European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
A dental source of infection should be suspected in patients presenting with an acute cervicofacial swelling or trismus. Dental infection originates in the tooth or in the tissues that closely surround it. These infections are common and generally resolve by spontaneous drainage through the gingival tissues of the tooth. ⋯ The spread of infection can lead to life-threatening complications, such as airway compromise, cavernous sinus thrombosis, and mediastinitis. Mortality from severe dental infections, although uncommon, is increasing. The aim of this review was to describe the clinical presentation, evaluation, and management of patients presenting with severe or potentially severe dental infection.
-
Patients with hereditary angioedema may present to the emergency department (ED) with subcutaneous and submucosal swellings, the most important being the development of laryngeal oedema, which can rapidly obstruct the airways and cause death. The aim of this study was to establish whether local guidelines exist for the management of such patients and to determine where the C1 inhibitor concentrate (C1 INHC) was kept in the trusts. A questionnaire survey of the availability and use of C1 INHC was sent to 35 EDs across the UK with established immunology services within their trusts. ⋯ Only 17 departments had any guidance with regard to their use. There is a significant lack of guidance for C1 INHC use in the EDs surveyed. A guideline was developed as a result that can be used by EDs across Europe.
-
Initiating and weaning procedure of noninvasive positive pressure ventilation (NIPPV) on acute cardiogenic pulmonary edema (ACPE) has been determined empirically, and the total time of its use has been sometimes prolonged unnecessarily. A simple protocol for its use may facilitate initiation and avoids prolongation of the NIPPV treatment. We designed a step-wise protocol for NIPPV use and retrospectively examined the clinical outcome of our protocol for initiation and weaning of NIPPV in 45 patients with ACPE. ⋯ In most of the cases, maximal-end expiratory pressure was less than 7-cm H2O. The mean duration of NIPPV was 19.5±28.0 h and the median duration was 8.0 h (interquartile range=14.0 h). This simple step-wise NIPPV protocol for ACPE can facilitate quick and safe initiation and termination of the treatment.
-
Courses in the Advanced Trauma Life Support are a well-accepted concept throughout the world for training in the emergency treatment of polytraumatized patients. Switzerland, a multilingual country with a long tradition of multidisciplinary collaboration in trauma care, introduced its first student courses in 1998. Unlike some countries where the courses are attended only by surgeons, instructors and students in Switzerland include surgeons, anaesthetists and physicians from other specialties. ⋯ The practical format of Advanced Trauma Life Support courses is appreciated by students, and the involvement of anaesthetists, general practitioners and other specialists as instructors is successful. Course rating was influenced by chosen specialty, sex and language of the students, and this should be taken into consideration when evaluating course modules and instructors.
-
The aim of this study was to determine the outcome of patients with severe sepsis and septic shock who did and did not receive early goal-directed therapy (EGDT) in the emergency department (ED). The primary end point was the in-hospital mortality rate. The secondary end points were lengths of stay in the ICU and in hospital. ⋯ Initiating EGDT in the ED in patients with severe sepsis and septic shock was associated with a significant reduction in in-hospital mortality and length of stay in ICU.