European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review Case Reports
Traumatic blunt carotid injury: clinical experience and review of the literature.
To evaluate the symptoms, the associated lesions, the treatment and the outcome of patients with blunt carotid injury (BCI), we reviewed the records of all patients admitted to our intensive care unit with head trauma between May 1991 and May 1995. A patient's assessment included the commonly used severity scores and cranial computed tomography (CT). Other diagnostic investigations were performed according to the clinical setting. ⋯ In every patient the radiologic investigations demonstrated a thrombotic obstruction of the internal carotid artery (ICA), associated with an intimal dissection in two cases. Three patients were discharged with only minor neurologic symptoms. The fourth patient was referred to our ICU after the development of a massive hemispheric infarction, and died 3 days after admission.
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Comparative Study
Patients with psychiatric emergencies transported by an ambulance in an urban region.
This paper studies the use of an ambulance service in the case of psychiatric emergency referrals. A cross-sectional design was used to compare the patients brought in by an ambulance with all other psychiatric emergency referrals. ⋯ However, for another group of referrals the ambulance is used for other reasons. The possibility of using alternative social services in these cases are discussed.
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We report on the use of Biers Block in an accident and emergency department carried out during the period 1987 to 1994. A total of 915 procedures were carried out, of which 815 (98%) involved emergency procedures. ⋯ Acceptability by the patients was uniformly good. We feel it is a useful method of producing analgesia in the limb that does require training but no extensive experience or anaesthetists' expertise.
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The aim of this study was to observe cerebral and systemic oxygen extraction after human cardiac arrest with return of spontaneous circulation. Eight adult patients after non-traumatic, cardiac arrest were included. Cerebral and systemic oxygen extraction ratios were measured together with haemodynamic variables beginning 2 hours after cardiac arrest and every 4 hours thereafter until 24 hours. ⋯ In conclusion cerebral oxygen extraction was higher in long-term cardiac arrest survivors than in non-survivors between 12 and 24 hours after the event. Further, a better quality of neurological recovery was associated with higher cerebral oxygen extraction. Systemic oxygen extraction was also impaired, but to a lesser extent, especially in long-term survivors.
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Verapamil overdose, because of its frequency and severity, represents a significant problem for the emergency physician. With recent search recommending specific therapies for verapamil toxicity, aids to rapid diagnosis hold promise for decreasing morbidity and mortality from overdose of all calcium channel blockers. At this time, diagnosis of verapamil toxicity depends primarily on patient history and identification of cardiac dysrhythmias. ⋯ The next most commonly seen rhythms were tertiary atrioventricular (AV) block (16.3%) and idioventricular rhythm (11.6%); other animals manifested low grade AV block. Of interest, prominent U waves were noted in 25.6% of animals. While these results are subject to the limitations inherent in the use of an animal model, the data generated provide potentially useful patterns of dysrhythmia which may be encountered in humans with verapamil toxicity.