Hyperventilation and head injury: controversies and concerns.

The use of hyperventilation for the treatment of severe head injuries has been the standard of care for more than two decades in the prehospital, emergency department and critical care settings. Controversy has surrounded its use, even when advocates recommended use for all unconscious, head-injured patients. Autoregulation, cerebral acidosis control, reduction of elevated intracranial pressure and the "steal phenomenon" were thought to be beneficial effects of hyperventilation therapy. Current researchers and developments in technology, however, have provided controversial information which suggests that hyperventilation therapy can be harmful, warranting the need for careful monitoring and selective treatment. This information calls into question the use of unmonitored hyperventilation therapy in the prehospital and early hospital settings.

Head injury in the presence of alcohol intoxication.

The difficulty of distinguishing between serious head injury and intoxication is presented in the case of an injured patient whose signs and symptoms were attributed to alcohol withdrawal. This report emphasizes the need for a high level of suspicion for all trauma patients, for all health care providers to be familiar with common forms of life-threatening trauma, and how to distinguish between altered levels of consciousness resulting from alcohol intoxication versus intracranial disorders. This case may also demonstrate that a person's wealth and social influence and an institution's orientation to a medical specialty can affect care giver's decisions.

An observational study of the emergency triage nursing role in a managed care facility.

Introduction A 72-hour observational pilot study was conducted at a large managed-care facility to determine what functions triage nurses fulfilled, how often they fulfilled these functions, and how much time was taken for these functions. Methods Patient arrival times, nursing activities, and patient dispositions were recorded. Activities were classified as either primary or nonprimary, according to defined triage purposes. Two alternating observers collected data continuously for 72 hours, during which they observed 13 triage nurses as they completed their regularly scheduled shifts. All nonprimary functions that occurred while the triage nurses fulfilled primary functions were classified as interruptions. All data were entered into computer software and whole minutes were used for calculating times. Results Nurses provided triage for 466 patients, and 655 telephone calls occurred. Twenty-nine physical triage activities and 26 telephone activities were observed. Telephone functions occupied about 22% of the time. Nonprimary telephone or triage functions interrupted 251 (54%) of all patients who were seen for triage. These interruptions notably increased pretriage waiting times for all patients who were interrupted but were most significant for patients with acuity levels 2 (p < 0.05) and 3 (p < 0.05). Number of interruptions and length of time spent waiting to see the triage nurses were significantly correlated (r = 0.69). Discussion Our study describes a method of evaluating triage nursing activities and suggests that some functions may contribute to delays in physician and nurse access.