Praxis
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In avalanche accidents the cause of cardio-respiratory arrest (asphyxia, hypothermia, trauma) is difficult to determine in the field but may be important (high number of victims, limited number of rewarming places). 32 avalanche accidents (16 survivors/16 deaths) were therefore reviewed retrospectively. In 19 patients with cardiorespiratory arrest, asphyxia was frequent (17 patients, 89%) hypothermia was rare (two patients, 11%). The cooling rate between the accident and the arrival at the hospital was 3.0 degrees C/h. (range 0.75-5.8). ⋯ The maximal cooling rate under the snow was estimated at 8 degrees C/h. Cardiorespiratory arrest in hypothermic patients without asphyxia seems only to be possible after being buried for at least 1 h. under the snow. Serum potassium was elevated in most cases of asphyxia.
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A 30-year-old male patient was admitted to our outpatient clinic because of fever, headache and cerebellar symptoms. Clinically he presented with a slight meningism. ⋯ The patient recovered without neurological residua within two months. The clinical course, dates of new epidemiologic studies and problems of vaccination are discussed.
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Review
[Clinical-toxicological case (1). Dosage of N-acetylcysteine in acute paracetamol poisoning].
There are currently three protocols used for the administration of N-acetylcysteine in the treatment of acute paracetamol poisoning. In the USA only the oral protocol is approved, while in Europe an intravenous protocol is used. ⋯ N-acetylcysteine is effective also when started more than 15 h after the ingestion. Patients who present with liver failure after paracetamol poisoning should be treated with a prolonged course of N-acetylcysteine.