European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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In this review the epidemiology of bacterial meningitis and the new insights in the pathophysiology are thoroughly discussed. The different diagnostic steps are described and the present day antibiotic strategy and adjunctive inflammation-modulating therapy are delineated.
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For 25 years aggressive prehospital fluid administration in trauma patients has been common practice. Recent studies suggest that this may increase mortality in patients with hypovolaemic shock. ⋯ Fluid resuscitation before definitive haemostasis has been achieved, may accelerate blood loss, cause hypothermia and result in a dilutional coagulopathy. Further studies are needed to establish optimum volume replacement in trauma patients with hypovolaemic shock.
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In order to get an update on prehospital emergency medicine practice all over Europe we submitted questionnaires with a total of 61 questions concerning prehospital emergency medicine in Europe, to 123 European members of the World Association of Emergency and Disaster Medicine (WAEDM). Sixty (49%) questionnaires were returned. One up to seven questionnaires from 22 European countries were analysed: 37 (62%) from urban and 23 (38%) suburban or rural areas; 12 being from former Eastern European countries. ⋯ Physicians are frequently involved in prehospital emergency care in the Eastern European Countries, France, Germany, Italy, Belgium and Turkey, rarely in Switzerland, Denmark, the United Kingdom, Greece, Ireland and Finland, never in the Netherlands and Sweden. In more than 50%, a combination of national, regional and local organizations provide emergency care, which results in large differences of standards. We discovered remarkable differences which could be overcome by enhanced co-ordination and information exchange provided by the European Society for Emergency Medicine, WAEDM, the European Red Cross or the European Academy of Anaesthesiologists.
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The hypothesis that high level on-the-field ATLS could influence mortality in severe trauma patients was tested by means of a prospective study. During a 7 month period, data of all the victims of severe involuntary trauma (road traffic accidents, work and sport accidents) in 3 Provinces of north-east Italy were entered in a database and analysed. The whole area is covered by a single emergency service which has direct control over all the ambulances and the Emergency Helicopter Service (EMHS). ⋯ The average time elapsed between the emergency call and the final admission to the definitive care institution was 55'. Mean ICU stay was 11 days. Mortality rate in this group was 12%, significantly lower than in group A (p < 0.005) and group B (p < 0.05).
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The proportion of abnormal chest radiographs in patients admitted following a femoral neck fracture was assessed. Significant abnormalities were found in 14%. In all these cases chest radiography was indicated. No abnormality was unexpected clinically.