European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Mass gatherings are special situations for which mass medical care must be preplanned. Acute emergencies occur at public gatherings and medical coverage on site has proven benefit. ⋯ In mass gatherings the whole emergency medical service (EMS) planning and management has to depend on the emergency department direction, with its authority on all aspects of patient care in the EMS system. This report concerns the planning of EMS and of medical care in a situation at risk for mass casualties at the Formula I Grand Prix-Championship Racing 'San Marino' of Imola.
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Measuring intracompartmental pressure is a well-accepted method in evaluating a compartment syndrome, which may occur after limb ischaemia followed by reperfusion. As a compartment syndrome is paralleled by a decreased microcirculation it should be possible also to evaluate a compartment syndrome by measuring intramuscular partial oxygen tension (PO2). In this study, anaesthetized rats (spontaneous breathing via tracheotomy) were subjected to infrarenal ligation of the aorta. ⋯ There was no significant change in compartment pressure throughout the study, and PO2 remained significantly decreased even during reperfusion (2.0-3.0 mmHg). Normal compartment pressure could mislead to false negative interpretation of microcirculatory disorders preceding or following compartment syndrome, whereas PO2 clearly identifies the microcirculatory state of the muscle. Thus, intramuscular PO2 monitoring presents a valuable method in evaluating compartment syndrome, especially where there are suspected clinical signs and risk of ischaemia but normal compartment pressure.
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Comparative Study
Anaesthesia for the management of distal radius fractures in adults in Scottish hospitals.
The objective of this study was to determine the methods of anaesthesia used for the reduction of distal radius fractures in adults in Scotland and to compare this with the UK situation. The method used was a telephone questionnaire of accident and emergency doctors in 25 Scottish hospitals dealing with trauma. Thirty-two per cent still use general anaesthesia routinely for these procedures despite its cost, complexity and need for admission in the majority of cases. ⋯ Twelve per cent use intravenous sedation and 12% use haematoma blocks for manipulations. It is concluded that Bier's block may be the anaesthetic method of choice for the management of distal radius fractures both in efficiency and economic terms in Scotland. However, training for Bier's blocks needs to be standardized and improved.
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Comparative Study
Long-term prognosis in men and women coming to the emergency department with chest pain or other symptoms suggestive of acute myocardial infarction.
The aim of this study was to describe mortality, mode of death and risk indicators for death during 5 years of follow-up among men and women coming to the emergency department with chest pain or other symptoms raising suspicion of acute myocardial infarction (AMI). During the 21 months of the study, all patients who came to the medical emergency department of one single hospital with chest pain or other symptoms suggestive of AMI were prospectively followed for 5 years. A total of 5362 patients came on 7157 occasions; men accounted for 55% of the admissions. ⋯ Independent risk indicators for death during 5 years of follow-up differed in men and women. It was concluded that in a consecutive series of patients with chest pain or other symptoms suggesting AMI in the emergency department, male gender was an independent risk indicator for death during a 5-year follow-up. This might be explained by a higher occurrence of coronary artery disease in men than in women in this patient population.