Sudden unexpected death in the emergency department: caring for the survivors.

OBJECTIVE: To determine whether emergency department staff met the needs of the next of kin and close friends ("survivors") of patients dying in an emergency department and to assess the effectiveness of a program to improve care of survivors. DESIGN: Mail survey before and after program implementation. SETTING: Emergency department of a tertiary care, adult teaching hospital. PARTICIPANTS: Two groups of survivors, identified through a review of emergency department records of deaths during two 6-month periods. In the first group, surveyed in 1987, before program implementation, 26 (53%) of 49 responded; in the second group, surveyed in 1990, after program implementation, 40 (70%) of 57 responded. INTERVENTIONS: A structured, multidisciplinary protocol for notifying next of kin of death and supporting the survivors was implemented. An educational program was provided to all emergency department staff. An information pamphlet was created and provided to survivors. MAIN OUTCOME MEASURES: Questionnaire responses regarding the adequacy and timeliness of information provided, the support and actions by emergency department staff and the survivors' desire to be present during resuscitation efforts. RESULTS: Comparison of responses before and after program implementation showed that adequate information was provided before notification of death in 32% and 83% of cases respectively (p < 0.001), lengthy delays in receiving medical information occurred in 60% and 15% of cases (p < 0.01), adequate medical information concerning the events of death was provided in 53% and 88% (p < 0.05), the presence of emergency department staff was sufficient in 40% and 79% (p < 0.01), survivors spent less than 2 hours in the emergency department in 50% and 81% (p < 0.05), and survivors expressed a desire to be present during resuscitation efforts in 95% and 11% of cases (p < 0.001). CONCLUSION: The grievous experience of learning that a loved one has suddenly and unexpectedly died in the emergency department can be alleviated somewhat by a structured, multidisciplinary approach combined with staff sensitization and education.     

Coping with occupational stress in an accident and emergency department

Kingston Regional Hospital's Accident and Emergency Department (A&E), located in a volatile area of Kingston, Jamaica, treats 90-170 patients daily. It does so with limited staff and a potentially stressful work environment. This study explores the factors associated with occupational stress in the Department, and the coping strategies used by the doctors and nurses working there. A pre-tested self-administered questionnaire was completed by 28 (84.8%) of the total population (n = 33) of health personnel working in the A&E. The participants were 15 (53.6%) doctors, eight (28.6%) registered nurses and five (17.8%) enrolled assistant nurses. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 7.5. Qualitative data were analyzed by sorting texts into related themes and describing the ideas of the subjects. The median age was 32 years, range 23-50 years. Median duration of employment in the A&E was three years, range 0.5-22 years. Eighteen (60%) rated the A&E as "stressful". The major sources of stress were the external environment and the amount and quality of the workload. Ninety-six per cent reported experiencing one to seven emotional and physical symptoms. Forty-six per cent also reported behavioural symptoms. The emotional, physical and behavioural symptoms of stress were associated (p < 0.05). The number of behavioural symptoms experienced was associated with age (p < 0.05). The majority (89.2%) of doctors and nurses reported that they were satisfied with their jobs and had no intention of leaving their jobs within a year. This suggested the effectiveness of the reported humour, teamwork and "extracurricular" activities in buffering the effects of stress. Nurses were more likely to be "burned out" than doctors (p = 0.03). The respondents suggested increased monetary compensation, more staff and positive feedback from managers as factors which may relieve work stress. They suggested that organized counselling and stress management programmes would be useful.     

Acute confusion in the elderly

Acute confusion is common in the elderly ill patient. Its presence should provoke an urgent search for its cause. The key to management of acute confusion is in the removal or reversal of the factors responsible together with good nursing care.     

急诊科急救设备的配置与管理

文章简要介绍了急诊科医疗设备的配置与日常管理,以期对急救设备的配置形成一个相对比较合理完善的布局和管理体系,在投资不变的前提下,尽量为急诊科医生提供一个更加有效的支持.     

Quality improvement program in an emergency department

OBJECTIVE: To describe the quality assurance/improvement program in our emergency department ED. METHODS: This program involved monthly data collection and analysis, data-driven process change, staff education in the core concepts of quality, and data reanalysis from the years 2003 to 2006 at the King Abdul-Aziz Hospital, Al-Ahsa, Kingdom of Saudi Arabia. Data captured during the program included census data, chart review, and focused clinical audits. Continuous quality improvement measures collected at the beginning of the program and quarterly included: 1) quality indicators (length of stay [LOS] and rates of left against medical advice [AMA] or left without being seen [LWBS]), 2) percentage of patients that stay > or =3 hours in ED, unscheduled returns within 48 hours, inter-hospital transfer data, sentinel events tracking rates, and 3) nature of patient complaints. RESULTS: During the study period, the program demonstrated improvement in all measured areas. Despite an increase in patient volume of 47% to 51,698 visits/year, the mean monthly LOS remained static, the unscheduled returned visits dropped by 50% (2% to 1%), and patients leaving AMA decreased from 1.5% to 1.2%, and LWBS decreased from 1.6% to 0.8%. The rate of complaints dropped by 5 fold (1.3 per 1000 patients to 0.25). CONCLUSION: Our program demonstrated improvement in all the measured parameters.     

Short-term prognosis after emergency department diagnosis of TIA

Context  Management of patients with acute transient ischemic attack (TIA) varies widely, with some institutions admitting all patients and others proceeding with outpatient evaluations. Defining the short-term prognosis and risk factors for stroke after TIA may provide guidance in determining which patients need rapid evaluation. Objective  To determine the short-term risk of stroke and other adverse events after emergency department (ED) diagnosis of TIA. Design and Setting  Cohort study conducted from March 1997 through February 1998 in 16 hospitals in a health maintenance organization in northern California. Patients  A total of 1707 patients (mean age, 72 years) identified by ED physicians as having presented with TIA. Main Outcome Measures  Risk of stroke during the 90 days after index TIA; other events, including death, recurrent TIA, and hospitalization for cardiovascular events. Results  During the 90 days after index TIA, 180 patients (10.5%) returned to the ED with a stroke, 91 of which occurred in the first 2 days. Five factors were independently associated with stroke: age greater than 60 years (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.7; P = .01), diabetes mellitus (OR, 2.0; 95% CI, 1.4-2.9; P<.001), symptom duration longer than 10 minutes (OR, 2.3; 95% CI, 1.3-4.2; P = .005), weakness (OR, 1.9; 95% CI, 1.4-2.6; P<.001), and speech impairment (OR, 1.5; 95% CI, 1.1-2.1; P = .01). Stroke or other adverse events occurred in 428 patients (25.1%) in the 90 days after the TIA and included 44 hospitalizations for cardiovascular events (2.6%), 45 deaths (2.6%), and 216 recurrent TIAs (12.7%). Conclusions  Our results indicate that the short-term risk of stroke and other adverse events among patients who present to an ED with a TIA is substantial. Characteristics of the patient and the TIA may be useful for identifying patients who may benefit from expeditious evaluation and treatment.      

急诊心血管疾病的超声诊断价值

目的讨论急诊心血管疾病的超声诊断价值。方法现随机选取2017年1~12月我院收治的心血管疾病患者100例进行超声检查,将检查结果和病理结果进行对比。结果参与本次调查的100例患者中,超声诊断结果和患者病理结果差异无统计学意义(P0.05);超声诊断检出疾病种类和病理疾病种类差异无统计学意义(P0.05)。结论在急诊心血管疾病的诊断中可采取超声检查方式,检查效果显著,值得临床推广和应用。     

Improving the interpretation of electrocardiographs in an accident and emergency department.

In this study we have examined the ability of senior house officers in the Accident and Emergency (A&E) Department to interpret electrocardiographs (ECGs) and tested the value of a single seminar and guidelines on interpretation. We prospectively audited ECG interpretation taken from notes over a two-month period and repeated this audit following a single seminar by a consultant cardiologist and after the issue of guidelines. A formal test of interpretation of a set of 20 ECGs by senior house officers in A&E was also carried out. 245 case notes were reviewed and in one third the ECG was interpreted incorrectly by senior house officers in A&E but incorrect clinical management followed in only 3.2% of cases. Following the intervention, 242 case notes were reviewed and serious misinterpretations were halved as was the number of patients mismanaged as a result (1.7%). In conclusion, formal training in ECG interpretation can reduce serious errors.     

Alcohol-related attendances at an accident and emergency department.

Using a self-administered alcohol-related questionnaire and the clinical records a survey was made of the prevalence and severity of alcohol-related problems in the accident and emergency department at the Belfast City Hospital. Of 10,410 consecutive attendances during three months, 6,625 completed a questionnaire: 4,349 admitted they took alcohol at some time, 906 men exceeded 21 units weekly, and 490 women exceeded 14 units weekly. The majority of those who drank were under the age of 35 years. Only 182 considered that they might have an alcohol-related problem. Possible health promotion initiatives for these at-risk patients are considered which might be used specifically in an accident and emergency department.     

Acute asthma: emergency department management and prospective evaluation of outcome.

To determine the current management of acute asthma in the emergency department and to evaluate outcome we reviewed the charts of 99 patients aged 15 to 55 years who presented to the emergency department of a tertiary referral, university-affiliated hospital and were subsequently discharged with a diagnosis of acute asthma. Outcome was evaluated prospectively, with a structured questionnaire, by telephone. During the visit pulsus paradoxus was documented in four patients. Spirometry was done in 63 patients; postbronchodilator values ranged from 0.9 to 4.1 L. A total of 92 patients received inhaled bronchodilator therapy, most by wet nebulization. Sixteen patients received anticholinergic agents and three received theophylline. Ingested corticosteroids were given to 27 patients. Of the 71 patients contacted, a mean of 12 days after the visit, 26 (37%) had sought further medical attention, 19 at the emergency department; 9 had required admission. Forty-six patients reported that their condition had improved, but over 60% continued to have cough, sputum production, nocturnal waking and early-morning chest tightness. The results indicate that asthma continues to be undertreated in the emergency department and highlight the importance of routine spirometry in all patients and the need for systemic corticosteroid therapy.     

Audit of an urban paediatric emergency department visits

Background:

This study aimed to highlight the health seeking behavior of children in an Emergency Department (ED).

Materials and Methods:

Retrospective files review of ED was done for the month of July, 2008. Data about the children ≤12 years of age was gathered.

Results:

In one month period a total 21000 patients visited our ED, out of them 6120 (29%) were children. Males, Saudis and children of (1-6 years) were more frequent, i.e., 3540 (57.8%), 5760 (94.1%) and 3180 (52%), respectively. Majority of patients visited in shift “2”, i.e., 15:30 hours to 23:30 hours. Among the patients “diseases of respiratory system” were found more frequent 4170 (68.1%) and main diagnosis was “acute upper respiratory tract infection” 3300 (53.9%). Non-urgent cases were 2020 (33%) while 244 (4%) were admitted.

Conclusion:

Young children as well as non-urgent cases were predominant. Evening shift was the busiest one.     

急性脑卒中并发高渗性非酮症糖尿病昏迷急诊诊治分析

目的分析急性脑卒中并发高渗性非酮症糖尿病昏迷急诊诊治效果。方法选择2014-01—2016-12间在息县人民医院接受治疗的92例急性脑卒中并发高渗性非酮症糖尿病昏迷患者,均经由急诊收治入院,分析治疗效果。结果 92例患者主要发病因素为呼吸系统感染,其次为尿路感染及消化系统炎症;所有患者苏醒时间(21.20±6.82)h,渗透压恢复正常时间(32.69±11.52)h、休克纠正时间(12.82±5.63)h;92例患者血糖、血钠、血钾、血素氮以及血浆胶体渗透压治疗后均明显好转,优于治疗前,差异有统计学意义(P<0.05);发生并发症22例,死亡18例(19.57%),抢救失败13例,放弃5例),初诊误诊27例(29.35%)。结论急性脑卒中并发高渗性非酮症糖尿病昏迷死亡风险非常高,因此需尽早发现,准确诊断,迅速评估病情,尽快纠正其水电解质紊乱情况,针对诱发因素积极改善临床表现,提高抢救成功率。