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 dispatcher plays a key role in allocating the right resource to patients in cases of medical emergency. In order to evaluate the performance of the dispatcher, it is necessary to analyse who is the caller, because this has an impact on the development of decision support systems. In the present study, all calls for an ambulance (n=565) during a one-week period at the dispatch centre in Uppsala, Sweden, were analysed with respect to the caller's relationship to the patient, the location of the caller, and the dispatcher's priority of the case. ⋯ During a 2-week period we also analysed the physiological impairment of patients in cases dispatched as medical emergencies (n=595) by using the rapid acute physiological score. The rapid acute physiological score was significantly higher in the group dispatched as potentially life-threatening by the dispatcher compared with other emergencies. The study highlights the fact that dispatching often has to be carried out using second or third-hand information, and those patients prioritized as suffering from potentially life-threatening conditions have a more impaired physiological status.
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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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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.