Twelve years of emergency medicine at Hennepin County Medical Center. Changing critical care experience.

OBJECTIVE: To elucidate the critical care experience of emergency medicine faculty and delineate changing patterns of practice. METHOD: A retrospective review of the resuscitation room dictations for all patients treated in the emergency department resuscitation room by one emergency medicine physician from July 1, 1985, to June 30, 1997, was performed. RESULTS: A total of 1,325 cases were reviewed. The number of cases of arrhythmia (p < 0.01) and medical cardiac arrest (p < 0.01) significantly decreased over time, while the number of cases involving firearm injury (p < 0.01) increased. The percentage of trauma cases steadily rose from 38.5% in year 1 to 50.2% (p < 0.01) in year 12. Significant decreases in the rate of arterial line placement (p < 0.01), central line placement (p < 0.01), nasotracheal intubation (p < 0.01), and thoracotomy (p < 0.05) have occurred. Significant increases were seen in cardiac ultrasound examination (p < 0.01), rapid sequence induction for intubation (p < 0.01), and the use of paralytic medications (p < 0.01). CONCLUSION: Significant changes have occurred in the type of case and rate of utilization of various diagnostic and therapeutic procedures.