European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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To evaluate the rate of diagnostic errors leading to preventable deaths among patients admitted to our intensive care unit (ICU), we retrospectively reviewed the medical and autopsy records of all patients who died in the ICU between 1 January 1991 and 31 December 1993. Excluded were patients with traumatic injuries, cerebrovascular accidents and primary cardiac arrest. According to their length of stay (LOS) in the ICU, patients were subdivided into Group A (LOS 0-24 hours), Group B (LOS > 24 hours-14 days), and Group C (LOS > 14 days). ⋯ Type 2 errors were 18% in Group A, 34% in Group B, and 30% in Group C. Fully correct diagnoses or Type 3 errors were present in 77% of patients in Group A, 62% of patients in Group B, and 61% of patients in Group C. Clinical errors of any type were not related with the LOS in the ICU or in the hospital, age and the number of underlying chronic diseases.
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Randomized Controlled Trial Clinical Trial
Intravenous magnesium sulphate in the management of moderate to severe acute asthmatic children nonresponding to conventional therapy.
Management of severe acute asthma attacks in children sometimes bring difficulties to the physician. Some current treatment strategies have focused on intravenous magnesium sulphate administration in patients nonresponding to therapy with beta-2 agonists and corticosteroids. The use and efficacy of this drug has been discussed in this randomized, double-blind, placebo-controlled clinical trial consisting of 20 children with moderate to severe acute asthma exacerbation admitted to the emergency department in Dicle University Hospital, Turkey. ⋯ These significant changes persisted at 45, 60, 75 and 90 minutes. No significant side effects were observed. In conclusion, severe asthmatic cases may benefit from magnesium sulphate therapy when beta-2 agonists are inadequate in preventing deterioration.
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We prospectively studied 56 patients with an acute ankle injury and an effusion to determine the significance of the ankle effusion to functional outcome. The average size of effusion was 15 mm. ⋯ No correlation was found with size of effusion and the functional and clinical outcome. We conclude that an ankle effusion does not reliably distinguish which injuries require further investigations and unless there are clinical indications further investigations are not indicated.
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Two case reports characterized by the complete occlusion of the basilar artery, secondary to dissection of the vertebral artery after closed head trauma are described. These lesions, often clinically silent in the beginning, were able to cause severe neurologic impairment, even after minor head trauma in healthy individuals without predisposing structural disorders. ⋯ Therapeutic management is discussed. Anti-coagulants, thrombolytic agents or surgical ligation of the vessel has been proposed to prevent the extension of the lesion and to improve the outcome.