European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Dizziness is a common and vexing diagnostic problem in emergency departments. The term is rather undefinite and often misused, but can in practice be classified into four categories: fainting, disequilibrium, vertigo and miscellaneous syndromes. Vertigo is the most common category of dizziness. ⋯ Physicians working in emergency departments must be able to rapidly identify patients with potentially serious forms of vertigo, which could cause death or disability, and patients with mild conditions, that can be effectively treated. Previous studies and the experience of the authors have shown that reliable diagnostic hypotheses can be generated by taking a proper clinical history (focused on the onset and duration of the disease, the circumstances causing the vertigo and associated otological or neurological symptoms) and performing an accurate physical examination (evaluation of neurological defects and spontaneous or provoked nystagmus), supplemented by few laboratory tests and diagnostic procedures. Therapy of vertigo in emergency settings is mainly symptomatic and based on sedation and use of vestibulosuppressant drugs (antihistamines, phenothiazines).
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The system of prehospital trauma care in the Netherlands is the subject of great concern. Although many improvements have been achieved in the last decade, there are still some deficits. Legislation concerning the minimal level of education for ambulance attendants was recently upgraded to 'registered nurse', a standard which must be achieved by 1997. ⋯ The deficits of the Dutch system of care related to the PHTLS/ATLS standard are pointed out, resulting in recommendations to improve the Dutch system. The requirements of the dispatcher are far inferior to the optimal situation, which, together with the lack of technical equipment, results in serious communication problems. The Dutch ambulance attendant education, in which in the present system the education level reaches 'registered nurse' in only 91% and specialized courses are not mandatory, should be upgraded to the PHTLS level of care.
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The aim of this study was to assess the influence of prehospital advanced life support (PALS) on the survival of victims of severe trauma in our hospital. During a period of 24 months, 46 patients with severe trauma were admitted to our Emergency Department after receiving PALS; this included endotracheal intubation and ventilatory support (IVS) in 35 cases, and cardiopulmonary resuscitation (CPR) in 11. ⋯ The survival rate was 48% in patients with prehospital IVS rate and 18% in those receiving CPR. We conclude that PALS in severe trauma was able to save the lives of many patients at high risk of dying before reaching hospital.
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Traumatic cervical spine injuries can result in severe disability or death unless promptly diagnosed and treated. Advanced trauma life support guidelines recommend that three-view cervical spine X-rays should be obtained routinely in all blunt trauma patients. In this retrospective study, we evaluated whether cervical spine X-rays are indeed necessary in all such patients. ⋯ On the other hand, none of the patients without neck pain and tenderness were found to have cervical spine injury. We conclude that pain and/or tenderness in the neck area are valid criteria with regard to the timely diagnosis of cervical spine injuries, and that routine cervical spine X-rays may be unnecessary for those blunt trauma patients who are conscious, fully orientated, co-operative, non-intoxicated, exhibit no neurological deficits and who do not have neck pain or tenderness. Omitting cervical X-rays speeds up patient evaluation, protects the department staff from unnecessary exposure to ionizing radiation and mitigates treatment costs, while maintaining the quality of the healthcare provided.