European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The use of recreational drugs in society is becoming a widespread problem increasing the workload of all the emergency services. Gamma hydroxybutyric acid (GHB) is one of these, a drug used primarily for its euphoric effect. ⋯ The presentation, clinical features and management of these cases are described. All health care personnel involved in the emergency setting need to know of its existence, toxic effects and initial management with particular reference to airway control and possible assisted ventilation.
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Outcome of major trauma in a Turkish university hospital: did integrated approach make a difference?
The aim of this study was to determine the effect of the institution in an in-hospital integrated approach to trauma on the mortality of severely injured patients in a university hospital in Turkey. We examined the effects of several risk factors, namely physiological parameters, anatomical findings, and the timeliness of therapeutic approaches, on the mortality of major trauma patients before and after the institution of integrated trauma care. The investigated risk factors were injury severity score (ISS), revised trauma score (RTS), anatomical localization of the injury, the type of injury, prehospital time, emergency room time, and referral from another hospital. ⋯ A significant improvement was seen in the Z-statistics between the two periods. Z value increased from -2.47 to 0.55. In-hospital integrated approach to trauma made major improvements in the care of the patients with severe injuries, especially those with significant airway, ventilation and circulation problems.
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Mobile emergency care units provide immediate benefit for patients with acute cardiovascular disease, but the subsequent prognosis of this patient population is unclear. We, therefore, aimed to determine whether the long-term survival of patients with acute cardiovascular syndromes requiring emergency medical care differs from controls of the general population. The long-term survival was analysed in all consecutive patients who were treated for acute cardiovascular events (coronary syndromes/cardiac arrest, pulmonary oedema, stroke, vascular disorientation/unconsciousness) by a mobile emergency care unit or rescue helicopter in Berlin from 1987 to 1988 and were admitted to hospital. ⋯ Older patients had a similar long-term survival compared with controls (27% vs. 28%), whereas younger patients sustained a relatively lower long-term survival compared with controls (75% vs. 86%, p < 0.05). It is concluded that a novel population-based approach demonstrates similar long-term prognosis of cardiovascular patients following mobile emergency care compared with matched controls. The present results may contribute to the assessment of long-term effectiveness and the appropriate design of emergency care systems.
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Fatalities are still reported following methanol poisoning. Methanol is extensively metabolized by alcohol dehydrogenase to formaldehyde and by aldehyde dehydrogenase to formic acid which is the main toxic metabolite. Survival with extremely high blood methanol concentration is possible provided that aggressive symptomatic and specific therapy is applied. ⋯ Treatment included correction of metabolic acidosis, ethanol infusion, haemodialysis and peritoneal dialysis. The patient survived with moderate visual sequelae and oesophageal stenosis. The range of toxicity of methanol according to blood levels determination is discussed.
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Editorial Comment
Early observation of critically ill or injured patients.