Around 10 million US emergency department visits are related to an underlying medical issue, and around 40% of patients have to be admitted to a hospital. Half of these patients require observation in an urgent care clinic, and almost 3% need to be given a medical evaluation in a hospital. Overall, there are approximately 15,000 inpatient hospitalizations a year in emergency departments that are caused by an unknown medical condition, and more than 600,000 inpatient stays are related to medical complications that arise from hospital care that involves diagnostic radiology, surgery, treatment, or medications. All of these patients might be managed safely in an urgent care clinic, an urgent care observation unit, or a hospital bedside observation unit, without the use of emergency department services.
We have demonstrated that the majority of emergency cases can be managed in 90 min without deterioration of outcome by emergency team assessment and patient transfer within 90min of arrival to definitive care.
Common treatments for emergency patients include simple analgesia and symptatics, analgesics in the case of serious pain, nonsterile intravenous therapy, urgent surgery, and emergency explorations such as thoracic, chest, or abdominal. Most emergency treatment is delivered within 30 minutes from first arriving to a triage center.
There is a shortage of emergency medical services in the UK. Emergency medical services respond best to what people call an “emergent”. The underlying reasons for this call can often be grouped into health, medical and psychiatric or stress related. A person requiring emergency medical care may be experiencing a health problem that is not life threatening but may result in further harm by delay to other parts of their health care.\n\nThe NHS emergency department handles about 40,000 patients each year. This is in spite of the fact the number of people calling an NHS telephone number every day in the UK is around 150,000.
There are several definitions for emergencies that overlap to some degree. There is substantial heterogeneity amongst stakeholders who are involved in emergency medicine, with terms such as 'emergencies' not used consistently and with some concerns regarding the impact on patient care. There are also a number of definitions that are more specific in nature. Future research and education on definitions of emergency is required to strengthen the role of emergency physicians.
The presentation of the emergency patient is changing from one who has had a prior episode of injury, is more likely to be male, and more likely to be aged 44 and younger (vs. an older female with a history of prior injury). The presence of risk factors for chronic illness raises the possibility of the patient with a previous episode of injury requiring emergency care being admitted with a poor prognosis, with the attendant challenges this presents in the acute care setting.
Recent studies have identified treatment algorithms to improve survival after acute onset of a potentially life-threatening illness. Clinical trials are underway to identify the most effective treatment for these conditions. The treatment protocols that provide the strongest evidence will have the greatest potential to improve clinical outcomes. Many of the treatments identified in emergency practice are not evaluated in clinical trials because they are thought to be of low clinical benefit or because they present a substantial risk to patients and research is not considered to have sufficient priority in the healthcare system. We believe development of an Emergency Clinical Trial Network will improve treatment protocols for illnesses and conditions of potential immediate benefit to patient treatment.
Recent findings shows that the addition of surgecon to an already existing regimen of a proton-pump inhibitor (PPI) with an HCCP-based treatment is more effective than a placebo in resolving HCCP-induced symptoms in a majority of patients. The long-term efficacy and potential harms of the combination regimen are to be evaluated in the upcoming phase III RACES trial.
There have been other studies evaluating this agent for the treatment of achalasia. Although the results of recent studies are conflicting, all report a significant improvement in symptoms such patients with advanced (esophageal) achalasia compared to placebo. Thus, we would recommend consideration of this drug for patients with severe symptoms or who remain symptomatic despite standard therapy.
There was no evidence that using surgecon increased serum creatinine levels in people, either in the first 24-hour period after treatment or in the two week follow up period.
Emergency department (ED) visits are extremely common. Of the 25 emergency department visits requiring hospitalization, 15 involved gastrointestinal, musculoskeletal, and neurological emergencies. One was an appendectomy and one was a heart attack. Two patients had cardiac resuscitation after arriving at the ED. One had a fractured femur. Three patients had intestinal ischemia. One was in cardiopulmonary arrest. Two patients had ruptured aneurysms. Two patients experienced a perforated duodenum and one ruptured aneurysm of the abdominal aorta. An intestinal obstruction was diagnosed in four patients. For each of these emergencies, treatment was implemented quickly and efficiently in the ED.
In the absence of an absolute indication for a specific agent and following an audit, we were no more successful in reducing pain scores at day 4 following a surgecon than after a bolus of alvimopan or morphine. When administered early in the course of surgery, when surgeons perceive a need for a specific agent they administer the desired agent. Using these audit findings as a guide to prescribing a specific agent is unreliable.