RESUMO
The objective of this study was to determine in a significant temporal pattern exists in the presentation of sickle cell vaso-occlusive pain crisis (SC-VPC) patients to an emergency department (ED) for treatment. This 28-month retrospective study of ED sickle cell crisis treatment involved 1128 presumably diurnally active SCVPC patients presenting to the ED of a university-affiliated hospital between January 1, 1991 and April 30, 1993. Data for adult subjects (> or equal to 15 years) were used for analysis. Date and time of presentation for each patient were recorded. Data were submitted to chi 2 and single cosinor analysis for determination of circadian and circannual patterns. chi 2 analysis suggested that the incidence of SCVPC events treated in the ED was not equally distributed throughout the 24 h. Single cosinor analysis identified a significant circadian rhythm (p < 0.001) for all subjects, with peak ED presentations occurring in the early evening. The best-fit cosine curve accounted for 50% of the sample variance. While the etiology of this finding is unclear, determination of a temporal pattern in SCVPC presentation to the ED may lead to identification and control of conditions that precede the occurrence of a SCVPC. Interventions for SCVPC may require modification based on chronobiological trends.
Assuntos
Anemia Falciforme/fisiopatologia , Ritmo Circadiano/fisiologia , Adulto , Analgésicos/administração & dosagem , Anemia Falciforme/tratamento farmacológico , Serviço Hospitalar de Emergência , Humanos , Dor/tratamento farmacológico , Dor/fisiopatologia , Estudos RetrospectivosAssuntos
Moduladores GABAérgicos/uso terapêutico , Midazolam/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Adulto , Emergências , Moduladores GABAérgicos/administração & dosagem , Humanos , Injeções Intramusculares , Masculino , Midazolam/administração & dosagem , Resultado do TratamentoAssuntos
Eletrocardiografia/métodos , Auxiliares de Emergência/educação , Cardiopatias/terapia , Terapia Trombolítica/estatística & dados numéricos , Eletrocardiografia/estatística & dados numéricos , Florida/epidemiologia , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Humanos , Terapia Trombolítica/normasRESUMO
Federal [U.S.] law and the Joint Commission on the Accreditation of Healthcare Organizations mandate plans and mechanisms for response by hospitals to hazardous material incidents/accidents be developed and implemented. This paper describes the response of the University Hospitals of Cleveland to these regulations and to the anticipated needs of the community and local industry. The physical plant constructed and its relationship to the emergency department personnel for staffing this unit are described. Utilization patterns since implementation of this program are presented.
