European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
We report the case of a 32-year-old male who presented to the emergency department with left-sided chest pain associated with burning epigastric discomfort and radiation to the back. Similar symptoms had prompted his visit to another emergency department 1 week earlier. He was discharged from that institution after a negative upper gastrointestinal series. ⋯ Aortic dissection is rarely seen in young, healthy individuals. Atypical clinical representations are reviewed. The emergency department work-up of aortic dissection is discussed.
-
Comparative Study
Clinical status before and during cardiopulmonary resuscitation versus outcome in two consecutive databases. Belgian CPCR Study Group.
The outcome of out-of-hospital cardiac arrest is very much determined by uncontrollable precardiopulmonary resuscitation (CPR) conditions. Two consecutively registered databases containing variables related to pre-arrest, arrest and CPR are similarly analysed to produce and validate a simple clinical algorithm for acute decision making during CPR. ⋯ The simultaneous and persistent absence of ventricular fibrillation, gasping and light-reactive pupils after arrival of the second tier was strongly associated with a poor outcome. Unresponsiveness of these variables to a full and optimal trial of advanced life support can in itself be considered as an index for irreversible myocardial and neurological damage.
-
All prehospital resuscitations performed by emergency physicians in the city of Bochum, Germany, were recorded and evaluated prospectively from 1 August 1989 to 30 September 1990. Initially successful cardiopulmonary resuscitation (CPR) was achieved in 33.8% (alive at admission), and definitive success in 10.4% (discharged alive). Of the patients who presented with cardiac arrest before the arrival of the emergency physician, 28.4% could be resuscitated initially and 7.6% survived definitively. ⋯ This decrease, however did not improve either the initial or the definitive success of CPR. From these results we conclude that further improvement of prehospital resuscitation can only be achieved to a small extent by reducing the call to arrival time of ambulances staffed with emergency physicians. Improvement is more likely to be seen when immediate resuscitation is performed by bystanders present at the scene.
-
This retrospective study was conducted to evaluate whether an observation unit (OU) attached to the emergency department (ED) of a tertiary care hospital in India is safe, is effective in minimizing hospitalization of acutely ill patients and is acceptable to the patients. Of 115,916 patients who attended the ED, 11,130 (9.6%) were observed in the OU. ⋯ Twenty-four patients left the hospital against medical advice, and three patients died in the OU. It is concluded that an OU in the ED is safe in treating acutely ill patients, is effective in reducing substantially the number of patients requiring admission to the hospital, and is acceptable to the patients.
-
During the last two decades the reported risk of overwhelming postsplenectomy infection (OPSI) has resulted in a conservative approach to splenic trauma, with the aim of splenic salvage. The appropriateness of this strategy is now questioned. The risk of OPSI varies with age and indication for splenectomy from less than 1% in adults to more than 4% in children. ⋯ A prerequisite for splenic preservation procedures should be a haemodynamically stable patient without other intraabdominal injuries. The benefits derived from non-operative treatment of splenic salvage procedures may be overshadowed by the potential risk of transfusion-related bacterial and viral diseases. Polyvalent pneumococcal vaccines given early after splenectomy appear to reduce the incidence of OPSI substantially.