European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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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.
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Review Case Reports
Acute myocardial infarction induced by alcohol ingestion in an asymptomatic individual.
This case report deals with a 47-year-old asymptomatic man without risk factors for coronary artery disease. He developed acute myocardial infarction 6 hours after ingestion of 0.5 litre of whisky within 30-60 minutes. ⋯ The sequence of events and objective data support our hypothesis that disturbance of coronary flow could be induced by an excessive ingestion of alcohol. The article discusses possible mechanisms of alcohol effects on arteries.
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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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In order to evaluate the risk of collision during emergency responses of mobile intensive care units (MICUs) in Flanders, Belgium, a questionnaire was sent to 37 MICU services. The response rate was 84%. During the study period (1992-96) the incident rates for collision, collision with significant physical harm, and collision leading to a wrecked MICU vehicle were 1 per 52,000 km, 1 per 214,000 km and 1 per 250,000 km, respectively. ⋯ The use of seat belts was imposed by the hospital authorities in 21 services (72%). Vehicles equipped with airbags and an ABS-braking system were used in eight (28%) and 13 (45%) services, respectively. Our data confirm that the collision rate for MICUs is high and that measures to reduce the risk of collisions and resulting injuries and damage are at present not optimal.
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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.