European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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For optimal treatment of burns an understanding of the pathophysiological changes occurring locally and systemically after injury is necessary. Accurate estimation of burn size and depth as well as early treatment is essential. Knowledge of the circumstances of the accident and experience in diagnosing physical signs are required in terms of the need for intubation, treatment of poisoning and the occurrence of other trauma.
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The unique physiologic and medical consequences of blast injuries are often unrecognized and frequently poorly understood. The medical consequences, including pulmonary, gastrointestinal and auditory injury, have a defined and unique set of physiologic sequelae. Understanding the mechanism of injury, treatment issues and the potential long-term morbidity of primary blast injuries will enhance survival.
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The Great Hanshin earthquake on 17 January 1995 caused a complete disruption of both the communications and transportation systems which, as a result, severely hampered a prompt and timely system response. The survival rate of the extricated victims was 80.4% on the first day, and 1892 victims were extricated with an overall survival rate of 40%. ⋯ Crush syndrome was the most prominent medical syndrome necessitating critical care after the Kobe earthquake. The Japanese Association for Acute Medicine has since made eight new proposals for emergency medicine during mass-disasters that will hopefully improve the survival of patients in any future disasters.
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Setting standards and implementing quality improvement in trauma care needs consideration of the definitions of standards, guidelines, recommendations and the present quality of trauma care. Essential factors for consideration are the chain of survival and different intervals which may decide on patient outcome: (a) the trauma (occurrence) to trauma recognition interval which has, until now, not been taken into consideration with regard to morbidity and mortality; (b) the scene time is part of the total prehospital time which comprises rescuing the entrapped patient, preparation of the patient for treatment, and transfer to a rescue vehicle. The medical part of the scene time, however, represents only 25% of the total scene time and an even lower percentage of the total prehospital time. ⋯ This is the case for fluid administration, endotracheal intubation, etc. Furthermore, the qualification of the different personnel responding to trauma alert needs to be taken into consideration as well as the quality of care provided by the individual hospitals. The following conclusions may thus be drawn: that, currently there is no scientifically proven standard or care for trauma patients; the role of trauma care standards in the reduction of mortality and morbidity has not yet been identified; implementing incorrect standards may lead to entirely inappropriate conclusions; and that it is essential to perform scientific investigations of the outlined factors in order to establish future standards of trauma care.
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Review Case Reports
Early electrocardiographic signs in acute massive pulmonary embolism.
As a result of the increasing accuracy in diagnosing acute pulmonary embolism by isotopic ventilation-perfusion scintigraphy and pulmonary arterial angiography, the electrocardiographic changes associated with acute cor pulmonale are being abandoned as a diagnostic tool for this life-threatening disease. Nevertheless, certain electrocardiographic findings can raise the suspicion of pulmonary embolism. ⋯ In this case report we emphasize the importance of the electrocardiographic findings which forwarded the diagnosis of pulmonary embolism. Hence the necessary invasive diagnostic and therapeutic measures, i.e. pulmonary arterial angiography and thrombolytic therapy, can be taken immediately after admission to the emergency department.