European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
Cocaine-related myocardial infarction is a well-known phenomenon. Concurrent heroin use can mask signs and symptoms of myocardial infarction. We discuss an unusual presentation of myocardial infarction, associated with both cocaine and heroin ("speedball") self-injection, that initially went undiagnosed.
-
Staff in the emergency departments of hospitals are reported as being negative or ambivalent toward suicidal or self-harming individuals. According to the literature, these patients are subjected to stigmatization and lack of empathy. ⋯ In this paper, evidence suggesting staff attitudes toward suicidal and self-harming patients is reviewed. An overview of related issues such as clinical judgment, the use of scales and nurses' role is also included in this report.
-
Mediastinal widening is a frequent radiological finding in the emergency department patient. The causes of mediastinal widening can be divided into traumatic and nontraumatic mediastinal widening. An important association of moderate to high velocity trauma is the mediastinal haematoma. ⋯ Multidetector spiral CT plays an important role (Alkadhi et al., Radiographics 2004; 24:1239-1255), but usually as a second line procedure. This article discusses the radiological signs of traumatic mediastinal widening. Different traumatic lesions resulting in a widened mediastinum are presented, and some nontraumatic causes of a widened mediastinum are shown, in order to facilitate the differentiation between both entities.
-
Case Reports
Suicidal bus bombing of French Nationals in Pakistan: physical injuries and management of survivors.
Suicidal bombing is particularly devastating and an increasingly common form of terrorist violence. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the suicidal bombing attack in the context of the limited medical resources of a developing nation. ⋯ All of the 12 patients transferred to the Aga Khan University Hospital survived. Unlike the reported injuries, calcaneal fractures were most commonly encountered in the survivors.
-
Randomized Controlled Trial
The 50 ml syringe training aid should be utilized immediately before cricoid pressure application.
Cricoid pressure, applied during rapid sequence induction of anaesthesia, should be performed only by trained staff. Recommended training intervals vary from weekly to every 3 months, but this is unrealistic in day-to-day practice. Performance, when assessed, is often shown to be unacceptable before training. Unfortunately, most training aids are either expensive or unavailable. Assessment and training in previous studies was carried out on the same cricoid pressure simulator, introducing learning bias. In our study, we tested whether a 50 ml syringe utilized as a training aid immediately before the assessment of simulated rapid sequence induction on a different cricoid pressure simulator would improve staff performance. ⋯ Brief training with a 50 ml syringe will increase the likelihood of satisfactory force application during Sellick's manoeuvre. Applied to clinical practice, this will make cricoid pressure both more effective and reliable, and may improve patient safety. Therefore, the 50 ml syringe should be utilized before any clinical application of cricoid pressure.