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Penetrating trauma to the torso can present a complex diagnostic and therapeutic challenge. Injuries can occur to the precordium, the thoraco-abdominal region, abdomen, flank, back, and pelvis. Injuries often occur simultaneously in several body cavities. Each of these body regions may require a different approach for both diagnosis and treatment. Penetrating injury from the nipple line to the inguinal ligaments anteriorly and from the tip of the scapula to the inferior gluteal folds should prompt suspicion of intra-abdominal injury.
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Remember the days before sensitive serum pregnancy tests and 24-hour ultrasound availability? Remember performing a culdocentesis to determine if the patient was stable for discharge? I do, and I don't miss them.
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This web-based survey assessed 1976 critical care practitioners' perceptions of the risks for unplanned extubation. Members of the American Association for Respiratory Care, the American Association of Critical Care Nurses, and the Society of Critical Care Medicine reported a number of factors associated with unplanned extubation, including outward migration of the endotracheal tube (ETT; reported by 73% of respondents), the patient tugging on the ETT (87%), removing a nasogastric tube (71%), absence of physical restraints (72%), a nurse/patient ratio of 1:3 (60%), trips out of the ICU for tests (59%), and light sedation (42%).
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What should ED managers be doing while they wait for The Joint Commission to publish a new standard for medication reconciliation? Take a team approach, recommends Diana S. Contino, RN, MBA, FAEN, senior manager of health care with Deloitte Consulting in Los Angeles.
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As The Grateful Dead might say if asked to describe the various iterations of the National Patient Safety Goal (NPSG) for medication reconciliation, "what a long, strange trip it's been."
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There are any number of reasons why an ED and its hospital would have difficulty complying with The Joint Commission standard regarding egress, says Diana S. Contino, RN, MBA, FAEN, senior manager of health care with Deloitte Consulting in Los Angeles.
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Every summer The Joint Commission issues a list of those standards hospitals find most difficult to comply with. Among those challenging standards are three that experts say most directly impact the ED:
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When the University of Michigan Health System, Ann Arbor, instituted a "rolling forecast" approach to budgeting, its administrators established a target to improve labor productivity by 2% in fiscal 2010.