European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review Case Reports
Pulmonary oedema in SCUBA divers: pathophysiology and computed risk analysis.
SCUBA diving has become a popular sport, with an increasing number of people participating in it. Although it is an essentially very safe activity, several specific medical problems are associated with diving. The present paper addresses diving-related pulmonary oedema, which is a rarely reported condition. ⋯ Consequently, we could design and construct a bio-mechanical computer model of the alveolar septa to explore the pathophysiology of diving-related pulmonary oedema and the vulnerability of individual divers as they relate to some mechanical characteristics of their lung structure. The physiological mechanisms of diving-related pulmonary oedema and the results provided by the computational model successfully delineated the process. The model predicted that the risk of injury is significantly increased in individuals who have a stiffer lung parenchyma or lower lung compliance values.
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Airway management is the cornerstone of resuscitation. Emergency endotracheal intubation is more likely to be difficult in the accident and emergency (A&E) department setting compared with the operating room. A&E departments must have an appropriate selection of equipment to deal with difficult airway problems. ⋯ It is concluded that airway equipment in Scottish A&E departments is adequate for basic airway care and endotracheal intubation. Nearly all departments have access to a suitable rescue device for the failed or difficult airway. Capnographic confirmation of tube placement should be mandatory in A&E.
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Randomized Controlled Trial Clinical Trial
The impact of television fiction on public expectations of survival following inhospital cardiopulmonary resuscitation by medical professionals.
Research has shown that the public overestimates the survival chances of patients after cardiopulmonary resuscitation. Other studies have suggested that demonstrably exaggerated survival rates in medical television fiction might affect these estimates. Such studies were mostly conducted in the United States, dealt with cardiopulmonary resuscitation in general, and asked respondents to indicate their source of medical information, an unreliable survey technique. ⋯ The consumption of medical television drama is related to overestimating survival chances after inhospital resuscitation by physicians and nurses following cardiopulmonary arrest. A practical knowledge of basic cardiopulmonary resuscitation techniques moderates but does not eliminate the television effect.
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This prospective observational study was designed to shed light on the routine use of a hypertonic hyperoncotic solution for prehospital small-volume resuscitation in trauma patients. Effects on homeostasis and haemodynamics as well as safety were evaluated. ⋯ Per-protocol bolus infusions of hypertonic hyperoncotic solution containing hydroxyethyl starch do not compromise homeostasis clinically and are rarely associated with clinically manifest side-effects. The treatment regimens used (including small-volume resuscitation) provide early and effective haemodynamic control.
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To describe the non-traumatic clinical settings in which abdominal computed tomography (CT) is used and to determine its diagnostic utility. ⋯ Adult ED patients undergo abdominal CT for a variety of non-traumatic indications. Findings in less than half support the pre-test clinical suspicion and an alternative previously unsuspected diagnosis is suggested in 13%. Follow-up is inconsistent with CT results in a small but significant number of cases.