European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
Review Comparative Study
Is there a gender difference in aetiology of chest pain and symptoms associated with acute myocardial infarction?
Many previous studies have shown that there is a gender difference in terms of the use of diagnostic procedures and the treatment of patients with chest pain. The mechanisms behind these observations are less well described. This survey describes gender differences in the aetiology of chest pain and symptoms associated with acute myocardial infarction (AMI). ⋯ In terms of electrocardiographic changes, women seem to have less marked ST deviations than men. However, we do not believe that these differences between women and men are substantial enough and, as a result, we do not recommend that the initial medical care of patients seeking medical attention with chest pain or other symptoms raising a suspicion of AMI should be differentiated with regard to gender. The differences described here might partly explain the prolonged delay until hospital admission in women suffering from AMI.
-
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.
-
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.
-
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.
-
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.