European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The risk of violence directed at health care professionals in their working environment has aroused widespread concern in recent years. Clinical areas most associated with violence are accident and emergency departments, psychiatry, and general practice. Surveyed physicians reported rates of violence against them to vary from 54% to 79%. ⋯ This study was an attempt to measure the incidence and the severity of violence against doctors in accident and emergency departments in Kuwait. Eighty-seven (86%) out of 101 of our doctors reported having experienced verbal insults or imminent threat of violence; in addition, 28% had also experienced physical attacks, and 7% had experienced physical assaults likely to have caused serious or fatal injury. Similarly, out of a total of 781 violent incidents reported by our doctors, 73 involved physical attacks, and eight involved physical assaults likely to have caused serious or fatal injury.
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Review Case Reports
Frightening dreams and spells: a case of ventricular asystole from Lyme disease.
We present a case of a 20-year-old woman who presented with a febrile illness, frightening dreams and repeated short episodes of apparent seizure activity. Third degree heart block and ventricular asystole were noted on the monitor when the patient experienced a spell during conscious sedation for a lumbar puncture. ⋯ Lyme titres were strongly positive and subsequently confirmed by Western Blot analysis. Cardiac aetiologies and specifically heart block associated with Lyme disease should be considered in patients from endemic areas presenting with fever and unexplained spells or seizure-like activity.
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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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Comparative Study
Injuries in The Netherlands: results of surveillance-based public health research.
Public health is the scientific field which aims to study, preserve and improve the health of populations. Its primary diagnostic tool is public health surveillance. In this paper the methodology and results are presented of three surveillance-based studies on injury patients in The Netherlands. ⋯ A central issue is the recording of information on the injury diagnosis, including information on injury severity. This can only be obtained if clinicians are willing to collect data. Public health surveillance therefore highly relies on the co-operation of clinicians.
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The purposes of the study were to determine the total cost of Ankara Emergency Aid and Rescue Services (EARS), to calculate the cost of a single ambulance response and the cost per patient responded to. A descriptive study was planned to find out the cost of Ankara EARS, conducted between 1 October 1995 and 30 September 1996. The main variables of the study were the capital and recurrent costs of the system. ⋯ On the other hand the cost per patient or injured person was US$180.50. In Ankara, Turkey, the costs of such ambulance services could not be afforded by the private sector. The ambulance service activities should continue to be a part of primary health care services and the Ministry of Health should continue to serve in this field.