European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The aim of this survey was to explore treatment routines with regard to early heart attack care at various hospitals in Sweden. All the hospitals in Sweden with a coronary care unit or its equivalent were sent a postal enquiry about early heart attack care including use of various medications and educational level of health care providers. In all, 84 of 86 hospitals (98%) answered the enquiry. ⋯ This survey indicates that the vast majority of hospitals in Sweden use thrombolytic agents in more than 30% of AMI patients and aspirin in more than 80% of AMI patients. The use of intravenous beta-blockade is lower than expected. Considering the strong association between the delay before instituting therapy and outcome, it is surprising that treatment is not initiated more frequently outside hospital or in the emergency department.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative study of the efficacy of lysine acetylsalicylate, indomethacin and pethidine in acute renal colic.
The aim of this study was to compare the analgesic efficacy of intravenous lysine acetylsalicylate 1.8 g, indomethacin 100 mg and pethidine 100 mg in acute renal colic in a randomized double-blind clinical trial. One hundred and fifty patients with acute renal colic were divided into three groups. The first group received lysine acetylsalicylate 1.8 g, the second group received indomethacin 100 mg and the third group received pethidine 100 mg. ⋯ Lysine acetylsalicylate was less effective than indomethacin and pethidine. It is concluded that intravenous indomethacin is an effective alternative to intravenous pethidine in the treatment of acute renal colic. Intravenous lysine acetylsalicylate is inferior to intravenous indomethacin in treatment of acute renal colic.
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Review Case Reports
Early electrocardiographic signs in acute massive pulmonary embolism.
As a result of the increasing accuracy in diagnosing acute pulmonary embolism by isotopic ventilation-perfusion scintigraphy and pulmonary arterial angiography, the electrocardiographic changes associated with acute cor pulmonale are being abandoned as a diagnostic tool for this life-threatening disease. Nevertheless, certain electrocardiographic findings can raise the suspicion of pulmonary embolism. ⋯ In this case report we emphasize the importance of the electrocardiographic findings which forwarded the diagnosis of pulmonary embolism. Hence the necessary invasive diagnostic and therapeutic measures, i.e. pulmonary arterial angiography and thrombolytic therapy, can be taken immediately after admission to the emergency department.
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Laceration of the superior vena cava is an unusual result of blunt trauma and is almost invariably lethal. A case caused by a high speed road traffic accident is presented; the factors relating to survival are discussed.
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All in-hospital interventions by the crash team of our hospital were recorded and evaluated retrospectively from 1 January 1992 to December 1994 and prospectively for 1995. The most frequent diagnosis was some type of cardiac arrest with a maximal incidence of 32.4% in 1994. Intubation was required in 58.7% of the cases in 1995. ⋯ The inappropriate overruling of the 'do not attempt resuscitation' (DNAR) policy eventually resulted in one survivor. We identified at least five cardiac arrest patients with an unacceptable delay in advanced life support. Our in-hospital critical incident registry resulted in a better policy for appropriate and timely intensive care unit referral.