European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Smoke inhalation has become the principal cause of death in burns patients. There are few guidelines for the management of smoke inhalation in the accident and emergency department. The aim was to identify what factors influence immediate management. ⋯ Arterial blood gases, chest radiography and carboxyhaemoglobin estimation rarely influence immediate management. Patients presenting with normal vital signs and examination and short smoke exposure may be safe to discharge from the accident and emergency department without further investigation.
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The metabolic effects of chronic alcohol abuse can induce a broad spectrum of disorders. We describe the case of an initially unidentified alcoholic, poorly nourished woman who presented with ketoacidosis. She developed severe cardiac failure, which did not respond to classical treatment. ⋯ Laboratory examinations confirmed the diagnosis of alcoholic ketoacidosis and cardiac beriberi. The clinical entity and treatment of these two uncommon disorders are discussed. If recognized early both diseases (and their combination) are fully reversible.
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To illustrate the types of injuries seen by the accident and emergency department as a result of the use of non-motorized 'microscooters' in children, and to increase awareness of scooter-related triplane fractures of the ankle. ⋯ The popularity of microscooters seems to represent a significant risk of bony injury in the paediatric population. Medical personnel who manage acute paediatric trauma should be aware of scooter-related triplanar ankle injuries.
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Dislocation of the patella around the vertical axis is rare. Previous reports suggest reduction requires general anaesthesia and occasionally open reduction is necessary. We describe a case of dislocation of the patella around its vertical axis with impaction in the intercondylar notch of the femur following minor trauma. Successful reduction was achieved without the need for general anaesthesia.
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Comparative Study
Convective air warming is more effective than resistive heating in an experimental model with a water dummy.
Trauma patients with accidental hypothermia have adverse outcomes when compared with normothermic patients. Studies with a small number of mild hypothermic volunteers suggested that convective warming is more effective than warming with 12 volt resistive heating blankets. In a laboratory study, we compared the warming effectiveness of two electric blankets and convective air warming. ⋯ Convective warming increased the dummy temperature 0.6 degree C per hour, Thermamed 0.3 degree C per hour (P<0.001 versus convective warming) and two Hella blankets 0.2 degree C per hour (P<0.001 versus convective warming). Our laboratory investigation confirmed the superiority of convective warming over resistive heating. Efforts should be made to incorporate convective warming into the out-of-hospital treatment of trauma patients.