Emergency room crowding: a marker of hospital health.

Emergency room (ER) crowding has become a widespread problem in hospitals across the United States. Two main reasons can be cited. First, emergency medicine is the only specialty in the "House of Medicine" that has a federal mandate to provide care to any patients requesting treatment. Second, primary care providers are in short supply, forcing sick people to seek medical care in ERs. Once seen as an "ER problem," crowding has become more appropriately recognized as a "hospital problem," related to factors beyond the doors of the ER. This realization has led many regulating agencies to launch corrective attempts, some of which have actually been effective. Now, the lack of ER crowding is considered a measure of the success of a hospital or system. This review considers the complex causative factors that contribute to ER crowding and explores corrective measures that may prove helpful in alleviating this paralyzing condition.

Approach to ophthalmologic emergencies.

This article presents evaluation and treatment approaches to ophthalmologic conditions that are likely to be encountered in a primary care office. These conditions can be organized by diagnostic category, symptoms, and location of complaint. By using one ora combination of these categories, the practitioner can provide appropriate, timely, and effective ophthalmologic evaluation and treatment. Acute conditions are categorized according to urgency of intervention.

North American snake envenomation: diagnosis, treatment, and management.

A bite from a venomous snake is a medical emergency involving not only the affected site but also multiple organ systems. Rapid transport of a snakebite victim to a medical facility is paramount. Management decisions must be based on close clinical monitoring of the potentially erratic envenomation syndrome. Because of the many variables inherent in the management of snakebite victims, consultation with a physician specialist is recommended.

Resolution of compartment syndrome after rattlesnake envenomation utilizing non-invasive measures.

Western diamondback rattlesnake envenomation is usually managed by administration of neutralizing antivenom. The development of compartment syndrome is a rare complication that has sparked considerable debate regarding medical vs. surgical management. We report a case of compartment syndrome resulting from a rattlesnake envenomation, which responded to large doses of neutralizing antivenom given concomitantly with mannitol and hyperbaric oxygen. This regimen obviated the need for surgical fasciotomy and its associated morbidity.