RESUMEN
No specialty better personifies the changes occurring throughout the health care delivery system than emergency medicine. It was just a short 25 years ago that the specialty of emergency medicine, as it is known today, emerged. The full-time staffing of EDs arose out of a need by patients who were presenting in ever-increasing numbers to hospital EDs that were staffed by a nurse or part-time physician. The specialty has continued to be responsive to the changing health care system throughout the past 25 years with innovations such as fast track units, observation units, and chest pain treatment center. To develop a vision for the future of the specialty, it is important to first evaluate the current trends in health care and their influences on the specialty. Three significant areas stand out in the current health care landscape: consolidation of hospital systems, emergence of publicly traded physician practice management companies, and the increasing penetration of managed care.
Asunto(s)
Medicina de Emergencia/tendencias , Programas Controlados de Atención en Salud/tendencias , Instituciones Asociadas de Salud/tendencias , Administración de la Práctica Médica/organización & administración , Administración de la Práctica Médica/tendenciasRESUMEN
Vital signs upon arrival to the emergency department were studied retrospectively in 59 consecutive patients with isolated penetrating abdominal injuries to determine their chronotropic response to hypotension. Forty-three patients with documented intraperitoneal injury were included in the study and separated into hypotensive and normotensive groups using a systolic blood pressure of 90 or 100 mm Hg. The difference in mean pulse rates between normotensive and hypotensive groups was not statistically significant (P greater than 0.05) although a wide range of pulse rates was noted in both groups. Nearly half of all hypotensive patients were not tachycardic, defined as a pulse rate less than 100. Similar findings were observed when the 117 sets of vital signs recorded both in the field and in the emergency department were analyzed as independent pieces of data. Several mechanisms are proposed for the lack of tachycardia in the presence of hypotension. This data suggest that tachycardia may not be a reliable sign of hypovolemic shock when defined by blood pressure criteria in these patients.
Asunto(s)
Traumatismos Abdominales/fisiopatología , Hipotensión/fisiopatología , Choque/fisiopatología , Taquicardia/etiología , Heridas Penetrantes/fisiopatología , Traumatismos Abdominales/complicaciones , Adolescente , Adulto , Anciano , Femenino , Humanos , Hipotensión/complicaciones , Hipotensión/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Choque/etiología , Heridas Penetrantes/complicacionesRESUMEN
The seemingly uncontrolled increase in the cost of medical care is one of the major problems facing the American physician. Although the reasons for escalated costs are multifactorial, the physician does play an important role in the problem. Several studies have suggested that physicians, the cost generators, and unaware of the economic impact of the care they provide. In the preparation of this report, 70 medical students, 316 interns and residents, and 41 faculty members at the University of Miami School of Medicine were surveyed on their knowledge of frequently ordered hospital billing items. A common lack of knowledge was noted in all three groups of respondents, with the faculty scoring as poorly as the medical students. Major efforts must be directed toward the cost education of physicians.