European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Modern emergency medicine requires the use of temporary observation (TO) to direct diagnostic and therapeutic decisions. The position of TO in the hospital structure has been well defined in the legal sense, inasmuch as it provides the preparatory stage for the final specialized medical treatment the patient will receive after admission. TO has become indispensable in emergency medicine to provide prompt treatment of critically ill patients and to clarify as rapidly as possible uncertain cases to avoid unnecessary admissions and transfers. To operate effectively, the service of TO must be provided well-trained staff, suitable physical facilities and support services, and access to rapid specialty consultations within the emergency room environment.
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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.
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Comparative Study
Approach to head trauma in childhood in a district general hospital.
The authors compared the management of children with head trauma in a general hospital in two different periods (1984-85 and 1988-90). In the first period 233 cases were retrospectively evaluated; no guidelines were available at that time. In the second period 709 paediatric patients were treated following a protocol with indications for hospital admission and diagnostic procedures. ⋯ From our data and from the literature it emerges that it is necessary to clearly distinguish the children from 10 to 14 years of age from the rest of the paediatric population for major risk of intracranial complications, as in this group the presence of a skull fracture represents a high risk factor, predictive of an intracranial haematoma. In the children under 10 years, the history and the clinical status have greater importance in establishing the diagnostic procedure to be followed. The asymptomatic cases (S0) or those with mild symptoms (S1) can be sent home with an instruction sheet explaining the symptoms of possible complications, without any further diagnostic procedures.