European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Isolated sternal fractures are seen with an increasing frequency in traffic road accidents especially after the introduction of the seatbelt legislation. In most cases, the victims are young, otherwise healthy individuals. The medical records of all patients who were treated with a diagnosis of sternal fracture over the past 10 years were retrospectively reviewed. ⋯ The cardiac enzyme studies, ECG and echocardiography revealed no consequent information about arrhythmias. In case of a sternal fracture, we recommend a chest X-ray to exclude other associated intrathoracic injuries. If no abnormalities are identified, admission to hospital is not necessary.
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The quality of the treatment by emergency physicians of patients with abdominal complaints, who visited the emergency department (ED) of a city hospital (OLVG), Amsterdam, The Netherlands, was evaluated in a prospective observational study. During 6 months 1853 patients with abdominal complaints visited the emergency department of the OLVG hospital, 1221 patients (66%) without referral by a general practitioner (GP). Of these 1221 patients, 933 (76%) were treated by the emergency physician without consulting a specialist. ⋯ It is concluded that most patients with abdominal complaints visit the ED of this hospital without referral by their GP. Of these patients, the emergency physician can treat 76% without further specialist consultation. In seven patients (1.1%) the diagnosis was missed.
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Brain oedema is a major factor contributing to the poor outcome of subjects with acute ischaemic stroke but the use of mannitol and other hyperosmolar agents in this setting is controversial and hardly debated. Recent data have demonstrated that mannitol at concentrations which may be achieved in clinical conditions and hyperosmotic stress itself can activate the process of apoptotic cell death. ⋯ Furthermore, apoptosis in ischaemic areas closely parallels the timing of brain oedema and this suggests that a cause-effect relationship links the two phenomena rather than simply a temporal correlation. On this basis, it is crucial that emergency-physicians critically rethink the management strategy of brain oedema associated with ischaemic stroke.
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The Trondheim region's (315 km2, population 154,000) emergency medical service (EMS) provides advanced cardiac life support (ACLS) with combined paramedic and physician response. This EMS system is commonly employed in Norway, yet no population based study of outcome in cardiac arrest has been published to date. This retrospective study reports incidence and outcome from every attempted out-of-hospital cardiopulmonary resuscitation (CPR) during 1990 through 1994 according to the Utstein template. ⋯ Most patients made a favourable cerebral outcome, although nine were severely disabled. This is the first population-based Norwegian study of outcome from out-of-hospital cardiac arrest in this combined paramedic/physician staffed EMS. Incidence, survival and neurological outcome are comparable with results obtained in other EMS systems.