European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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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.
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Contention over fluid resuscitation is not new. The issues however have changed considerably. The crystalloid/colloid debate has largely reached a stalemate with little to define clear differences between the two especially early in traumatic shock when increased capillary permeability is a minor issue. ⋯ Fluid resuscitation has necessarily become more complex as the potential to do harm has been more clearly demonstrated. The use of resuscitation fluids must now receive as much care and consideration as is currently given to the prescription of potent drugs, weighing the potential benefits of a course of action against its possible side effects. Much research is required to clarify and refine the data on fluid resuscitation but there is little doubt that the conceptual changes which underlie this work on haemorrhagic shock offer the most exciting advances in fluid resuscitation seen in the past 30 years.
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Comparative Study
Alteration in leukocyte adhesion molecule expression following minor, moderate and major trauma.
An understanding of the mechanisms of post-injury leukocyte trafficking is essential to the development of future therapeutic interventions aimed at preventing infection and multiple organ failure in trauma patients, yet very little is known about the cellular and molecular events resulting in mobilization of members of the leukocyte family following trauma. We have studied the post-injury expression of the lymphocyte, monocyte and neutrophil adhesion molecules CD11a (LFA-1), CD11b, CD11c, CD29 (beta-1 integrin) and CD62L (L-selectin) in a group of 36 trauma patients, 13 of whom had suffered major trauma (ISS > or = 16), 15 moderate trauma (ISS = 9-15) and eight minor trauma (ISS < 9). Three ml blood samples were taken within 2.5 h of injury (mean sample time = 1.2 h, median = 1 h) into EDTA anticoagulant. ⋯ Our results indicate that there is a reduction in CD11a expression after trauma which may play an important role in the demargination of neutrophils and monocytes. The strong increase in L-selectin expression in all cell populations was unexpected, and is potentially important because this molecule supports rolling behaviour in all members of the leukocyte family, and would promote close contact between leukocytes and the endothelium at the site of injury without firm adhesion taking place. These events may be of significance in planning future strategies to combat post-trauma complications.
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Comparative Study Clinical Trial Controlled Clinical Trial
Social work at the emergency department.
We have evaluated the level of satisfaction of patients assigned to a social worker whose role was to give information, support, advice, grief and shock counselling; and develop resource strategies for marginal peoples. Six hundred patients were admitted to the study; 300 of them were supervised by a social worker (group A) and the other 300 were not (group B). After the completion of the study, a questionnaire was sent to be filled in by group A and group B for later evaluation. ⋯ The most important areas were: 105 patients (94.5%) in group A vs. 73 patients (82%) (p < 0.005) consider the medical care good or very good. The waiting time was assessed as short or acceptable in 91 patients (81.9%) in group A vs. 55 patients (61.8%) in group B (p < 0.001). The psychosocial care was assessed as very good or good in 101 patients group A (90.9%) vs. 73 patients in group B (82%) (p < 0.5).
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It is well recognized by accident and emergency clinicians and the defence societies that radiological abnormalities are frequently missed by the clinician who first looks at the X-rays. These errors may be compounded if the X-rays are not reported by a radiologist. ⋯ The purpose of this article is to make the important point that false positive and false negative misses on X-rays need to be communicated to the accident and emergency department promptly so that appropriate action can be taken. We describe an efficient method of communication.