European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Laryngotracheal foreign bodies, although less common than bronchial foreign bodies, are potentially more dangerous. We report a 10-year-old girl with Down syndrome with asthma bronchiale symptoms, which was later found to be the result of a thin bone lamella impacted in her larynx. There was no clear history of foreign body aspiration. ⋯ The foreign body was removed via direct laryngoscopy. It was a white and thin bone lamella with sharp edges, measuring 28 x 19 x 2 mm. We thought the case was worth presenting because of its rare location, the size of the foreign body, and the long duration before the final diagnosis was made.
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To define the differences in emergency room usage patterns between patients with and without medical insurance coverage. ⋯ Uninsured patients arrived more frequently during weekends and at night than insured patients. They were on average less likely to be admitted to the hospital. Demographic differences between both groups seemed to play an important role in the admission rate. Despite differences in emergency room usage patterns, it cannot be concluded that either group used the emergency room in excess of the other.
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To assess the appropriateness of arterial carbon dioxide tension control in a group of 92 patients with traumatic brain injury who, despite receiving advanced prehospital care, showed no improved outcome in comparison with a group homogeneous but for a lower level of prehospital care. ⋯ Potentially dangerous alterations in capnia occurred in the majority of patients analysed. The possible consequences and causes are discussed. Further studies are needed to assess the consequences of any deviation from ideal standards, and to set realistic standards of arterial carbon dioxide tension control during prehospital ventilation.
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To determine the patient factors influencing UK Emergency Department doctors' assessment of suicide risk. To establish whether immediate clinical management is consistent with perceived risk. ⋯ In contrast to the negative findings of previous research, we found that Emergency Department doctors were influenced by key risk factors for suicide in their assessment of deliberate self-harm patients. Emergency Department doctors' assessments reflected the immediate risk of suicide, indicated by factors such as current mental state and strong suicidal intent. Background risk factors such as social adversity and psychiatric history were less influential. We would recommend that training for emergency doctors should emphasize the importance of both immediate and background risk factors.
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To obtain information about patient, staff and organization characteristics of Emergency Departments in the Netherlands, and evaluate the changes between 1996 and 1999. ⋯ Almost all hospitals in the Netherlands reported an increase in the number of patients visiting the Emergency Department, especially in the number of self-referred patients. A majority of the Emergency Departments are now staffed by emergency physicians instead of surgical residents. Developing specific training programmes for emergency physicians should be a priority for the Netherlands in the future.