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Ecocardiografia em terapia intensiva: avaliação de treinamento voltado para intensivistas e emergencistas pediátricos; Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians

Gonçalves, Heloisa Amaral Gaspar
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 08/08/2014 PT
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26.08%
Introdução: O exame ecocardiográfico direcionado realizado por médicos intensivistas e emergencistas pode ser uma ferramenta valiosa para a avaliação e manejo do estado hemodinâmico de crianças gravemente doentes. O objetivo do presente estudo foi avaliar o aprendizado de médicos pediatras de setores de emergência submetidos a um programa de treinamento teórico e prático supervisionado em ecocardiografia de emergência. Método: Treinamento com componente teórico e prático foi realizado por dois ecocardiografistas experientes e teve como alvo 16 médicos intensivistas/emergencistas pediátricos. O programa incluiu análises qualitativas de função do ventrículo esquerdo (VE) e ventrículo direito (VD), avaliação de derrame pericárdio/tamponamento cardíaco, regurgitação valvar e avaliação de variação respiratória de veia cava inferior através do índice de distensibilidade da veia cava inferior (dVCI), além de medidas objetivas de fração de ejeção (FE) e índice cardíaco (IC). As aulas práticas foram realizadas na unidade de terapia intensiva pediátrica do Instituto da Criança do Hospital das Clínicas e cada aluno realizou 24 exames direcionados de ecocardiograma durante o treinamento. Os alunos foram avaliados de forma prática...

Avaliação nutricional e do perfil lipídico de crianças e adolescentes, com processo inflamatório, em unidade de emergência de um hospital universitário; Nutritional assessment and lipid profile of children and adolescents, with inflammatory process, in emergency department of a university hospital

Muramoto, Giovana
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 05/03/2015 PT
Relevância na Pesquisa
35.93%
Objetivo: comparar o perfil lipídico de em crianças e adolescentes, com e sem inflamação, atendidas num pronto atendimento geral de pediatria de um hospital universitário de nível de atendimento secundário, segundo estado nutricional, sexo e idade. Métodos: Estudo transversal, realizado entre outubro de 2012 e agosto de 2013, avaliou 124 crianças e adolescentes (3 meses a 14 anos de idade) em atendimento na unidade de emergência do Hospital Universitário da Universidade de São Paulo, com queixa relacionada a processo inflamatório/infeccioso. Os pacientes foram separados em dois grupos de acordo com os níveis de proteína C reativa (PCR): grupo I se maior ou igual a 5 mg/L, e grupo II se menor que 5mg/L. Dosagens de colesterol total, lipoproteína de alta densidade (HDL) e baixa densidade (LDL), triglicerídeos e albumina foram comparadas entre os dois grupos, levando em conta o estado nutricional (avaliado através de medidas antropométricas), gênero e idade. Resultado: A mediana de idade foi de 51 meses, com maioria dos pacientes classificados como eutróficos (76,5%). Do total da amostra, 34,7% dos pacientes apresentaram colesterol total e/ou triglicerídeos alterados e 67% apresentaram baixos níveis de HDL. Não houve diferença significativa do perfil lipídico entre os dois grupos de pacientes separados de acordo com PCR. Dentre os pacientes com PCR >= 5mg/L...

Cystatin C as a marker of acute kidney injury in the emergency department

Soto, K; Coelho, S; Rodrigues, B; Martins, H; Frade, F; Lopes, S; Cunha, L; Papoila, A; Devarajan, P
Fonte: American Society of Nephrology Publicador: American Society of Nephrology
Tipo: Artigo de Revista Científica
Publicado em //2010 ENG
Relevância na Pesquisa
35.97%
BACKGROUND AND OBJECTIVES: The diagnosis of acute kidney injury (AKI) is usually based on changes in serum creatinine, which is a poor marker of early renal dysfunction. The discriminative and predictive abilities of serum and urinary cystatin C were examined for the prediction of AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective cohort study, serum and urinary cystatin C were serially measured in a heterogeneous group of patients (n = 616) presenting to a tertiary care emergency department. The primary outcome was AKI, classified according to RIFLE and AKIN criteria. The secondary outcome was an adjudication based on clinical criteria to AKI, prerenal azotemia, chronic kidney disease (CKD), and normal kidney function. RESULTS: Patients were adjudicated to have AKI in 21.1%, prerenal azotemia in 25.8%, CKD in 2.4%, and normal kidney function in 50.7%. For the diagnosis of AKI, the discriminatory ability of urinary creatinine and cystatin C was marginal. Both serum cystatin C and serum creatinine (at presentation and 6 hours later) showed high discriminatory ability for the diagnosis of AKI. However, only serum cystatin C attained a significant early predictive power (Hosmer-Lemeshow P value > 0.05). Serum cystatin C could differentiate between AKI and prerenal azotemia...

The Role of B-Type Natriuretic Peptide in the Diagnosis of Congestive Heart Failure in Patients Presenting to an Emergency Department with Dyspnea

Villacorta,Humberto; Duarte,Adriana; Duarte,Neison Marques; Carrano,Ângela; Mesquita,Evandro Tinoco; Dohmann,Hans J. F.; Ferreira,Francisco Eduardo G.
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2002 EN
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36.01%
OBJECTIVE: To determine the utility of B-type natriuretic peptide (BNP) in the diagnosis of congestive heart failure (CHF) in patients presenting with dyspnea to an emergency department (ED). METHODS: Seventy patients presenting with dyspnea to an ED from April to July 2001 were included in the study. Mean age was 72±16 years and 33 (47%) were male. BNP was measured in all patients at the moment of admission to the ED. Emergency-care physicians, blinded to BNP values, were required to assign a probable initial diagnosis. A cardiologist retrospectively reviewed the data (blinded to BNP measurements) and assigned a definite diagnosis, which was considered the gold standard for assessing the diagnostic performance of BNP. RESULTS: The mean BNP concentration was higher in patients with CHF (n=36) than in those with other diagnoses (990±550 vs 80±67 pg/mL, p<0.0001). Patients with systolic dysfunction had higher BNP levels than those with preserved systolic function (1,180±641 vs 753±437 pg/mL, p=0.03). At a blood concentration of 200 pg/mL, BNP showed a sensitivity of 100%, specificity of 97.1%, positive predictive value of 97.3%, and negative predictive value of 100%. The application of BNP could have potentially corrected all 16 cases in which the diagnosis was missed by the emergency department physician. CONCLUSION: BNP measurement is a useful tool in the diagnosis of CHF in patients presenting to the ED with dyspnea.

Headache in an emergency room in Brazil

Bigal,Marcelo; Bordini,Carlos Alberto; Speciali,José Geraldo
Fonte: Associação Paulista de Medicina - APM Publicador: Associação Paulista de Medicina - APM
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/05/2000 EN
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CONTEXT: When experiencing a headache attack, Brazilian patients usually look for a primary care service, where they are seen by general clinicians. In the town of Ribeirão Preto, these clinicians routinely refer patients to the Emergency Room of the University Hospital. OBJECTIVE: The objective of this study was to evaluate the quality of primary care by analyzing retrospectively the medical records of patients with a complaint of headache seen in this emergency room during the year of 1996. DESIGN: retrospective study. SETTIING: Emergency Room of the Universital Hospital, Ribeirão Preto, São Paulo, reference unit. PARTICIPANTS:1254 patients. The patients who sought the Emergency Room (ER) of the University Hospital of Ribeirão Preto, during the year of 1996 with a complaint of headache were studied retrospectively. MAIN MEASUREMENTS: Etiology, age, diagnosis, secondary cause, laboratory tests. RESULTS: Of the 1254 patients seen (61% women), 1190 (94.9%) were discharged after the administration of parenteral analgesics before they had spent 12 hours in the room. Only 64 (5.1%) patients remained for more than 12 hours. Of the patients who spent less than 12 hours in the room, 71.5% had migraine or tension type headache and did not require subsidiary exams for diagnosis. Of the patients who spent more than 12 hours in the room...

Short term effects of air pollution on emergency hospital admissions for respiratory disease: results of the APHEA project in two major cities in The Netherlands, 1977-89.

Schouten, J P; Vonk, J M; de Graaf, A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1996 EN
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STUDY OBJECTIVE: To assess the short term relationship between air pollution and the daily number of emergency hospital admissions for respiratory disease. DESIGN: Data were analysed using autoregressive Poisson regression allowing for overdispersion and controlling for possible confounding factors such as seasonal and other chronological variables, meteorological factors, and influenza epidemics. SETTING: The two major cities in The Netherlands-Amsterdam (694,700 inhabitants) and Rotterdam (576,200 inhabitants). PARTICIPANTS AND MEASUREMENTS: Emergency hospital admissions for respiratory diseases, registered on a daily basis by the National Medical Registration, for the period 1977-89 were used. ICD-9 codes included were: respiratory (460-519), chronic obstructive pulmonary disease (490-492, 494, 496), and asthma (493). The mean (range) of the total daily number of admissions for these three classifications were as follows: 6.70 (0-23), 1.74 (0-9) and 1.13 (0-7) respectively in Amsterdam and 4.79 (0-19), 1.57 (0-9), and 0.53 (0-5) in Rotterdam. Air pollution measurements were provided by the National Institute of Public Health and Environmental Protection. In The Netherlands, air pollution is at a low to moderate ("summer type") or a low ("winter type") level. The levels in Amsterdam and Rotterdam did not differ much for the "summer type". For 1977-89 the mean (range) values of ozone (O3)...

Guidelines for the emergency management of asthma in adults. CAEP/CTS Asthma Advisory Committee. Canadian Association of Emergency Physicians and the Canadian Thoracic Society.

Beveridge, R C; Grunfeld, A F; Hodder, R V; Verbeek, P R
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 01/07/1996 EN
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OBJECTIVE: To develop a set of comprehensive, standardized evidence-based guidelines for the assessment and treatment of acute asthma in adults in the emergency setting. OPTIONS: The use of medications was evaluated by class, dose, route, onset of action and optimal mode of delivery. The use of objective measurements and clinical features to assess response to therapy were evaluated in relation to the decision to admit or discharge the patient or arrange for follow-up care. OUTCOMES: Control of symptoms and disease reflected in hospital admission rates, frequency of treatment failures following discharge, resolution of symptoms and improvement of spirometric test results. EVIDENCE: Previous guidelines, articles retrieved through a search of MEDLINE, emergency medical abstracts and information from members of the expert panel were reviewed by members of the Canadian Association of Emergency Physicians (CAEP) and the Canadian Thoracic Society. Where evidence was not available, consensus was reached by the expert panel. The resulting guidelines were reviewed by members of the parent organizations. VALUES: The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. BENEFITS, HARMS AND COSTS: As many as 80% of the approximate 400 deaths from asthma each year in Canada are felt to be preventable. The use of guidelines...

Feasibility of Using Distributed Wireless Mesh Networks for Medical Emergency Response

Braunstein, Brian; Trimble, Troy; Mishra, Rajesh; Manoj, B. S.; Rao, Ramesh; Lenert, Leslie
Fonte: American Medical Informatics Association Publicador: American Medical Informatics Association
Tipo: Artigo de Revista Científica
Publicado em //2006 EN
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26.01%
Achieving reliable, efficient data communications networks at a disaster site is a difficult task. Network paradigms, such as Wireless Mesh Network (WMN) architectures, form one exemplar for providing high-bandwidth, scalable data communication for medical emergency response activity. WMNs are created by self-organized wireless nodes that use multi-hop wireless relaying for data transfer. In this paper, we describe our experience using a mesh network architecture we developed for homeland security and medical emergency applications. We briefly discuss the architecture and present the traffic behavioral observations made by a client-server medical emergency application tested during a large-scale homeland security drill. We present our traffic measurements, describe lessons learned, and offer functional requirements (based on field testing) for practical 802.11 mesh medical emergency response networks. With certain caveats, the results suggest that 802.11 mesh networks are feasible and scalable systems for field communications in disaster settings.

Bedside emergency cardiac ultrasound in children

Doniger, Stephanie J
Fonte: Medknow Publications Publicador: Medknow Publications
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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25.97%
Bedside emergency ultrasound has rapidly developed over the past several years and has now become part of the standard of care for several applications. While it has only recently been applied to critically ill pediatric patients, several of the well-established adult indications may be applied to pediatric patients. One of the most important and life-saving applications is bedside echocardiography. While bedside emergency ultrasonography does not serve to replace formal comprehensive studies, it serves as an extension of the physical examination. It is especially useful as a rapid and effective tool in the diagnosis of pericardial effusions, tamponade and in distinguishing potentially reversible causes of pulseless electrical activity from asystole. Most recently, left ventricular function and inferior vena cava measurements have proven helpful in the assessment of undifferentiated hypotension and shock in adults and children. Future research remains to be carried out in determining the efficacy of bedside ultrasonography in pediatric-specific pathology such as congenital heart disease. This article serves as a comprehensive review of the adult literature and a review of the recent applications in the pediatric emergency department. It also highlights the techniques of bedside ultrasonography with examples of normal and pathologic images.

Can Emergency Physicians Perform Common Carotid Doppler Flow Measurements to Assess Volume Responsiveness?

Stolz, Lori A.; Mosier, Jarrod M.; Gross, Austin M.; Douglas, Matthew J.; Blaivas, Michael; Adhikari, Srikar
Fonte: Department of Emergency Medicine, University of California, Irvine School of Medicine Publicador: Department of Emergency Medicine, University of California, Irvine School of Medicine
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
35.93%

Maturação dos frutos na emergência de plântulas e no potencial frutífero de pitangueira-do-cerrado (Eugenia calycina Cambess)

Borges, Kelly Cristiene de Freitas
Fonte: Universidade Federal de Uberlândia Publicador: Universidade Federal de Uberlândia
Tipo: Dissertação
POR
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36.2%
CAPÍTULO II: Eugenia calycina é uma espécie frutífera de ocorrência em áreas de Cerrado, cujas características morfofisiológicas de frutos e sementes são escassas. Diante disso, os objetivos do trabalho foram quantificar a influência da coloração do fruto nos caracteres morfofisiológicos de frutos e sementes da espécie; determinar o rendimento de polpa e indicar o potencial da espécie para programas de melhoramento genético. Em novembro de 2006, cinqüenta frutos, na coloração verde, laranja, vermelho-claro e vermelhoescuro, foram coletados, extraídas suas sementes e ambos medidos quanto ao comprimento e largura, além das massas das matérias fresca e seca da polpa. Em novembro de 2007, de vinte matrizes, determinaram-se o número de frutos por planta e o rendimento de polpa. A distribuição t de “Student” foi utilizada para construir intervalos de confiança para comprimento, largura e massa das matérias fresca e seca de polpa, e testar o coeficiente de correlação entre caracteres do fruto e a massa fresca de polpa. Freqüências percentuais e medidas de assimetria e curtose indicaram a natureza da distribuição da largura e do comprimento. Grandes amplitudes foram observadas na morfometria dos frutos (8-20 mm de largura; 10-30 mm de comprimento) e das sementes (8-14 mm largura; 7-14 mm comprimento)...

Variabilidade de cinco espécies arbóreas da região de cerrado do Brasil Central para medidas de germinação e emergência; Variability of five arboreous species of the Central Brazil cerrado region for germination and emergency measurements

Ferreira, Wanessa Resende
Fonte: Universidade Federal de Uberlândia Publicador: Universidade Federal de Uberlândia
Tipo: Dissertação
POR
Relevância na Pesquisa
56.27%
Os estudos básicos de germinação de sementes e emergência de plântulas assumem papel relevante dentro das pesquisas científicas diante da realidade de devastação e fragmentação da vegetação nativa do Cerrado. Em função disso, o presente trabalho teve por objetivos avaliar o processo de germinação de diásporos e a emergência de plântulas de cinco espécies do Cerrado do Planalto Central e, a partir de medidas desses processos, quantificar as correlações lineares entre as mesmas; quantificar a contribuição da variabilidade das matrizes para as espécies estudadas e de cada espécie em relação ao grupo estudado, utilizando-se modelos lineares hierárquicos e, estimar parâmetros genéticos entre matrizes dentro de espécies. Os diásporos foram coletados nas safras 2004/2005 numa região fragmentada do vale do rio Araguari, MG. Os testes foram realizados com diásporos recém-coletados de matrizes em separado, sendo os testes de germinação instalados em câmara de germinação e os de emergência em estufa coberta com telado redutor de luminosidade. A coleta dos dados foi realizada a cada 24 horas, observando-se a protrusão do embrião para os experimentos montados em laboratório e a emergência de qualquer parte da plântula acima do substrato para experimentos mantidos em estufa. Registrou-se variabilidade entre as matrizes das espécies estudadas em todos os aspectos do processo de germinação e emergência e...

Monitoring Radioactivity in Nuclear and Radiological Emergency in a European Perspective: Aims and Means

DE CORT MARC
Fonte: Inderscience Publishers Publicador: Inderscience Publishers
Tipo: Articles in Journals Formato: Printed
ENG
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26.03%
After the Chernobyl nuclear power plant accident, European countries have further enhanced their capacity and infrastructure for monitoring radioactivity in their environment. This paper gives a summary of the most commonly used tech-niques relevant to routine and nuclear and/or radiological emergency conditions, fol-lowed by a discussion of the various network types (routine, emergency preparedness, mobile monitoring) and some suggestions on how homogeneity of the monitoring in-formation can be improved. Keywords: Measurement strategy, radiation measurements, air contamination meas-urement, in situ measurements, surface contamination sampling, environmental sam-pling.; JRC.H.4-Transport and air quality

Automatic Mapping in Emergency: A Geostatistical Perspective

DUBOIS GREGOIRE; PEBESMA EDZER J.; BOSSEW PETER
Fonte: Inderscience Publishers Publicador: Inderscience Publishers
Tipo: Articles in Journals Formato: Printed
ENG
Relevância na Pesquisa
26.14%
In the case of a severe nuclear accident, radionuclides may be released into the atmosphere and contaminate large areas. Essential information for decision making and further modelling are maps that describe the radiological situation. Radiological maps are obtained after a spatial interpolation process that converts local measurements into information continuous in space. Ideally, the mapping process should be fully automatic and provide information in real time. It is the purpose of this paper to discuss results obtained from two statistical exercises that addressed the issue of automating the spatial interpolation step both in routine and emergency situations. The first exercise addressed mainly the current state of the art of mapping deposited radioactivity following an accident in wet conditions and explored the impact of human factors on the results obtained. The second exercise, conceptually similar to the first one, involved real gamma dose rate measurements to address specifically the automation issue. To further address the response of these mapping algorithms in emergency situations, simulated data have also been used to explore the impact of extreme values on the process. It is shown that if results tend to be similar in routine situations...

Differences in priorities assigned to patients by triage nurses and by consultant physicians in accident and emergency departments.

George, S; Read, S; Westlake, L; Fraser-Moodie, A; Pritty, P; Williams, B
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/1993 EN
Relevância na Pesquisa
26.05%
STUDY OBJECTIVES--To investigate whether the greater urgency assigned to accident and emergency patients by triage nurses than by accident and emergency doctors was uniform across all patient groups. DESIGN--Patients attending an accident and emergency department between 8.00 am and 9.00 pm over a six week period were assessed prospectively for degree of urgency by triage nurses, and retrospectively for urgency by one of two consultant accident and emergency doctors. Patients were grouped according to their clinical mode of presentation. SETTING--An accident and emergency department of a district general hospital in the Midlands, UK, in 1990. PATIENTS--1213 patients who presented over six weeks. MEASUREMENTS AND MAIN RESULTS--As might be expected, patients' conditions were assessed as being more urgent prospectively than retrospectively. This finding, however, was not uniform across all patient groups. Nurses' assessments of urgency tended to favour children and patients who presented with eye complaints and gave less priority to medical cases, particularly those with cardiorespiratory symptoms. CONCLUSIONS--These findings have implications for all those involved in the organisation of triage systems and in the training of nurses in accident and emergency departments. It is essential that judgements on how urgently patients need to be seen are made in a completely objective manner.

Evaluation of a New Nonnvasive Device in Determining Hemoglobin Levels in Emergency Department Patients

Knutson, Tristan; Della-Giustina, David; Tomich, Eric; Wills, Brandon; Luerssen, Emily; Reynolds, Penny
Fonte: Department of Emergency Medicine, University of California, Irvine Publicador: Department of Emergency Medicine, University of California, Irvine
Tipo: Artigo de Revista Científica
Publicado em /05/2013 EN
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45.97%
Introduction: The Masimo Radical-7 Pulse CO-Oximeter is a medical device recently approved by the US Food and Drug Administration that performs noninvasive oximetry and estimated venous or arterial hemoglobin measurements. A portable, noninvasive device that rapidly measures hemoglobin concentration could be useful in both austere and modern hospital settings. The objective of this study is to determine the degree of variation between the device's estimated hemoglobin measurement and the actual venous hemoglobin concentration in undifferentiated emergency department (ED) patients.

The Association of Near-Infrared Spectroscopy-Derived Tissue Oxygenation Measurements with Sepsis Syndromes, Organ Dysfunction and Mortality in Emergency Department Patients with Sepsis

Arnold, Ryan; Sherwin, Robert; O'Connor, Jennifer; Najarro, Gabriel; Lundy, David; Nelson, Teresa; Shapiro, Nathan Ivan; Singh, Sam; Trzeciak, Stephen W.; Jones, Alan E.; Emergency Medicine Shock Research Network
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
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Introduction: Near-infrared spectroscopy (NIRS) noninvasively measures peripheral tissue oxygen saturation \((StO_2)\). NIRS may be utilized along with a vascular occlusion test, in which limb blood flow is temporarily occluded and released, to quantify a tissue bed's rate of oxygen exchange during ischemia and recovery. The objective of this study was to test the hypothesis that NIRS-derived \(StO_2\) measures \((StO_2\) initial, \(StO_2\) occlusion and \(StO_2\) recovery) identify patients who are in shock and at increased risk of organ dysfunction (Sequential Organ Failure Assessment (SOFA) score ≥ 2 at 24 hours) and dying in the hospital. Methods: This prospective, observational study comprised a convenience sample of three cohorts of adult patients (age > 17 years) at three urban university emergency departments: (1) a septic shock cohort (systolic blood pressure < 90 after fluid challenge; the "SHOCK" cohort, n = 58), (2) a sepsis without shock cohort (the "SEPSIS" cohort, n = 60) and emergency department patients without infection (n = 50). We measured the \(StO_2\) initial, \(StO_2\) occlusion and \(StO_2\) recovery slopes for all patients. Outcomes were sepsis syndrome severity, organ dysfunction (SOFA score at 24 hours) and in-hospital mortality. Results: Among the 168 patients enrolled...

How consistent are emergency and disaster measurements and scales?

Alrashed, Hamed
Fonte: University of Delaware Publicador: University of Delaware
Tipo: Tese de Doutorado
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McNeil, Sue; Measurements play major roles in our lives and in many fields including the natural sciences, social sciences, economics, and technology. Emergency managers utilize emergency and disaster scales and measurements in their planning for, mitigation of, preparedness for, response to and recovery from emergencies, disasters and other events. The thesis explores the consistency of different emergency and disaster scales by measuring thirteen (13) case studies representing a range of different emergencies in terms of type, size, location, and impact using at least three (3) different emergency scales from a total of seven (7) selected scales from practice and the literature. The thesis then compares measurement results per emergency event showing very low consistency that could mislead emergency managers. The comparisons of measurement results per scale revealed important findings shared at the end of the thesis in addition future research suggestions.; University of Delaware, School of Public Policy and Administration; M.S.

Blood pressure measurements in the ankle are not equivalent to blood pressure measurements in the arm

Goldstein,L N; Wells,M; Sliwa,K
Fonte: SAMJ: South African Medical Journal Publicador: SAMJ: South African Medical Journal
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2014 EN
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26.11%
BACKGROUND: Blood pressure (BP) is often measured on the ankle in the emergency department (ED), but this has never been shown to be an acceptable alternative to measurements performed on the arm. OBJECTIVE: To establish whether the differences between arm and ankle non-invasive BP measurements were clinically relevant (i.e. a difference of >10 mmHg. METHODS: This was a prospective cross-sectional study in an urban ED making use of a convenience sample of 201 patients (18 - 50 years of age) who were not in need of emergency medical treatment. BP was measured in the supine position on both arms and ankles with the correct size cuff according to the manufacturer's guidelines. The arm and ankle BP measurements were compared. RESULTS: There was a clinically and statistically significant difference between arm and ankle systolic BP (SBP) and mean arterial pressure (MAP) (-13 mmHg, 95% confidence interval (CI) -28 - 1 mmHg and -5 mmHg, 95% CI -13 - 4 mmHg, respectively), with less difference in diastolic BP (DBP) (2 mmHg, 95% CI -7 - 10 mmHg). Only 37% of SBP measurements and 83% of MAP measurements were within an error range of 10 mmHg, while 95% of DBP measurements agreed within 10 mmHg. While the average differences (or the bias) were generally not large...

Epidemiology of febrile diseases in the emergency department of a Caribbean Island: the Curaçao experience

Limper,M; Gerstenbluth,I; Duits,AJ; van Gorp,ECM
Fonte: West Indian Medical Journal Publicador: West Indian Medical Journal
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2012 EN
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35.93%
OBJECTIVE: The aetiology of febrile diseases in tropical countries often remains poorly characterized. We aim to describe the aetiology and outcome of febrile illnesses at the Emergency Department (ED) in Curaçao. METHODS: From April 2008 - April 2009, all adult febrile patients (T > 38.5°C) at the ED of the St Elisabeth Hospital, Curaçao, Netherlands Antilles, were included. Clinical data were recorded, routine laboratory measurements and blood cultures were taken. Final diagnoses were made at discharge by an independent physician and in retrospect by the main investigator. RESULTS: Four hundred and three patients were included: 223 patients (55.6%) were hospitalized, 32 patients (7.9%) died and 18 patients (4.5%) were admitted to the Intensive Care Unit. In 129 febrile patients (32.0%), infection was proven; 84.4% of patients had bacterial (29.0% urinary tract infection, 23.2% pneumonia infection), 5.6% viral and 10.0% parasitic or fungal infections. Twenty-one patients (5.2%) were discharged with a non-infectious diagnosis and 172 patients (42.7%) without a clear diagnosis. CONCLUSION: A high mortality rate of 7.9% was observed. We found a high prevalence of bacterial infections, with pneumonia and urinary tract infections as the most common causes of fever. One in 20 patients did not have an infectious disease.