Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients.

Background: For several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of "nonurgency".

Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France.

Background: For several decades, emergency departments (EDs) utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.

ED patients: how nonurgent are they? Systematic review of the emergency medicine literature.

Nonurgent visits to emergency departments (ED) are a controversial issue; they have been negatively associated with crowding and costs. We have conducted a critical review of the literature regarding methods for categorizing ED visits into urgent or nonurgent and analyzed the proportions of nonurgent ED visits. We found 51 methods of categorization.

Nonurgent patients in the emergency department? A French formula to prevent misuse.

Background: Overcrowding in emergency department (EDs) is partly due to the use of EDs by nonurgent patients. In France, the authorities responded to the problem by creating primary care units (PCUs): alternative structures located near hospitals. The aims of the study were to assess the willingness of nonurgent patients to be reoriented to a PCU and to collect the reasons that prompted them to accept or refuse.

Takotsubo cardiomyopathy associated with diving.

Takotsubo cardiomyopathy consists of cardiomyopathy with transient apical ballooning and left ventricular systolic dysfunction in the absence of atheromatous disease of the coronary arteries, accompanied by ECG changes together with elevated cardiac enzymes appearing in a context of emotional or physical stress. A 51-year-old woman was referred to our emergency department for treatment after chest pain associated with acute dyspnoea during diving. On questioning, the patient confirmed that she had twice dived to 35 m without any missed decompression stops and informed us that she had experienced tightening of the chest followed by sudden dyspnoea during her second ascent in a setting of marked emotional stress since the previous evening.

Haemodynamic management of severe sepsis: recommendations of the French Intensive Care Societies (SFAR/SRLF) Consensus Conference, 13 October 2005, Paris, France.

We present a consensus report from the SFAR/SLRF (Société Française d'Anesthésie et de Réanimation/Société de Réanimation de Langue Française) Consensus Conference, held on 13 October 2005 in Paris, France. The consensus report made recommendations on five topics relevant to the treatment of circulatory failure in sepsis and its underlying rationale. These topics are as follows: therapeutic goals of haemodynamic support in sepsis; goals of fluid resuscitation (including transfusion); role of inotropes and vasoactive drugs; role of other treatments; and treatment strategy.

Effects of helium-oxygen mixtures on endotracheal tubes: an in vitro study.

Question: To determine flow pattern and critical Reynolds numbers in endotracheal tubes submitted to different helium-oxygen mixtures under laboratory conditions.

Materials And Methods: Flow-pressure relationships were performed for seven endotracheal tubes (rectilinear position, entry length applied) with distal end open to atmosphere (predicted internal diameters: 6-9 mm). Nine helium-oxygen mixtures were tested, with FIHe varying from zero to 0.

[Imaging strategy for cervical spine injury].

MAKING THE DIAGNOSIS: Exploration strategies when faced with a suspected spine injury have improved with the recent development of new imaging techniques (notably the helical CT scan). A selection must be made between the techniques available in order to optimise diagnostic habits. THE FUNDAMENTAL POINTS: The clinical examination identifies the small group of patients that does not require radiographic exploration.

Helium-oxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease.

Objective: To evaluate whether helium-oxygen mixture reduces inspiratory work of breathing (WOB) in sedated, paralyzed, and mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).

Design And Setting: Open, prospective, randomized, crossover study in the medical intensive care unit in a university hospital.

Patients And Participants: 23 patients admitted for acute exacerbation of COPD and mechanically ventilated.

Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs.

Objective: To evaluate the impact of an intensive care unit (ICU) antibiotic-use policy on the microbial resistance in nosocomial infections and costs.

Design: Comparative study before and after policy implementation.

Settings: An eleven-bed ICU in a general hospital.