Landmark Trial Starts

3. Violence. Tempers flare and a few patients tend to become more agitated and violent in crowded conditions. Instances of violence have occurred in various ED waiting rooms over who is to be seen first, creating a hostile atmosphere. Bodily harm has occurred to both nursing staff and emergency physicians. 4. Lost " Golden Hour. " Bad outcome have resulted from overcrowded conditions. Patients with subtle presentations of serious diseases such as MI, PE, rupturing aortic aneurysms, ectopic pregnancy, or stroke may miss the " golden hour " of effective treatment waiting on a gurney in the hallway. Additionally, patients with serious infections such as sepsis, pneumonia or meningitis may experience delays which result in bad outcome. I am aware of a patient who sat in an ER waiting room for four hours with Fournier's Gangrene, and as a result had a bad outcome. As physicians are seeing more complex and acutely ill patients, some feel they do not have adequate time to thoroughly evaluate each patient. 5. Ambulance diversions. Ambulance diversion has increased both in urban and suburban areas. The consequences of these diversions include significantly increased transport times, risk of traffic accidents en route, and potential for poor clinical outcome. 6. Increased errors in treatment. Feeling rushed and under time pressure results in errors and risk for malpractice or legal action. Decision errors have resulted from miscommunication during periods of overwhelming patient volume. With increasing numbers of patients, errors such as mislabeled specimens or drug dosing also increase in frequency. The problem of overcrowding in EDs will not improve until hospitals invest money to improve service. EM physicians need to be active and vocal at the local, state, and national levels and demand legislation aimed at improving the overcrowding problem. appear to have a role in prevention of seizures from head injury in the alcoholic patient. Phenothiazines and butyrophenones are generally thought to increase risk of seizure in this subgroup, but no studies have demonstrated this specifically. These drugs appear to have little effect on the GABA receptor, and are rarely selected as first-line agents. BZDs, which first appeared in the 1950s, are the most commonly used pharmacologic agents for alcohol withdrawal. These drugs are GABA receptor agonists which increase the frequency of chloride channel openings, and undergo hepatic metabolism exclusively. The half-life varies considerably between specific drugs, and depends on lipid solubility and activity of specific metabolites. …