European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The aim of this study was to evaluate the day-to-day trauma care in a developing country highlighted by a major accident. In this accident, early management was not carried out according to triage principles. Scene mortality and in-hospital mortality were 72% (n = 55) and 14% (n = 3), respectively. ⋯ One liver laceration, one splenic rupture, one intraabdominal bleeding due to rupture of mesenteric vessels, two major cranial traumas and an abruptio placenta were the other pathologies. The missed injury rate in this accident was 16% (n = 6). It is concluded that the missed injuries in this incident reflect the inadequacy of trauma care in the rural area of the developing country.
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Repetition of psychiatric emergency department use by a relatively small number of patients constitutes a major problem for clinicians and service providers. This study aimed at the identification of risk factors for repetition by addressing the time interval between the first and second visits to the emergency department. The purpose was to investigate what patient characteristics and referral circumstances determine this interval. ⋯ Younger, male patients who present themselves spontaneously are more likely to repeat than others. Previous inpatient service use and the presence of a diagnosis of substance abuse disorder or psychotic disorder at the first visit further increases the risk for repetition. Previous service use and, to a lesser degree, demographic and clinical characteristics of psychiatric patients are useful in the prediction of variations in time between first and second referrals to the emergency department.
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The objective of this paper was to determine the views of accident and emergency consultants and trainees towards practice guidelines and their experiences using guidelines. A postal questionnaire survey of consultants, senior registrars and registrars in accident and emergency medicine was carried out in Yorkshire. The results of this survey show that the potential benefits of practice guidelines are appreciated, and that evidence-based and 'user-friendly' guidelines are wanted. It is concluded that unless rigorously developed and clear and easy to use, guidelines are unlikely to be implemented in accident and emergency departments in the UK.
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Review Case Reports
Fatal Streptococcus viridans descending mediastinitis: case report and review of the literature.
Mediastinitis is a life-threatening complication of cardiac, neck and oesophageal surgery. It has also been reported following upper digestive and respiratory procedures and as a consequence of oesophageal perforation following the ingestion of foreign bodies. ⋯ We describe the case of a patient with fatal mediastinitis and septic shock. The onset of mediastinitis was preceded by a 2-day course of sore throat and other flu-like symptoms.
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Epidemiologic research of disasters is hampered by a lack of uniformity and standardization in describing these events. By applying a classification and scoring system, which recently became available, an analysis could be performed of 416 disasters from the past 40 years. ⋯ It is concluded that the classification and scoring system used could serve as a tool for evaluating the majority of disasters. A small improvement of this system is recommended.