European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Case Reports
Medial subtalar dislocation: importance of clinical diagnosis in distinguishing from other dislocations.
In an emergency situation, the clinical picture of ankle and subtalar dislocation may be similar. This may lead to the use of the improper technique of reduction, especially in a subtalar dislocation, resulting in the failure of reduction and further damage to the articular surfaces. A case of medial subtalar dislocation is presented, which was managed as an ankle dislocation and manipulated inappropriately, leading to a failure of reduction. The clinical signs of ankle and subtalar dislocation, including points of differentiation between the two are discussed, and the correct method of reduction of subtalar dislocation is described.
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To describe the retroperitoneal organ injury pattern after anterior penetrating abdominal injury in children. ⋯ Retroperitoneal organ injury is commonly associated with anterior penetrating abdominal trauma. Even if there is no preoperative sign of retroperitoneal organ injury, an exploratory laparotomy and a meticulous retroperitoneal exploration should also be performed for associated retroperitoneal organ injury.
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Sharp wound debridement in local anaesthesia using EMLA cream: 6 years' experience in 1084 patients.
Sharp debridement is the most efficient method for clearing the woundbed in the exudation and granulation phase of wound healing. At our clinic the anaesthetic lidocaine-prilocaine cream, EMLA, has been used as an analgesic for sharp debridement since 1994. A review of patients' records was conducted, including ulcer size, dose of cream used, analgesic efficacy and complications. ⋯ We observed no allergic reactions, no clinical symptoms of local anaesthetic toxicity or methaemoglobinaemia. In 12 patients (1.1%) a burning sensation was reported directly after the application of EMLA cream to the ulcer, which, however, subsided within 15-20 min. In our experience, sharp debridement in percutaneous analgesia with EMLA is efficient, economical, safe, and tolerable for the patient.
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To describe the characteristics and mortality rates of 132 cardiogenic shock patients treated with intra-aortic balloon counterpulsation at a university hospital. ⋯ Mortality rates remain high in cardiogenic shock patients in need of intra-aortic balloon counterpulsation. The odds ratio for death tended to be lower in the intervention group compared with the no-intervention group, although the absolute difference in mortality as a result of an intervention was only 15.2%, and did not reach statistical significance probably because of the small sample size. Diabetes and an ejection fraction lower than 35% are significant predictors for a worse prognosis.
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Editorial Comment Biography Historical Article
International emergency medicine: the vision of a pioneer, Prof. Dr Peter Safar, on emergency medical care.