European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Clinical Trial
Patients intoxicated with heroin or heroin mixtures: how long should they be monitored?
Our investigation was carried out in subjects intoxicated with heroin or heroin mixtures to find out the time interval during which delayed life-threatening complications become manifest, such as pulmonary oedema or relapse into respiratory depression or coma after naloxone treatment. We studied prospectively all drug intoxications between 1991 and 1992. Of the 538 intoxications, we assessed in detail 160 outpatients who lived within the catchment area of our hospital. ⋯ Based on reliable report, the pulmonary oedema occurred between approximately 2 1/4 and 8 1/4 hours after intoxication. In the literature, only two cases of delayed pulmonary oedema have been reported with reliable time statements (4 and 6 h after hospitalization). We therefore conclude that surveillance for at least 8 h is essential after successful treatment to exclude delayed pulmonary oedema in patients intoxicated with heroin or heroin mixtures.
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Routine pelvic radiography is carried out in all blunt trauma patients referred to our Emergency Department according to advanced trauma life support protocols. In this retrospective study, we questioned whether it is cost-effective to obtain 'routine' pelvic X-ray films. The notes and X-rays of all consecutive patients with blunt trauma who were referred to the Emergency Department of Dokuz Eylül University Hospital, Izmir, Turkey, between August and December, 1993 were re-evaluated. ⋯ The difference between the groups were statistically significant (p < 0.001). As a result, we concluded that 'routine' pelvic radiography should be performed in the setting of blunt trauma only if the patient is: (a) unconscious, uncooperative or intoxicated, or (b) conscious, fully orientated and cooperative and complaining of pain both in the history and on pelvic examination. These limitations would allow us to decrease the amount of irradiation received, render more cost-effective treatment, and reduce the workload of emergency and radiology departments.
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Over a 3-year period, 663 children aged under 13 years were seen with a history of foreign body (FB) ingestion. Seventy-six per cent of the children were less than 6 years old. Coins and chicken or fish bones were the most common objects ingested. ⋯ All 224 FBs detected in the stomach or beyond were allowed to pass naturally, and delayed passage occurred in only one case. Passage of 11 alkaline disc batteries occurred without complication. No patient required surgical removal of an FB.
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Clinical Trial Controlled Clinical Trial
Transcutaneous PO2 measurement in compound fractures.
The transcutaneous assessment of tissue oxygenation has become a useful method for evaluating microcirculatory disorders in different diseases. In this clinical experimental pilot study, the impact of compound fractures on tissue oxygenation was examined. Using a special probe placed directly into the muscle, tissue oxygenation was measured at the site of tissue injury as well as at one non-injured site within the same fractured extremity. ⋯ After day 4 until the end of the study (day 10) a complete return to normal values was noted at both sites. In conclusion, it is most likely that, due to a change of microcirculation within the fractured extremity, the injured site is temporarily oversaturated by oxygen and this is associated with low oxygenation at the non-injured site on the same extremity. As the microcirculatory status may be important in making decisions about trauma surgery (e.g. whether or not to amputate), transcutaneous oxygen measurement is a practical and useful method in trauma care.
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The very early handling of patients with suspected acute myocardial infarction (AMI) is of critical importance to the outcome. The aim of this study was to relate the dispatcher's initial suspicion of AMI, among patients who call for an ambulance due to chest pain, to the subsequent diagnosis and outcome. All patients who called for an ambulance in Gothenburg due to acute chest pain during a 2-month period were included in the study. ⋯ Among patients with at least a strong suspicion of AMI, 29% subsequently developed infarcation, compared with 18% among patients with a moderate suspicion of AMI and 15% among patients with only a vague or no suspicion (p < 0.001). However, the priority level was similar in patients with and without a life-threatening condition, and the mortality rate remained similar in patients with a strong suspicion and those without a strong suspicion of AMI. Thus, among patients who called for an ambulance due to acute chest pain there was a direct relationship between the dispatcher's suspicion of AMI and the subsequent diagnosis, but the mortality rate was similar in the different groups.