Quality in emergency departments: a study on 3,285,440 admissions.

INTRODUCTION: A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS: The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION: The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.

[Acute salicylate intoxication after trancutaneous absorption]. / Intossicazione acuta da salicilato da assorbimento transcutaneo.

Topical salicylate preparations are primarily employed as keratolytic agents in the treatment of dermatologic disorders. A case of severe salicylate intoxication in a 70-year-old man with psoriasis, treated with a topical cream containing salicylic acid, is described. After five days the patient was admitted to ICU with encephalopathy and severe acid-base disturbances (respiratory alkalosis, metabolic acidosis, increased anion gap). A plasma salicylate concentration was elevated at 695 mg/Lt. Emergent hemodialysis was accompanied by a rapid lowering of plasma salicylate concentration and resolution of metabolic acidosis. Salicylate is well absorbed by normal and diseased skin. In this patient the lack of a normal epidermal barrier greatly enhances absorption of topical salicylate. It is therefore suggested that all topical salicylate treatments should be routinely monitored with salicylate blood concentration especially during the initial few days after onset or after any changes in treatment.

Electromechanical dissociation 48 hours after atenolol overdose: usefulness of calcium chloride.

Electromechanical dissociation (EMD) occurred in a 20-year-old woman 48 hours after an overdose of atenolol, despite intensive treatment of the beta-blocker poisoning (gastric lavage, charcoal, glucagon, epinephrine, atropine, correction of electrolyte abnormalities, administration of fluids, cardiac pacing, and mechanical ventilation). Administration of calcium chloride during EMD repeatedly restored blood pressure. Therefore it may have a role to play in management of atenolol overdose.