状态、呼吸、动脉收缩压、脉搏、经皮血氧饱和度、心电图、体温、快速血糖9项指标监测对患者进行病情评估,以期得到急诊快速病情严重程度评估方法（rapid emergency severity assessment, RESA）。方法本组临床研究采取自然收集资料、回顾性分析,选取2008-12-26～2010-09-13我院急诊科的急危重症抢救病例3089例,将患者急诊就诊后第7日的生存或死亡作为金标准,计算RESA 方法ROC 曲线下面积、敏感度、特异度。结果以7日死亡与存活为金标准,RESA ROC 曲线下面积为0．956。符合2项异常为界值,7日死亡率高,敏感度97．3％,特异度81．7％。结论 RESA 是继RAPS、EWS 和MEWS 评分系统、REMS、SCS 之后用于急诊病情评估的一种新的方法,优点是以定性代替定量评分,快速、简捷、实用性强。     

Structure and function of the emergency department: matching emergency department choices to the emergency department mission

Emergency caregivers experience considerable new challenges to the provision of competent, compassionate care. The good news is there are ample new approaches and new technologies to meet those new challenges.ED leaders who understand the ED mission and the resources available today and who engage vigorously in the change process will turn that mission into immensely beneficial action.     

Characterizing emergency departments to improve understanding of emergency care systems

Background

Air ambulance services in the Arctic have to deal with remote locations, long distances, rough weather conditions and seasonable darkness. Despite these challenges, the people living in the area expect a high quality of specialist health care.

Aims

The objective of this study was to analyse the air ambulance operations performed in the Norwegian Arctic and study variations in diagnoses and flight patterns around the year.

Methods

A retrospective analysis. All air ambulance operations performed during the time 1999 - 2009 period were analysed. The subjects were patients transported and flights performed. The primary outcome measures were patients' diagnoses and task patterns around the year.

Results

A total of 345 patients were transported and 321 flights performed. Coronary heart and vascular disease, bone fractures and infections were the most common diagnoses. Most patients (85%) had NACA score 3 or 4. Half of all fractures occurred in April and August. Most patients were males (66%), and one fourth was not Norwegian. The median flying time (one way) was 3 h 33 m. Ten percent of the flights were delayed, and only 14% were performed between midnight and 8.00 AM. The period April to August was the busiest one (58% of operations).

Conclusions

Norway has run a safe air ambulance service in the Arctic for the last 11 years. In the future more shipping and polar adventure operations may influence the need for air ambulances, especially during summer and autumn.