European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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We describe a case series of five patients with unusual presentations of acute dystonia seen over a 2-week period. Haloperidol, prescribed and allegedly purchased 'on the street', was thought to be a possible cause in each case. Bizarre clinical presentations and delayed onset of symptoms may make diagnosis difficult. A high index of suspicion combined with a careful drug history is essential.
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We aimed to investigate the utility of end-tidal carbon dioxide concentration as a prognostic indicator of initial outcome of resuscitation, we conducted a prospective study of EtCO2 in adult victims of out-of-hospital non-traumatic cardiac arrest. We prospectively studied 139 adult patients. The initial, final, average, minimal and maximal EtCO2 was significantly higher in resuscitated patients than in non-resuscitated patients. ⋯ Important observation from this study is that none of the patients with an average, initial and final EtCO2 level of less than 10 mmHg were resuscitated. Data from this prospective clinical trial indicate that initial, average and final EtCO2 monitoring during CPR is correlated with resuscitation. End-tidal CO2 monitoring has potential as a noninvasive indicator of cardiac output during resuscitation and a prognostic indicator for resuscitation.
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The aim of our research was to study the long-term prognosis among patients discharged alive after an out-of-hospital cardiac arrest (OHCA) in comparison with patients discharged alive after acute myocardial infarction (AMI) without OHCA, and also to study the long-term influence of AMI in connection with OHCA. Our research was conducted in the municipality of Göteborg. We retrospectively studied patients discharged from hospital 1990-91 after an OHCA of cardiac aetiology and patients discharged after an AMI without prehospital cardiac arrest. ⋯ Five-year mortality was 54% and 50% respectively (NS). It is concluded that survivors of an OHCA of cardiac origin differed from survivors of an uncomplicated AMI in that they were younger and more frequently had a history of cardiovascular disease. Their 5-year mortality after discharge was similar to that of survivors of an AMI without a prehospital cardiac arrest, even after adjusting for differences at baseline.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of alfentanil and morphine in the prehospital treatment of patients with acute ischaemic-type chest pain.
Patients with acute myocardial ischaemic pain would benefit from rapid pain relief. The clinical usefulness of alfentanil, which has a rapid onset of action, was therefore assessed as the initial pain relieving opioid in patients suffering from acute myocardial ischaemic pain. The effects of alfentanil were compared with those of morphine in the prehospital treatment of 40 haemodynamically stable patients suffering from acute ischaemic-type chest pain. ⋯ Alfentanil was found to provide effective analgesia during the follow-up period of 15 minutes. No haemodynamic or respiratory side effects occurred. It is concluded that alfentanil is an effective analgesic in the prehospital treatment of myocardial ischaemic pain.
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The aim of this study was to determine the outcomes of outpatient treatment of community-acquired pneumonia (CAP) when a prediction rule was followed by emergency physicians to guide the selection of patients. This was a prospective observational study conducted at the emergency department of a university-affiliated hospital in Hong Kong, China. A clinical prediction rule was implemented to guide the selection of patients with CAP for outpatient treatment. ⋯ The observation ward was utilized in 10 (16.7%) patients successfully treated as outpatients. It is concluded that the prediction rule can be safely implemented as a guide for emergency physicians. The short-stay observation unit may be usefully employed for treating low-risk CAP.