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A time lapse of > 4 hours in ICU transfer after the development of 1 or more physiologic threshold criteria was associated with greater mortality, longer hospital length of stay, and higher costs.
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Patients who were transferred directly to the authors medical ICU from other hospitals were sicker and had worse outcomes than those who were directly admitted. Benchmarking data generated without taking referral source into account erroneously indicated an excessive death rate and other adverse outcomes.
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The randomized, controlled trial (RCT) is believed to provide the strongest evidence for verifying both effectiveness and ineffectiveness of a given treatment. Once the RCT judges the proposed treatment as ineffective, it is rare that the treatment is ever evaluated again.
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Good ED/ICU networks are becoming more important as more rural hospitals close due to lack of funding, says Janet Williams, MD, FACEP, director of the Center for Rural Emergency Medicine and Professor of Emergency Medicine at West Virginia University in Morgantown.
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Advancing technology continues to reshape the way care management is practiced in the ICU and elsewhere, but early experience shows that technology is no guarantee for physician buy-in at the front end, much less patient compliance at the back end.
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Pediatric athletic head injuries are a significant problem, especially for emergency medicine physicians. The dedication of many young athletes to performance and their avoidance of restrictions makes it imperative that ED physicians recognize and give appropriate recommendations to parents and coaches of young athletes. The cumulative damage that may result from repetitive minor head trauma is not recognized by the majority of athletes, and the ED physician has the burden of conveying these potential risks to the family. This article provides a comprehensive review of sports-related head injuries and recommendations on grading of concussions, imaging, and the safe return of the athlete to competition.
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Although cervical spine injuries are uncommon in children, a missed or
delayed diagnosis may have devastating consequences for the patient. A
thorough understanding of normal pediatric anatomy, injury patterns,
and children who are at increased risk for injury is critical for the
physician caring for the acutely injured child.
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The diagnosis and management of patients with manifestations of drug-induced cardiotoxicity is challenging for even the most experienced emergency physician. The following report reviews the pathophysiology and clinical manifestations of cardiotoxins to provide the front-line practitioners with evidence-based protocols for managing patients with life-threatening toxicity.
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Child abuse can be difficult to recognize, especially in the often chaotic environment of the emergency department. As the leaders of the community and medical safety net that is the ED, emergency physicians play a unique role in detecting, treating, and preventing child abuse. This issue of Emergency Medicine Specialty Reports provides an update on the patterns, diagnosis, and treatment of physical child abuse injuries.
