European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
Atrial fibrillation (AF) is the most common cardiac arrhythmia observed in the emergency room (ER). We propose a new classification of AF which is useful for the standardization of terms to be used for future clinical trials and for clinical management of this arrhythmia in the ER. We recognized three categories: (1) atrial fibrillation lasting less than 72 hours (AF < 72 h); (2) persistent atrial fibrillation and (3) permanent atrial fibrillation. ⋯ In persistent AF the systemic thrombo-embolism is a significant risk and therapeutic anticoagulation must be associated to pharmacological or electrical cardioversion even though transoesophageal echocardiography does not visualize thrombi or spontaneous echocontrast in the cardiac chambers. These treatments can reconvert the persistent AF to sinus rhythm, but, in the absence of treatment, or if treatment fails, the arrhythmia goes into the permanent category. In permanent AF ventricular rate control and anticoagulation, if suitable, are the first choice for stroke prevention.
-
The aim of this study was to evaluate the injury pattern, morbidity, and mortality in pedestrians involved in train accidents. The study was performed in the Hacettepe University School of Medicine, Turkey. Hospital records of 41 cases who were hit by train between the period of 1985-97 were evaluated. ⋯ It is concluded that train-pedestrian injuries represent a different type of trauma. The mortality rate in suicide attempts is high. RTS lower than 11 and being hit by train are associated with high mortality.
-
Hereditary angioedema is a hereditary disorder transmitted as an autosomal dominant trait, characterized by reduced plasma concentration of C1 esterase inhibitor (type 1) or the presence of non functional C1 esterase inhibitor (type 2). We describe and discuss the case of a 35-year-old man who presented two unusual clinical manifestations of type 2 hereditary angioedema causing diverse emergency situations: acute abdomen and parasellar oedema.
-
Comparative Study
Prevalence of human immunodeficiency virus (HIV) antibody in critically ill emergency patients in Gijón, Spain.
The objective of this study was to find out the prevalence of infection by the human immunodeficiency virus (HIV) in critically ill patients treated in the resuscitation room of the emergency department of Cabueñes Hospital (Gijón, Spain) and to stress the need to adopt universal preventative measures. This was a prospective study that included all the patients treated in the resuscitation room during 1994. It contains a protocolized collection of clinical-epidemiological variables and HIV serology respecting anonymity. ⋯ No accidents with risk of contagion were recorded and preventative measures were adopted in all the cases. It is concluded that the prevalence of HIV positive figures detected did not differ from previous studies. Although the profile of the HIV positive patients was well defined in this study, we must insist on the need to take preventative measures with all patients.
-
Rupturing of the liver due to delivery is an uncommon but severe birth trauma. Although described in the preterm neonate with very low birthweight or after complicated delivery, we present a case of capsular liver haemorrhage in a term newborn with normal birthweight after a seemingly uncomplicated delivery. ⋯ Since shock was not amenable to fluid replacement therapy, the haemorrhage had to be managed surgically. Even without evidence of birth trauma, intra-abdominal bleeding must always be suspected in a newborn with suddenly prevailing shock and unexpected anaemia.