European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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A survey was conducted to determine differences in perspective towards Advanced Trauma Life Support (ATLS) between emergency medicine (EM) physicians and other specialties (OS), assess its value in the management of acute trauma, and identify areas in the course which could be revised or updated. The survey was devised and completed by physicians after ATLS. Of 26 course participants, there were 11 EM physicians (42%), four family practitioners (15%), four surgeons (15%), four internists (15%), two paediatricians (8%), and one anaesthesiologist (4%). ⋯ The EM group reported doing > 20 per year of airway, vascular, and thoracostomy procedures in their own practice, whereas OS did significantly fewer. ATLS may not be useful for EM practitioners actively involved in trauma care. Proposed changes from the EM perspective include shortening ATLS to one day, increased use of EM instructors, clarifying certain portions of the manual, and omitting the laboratory section or making it optional.
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An 11-year-old boy known to have asthma was referred to our intensive care unit (ICU) with progressive respiratory distress. He was sedated, paralysed, and intubated approximately 3 hours after arrival and nebulization with salbutamol and ipratropium was continued on the ventilator. ⋯ Computerized tomography scan revealed no signs of generalized cerebral oedema. Local contamination with ipratropium was most likely to be the cause of pupil dilatation, which could have occurred during connecting and disconnecting the nebulization system or through contaminated hands.
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The admission of a large number of victims in a hospital after a mass casualty incident can easily lead to chaos and disruption of the hospital's regular organization. To ensure that this chaos does not continue, a correct way of registration and continuous overview of registered patients can be very helpful. The Emergency Hospital, which is part of the University Medical Centre Utrecht and the Central Military Hospital, was confronted several times with groups of patients who had to be admitted immediately. ⋯ The system also registers urgency classes and primary diagnoses. It appeared that fewer errors were made in comparison with manual registration, while more information was stored and easily retrievable. Pilot studies are being performed to extend the usefulness of this method in a prehospital environment.
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Coma in children is uncommon and can pose difficulties in diagnosis and management. Resuscitation should concentrate on management of the airway, breathing and circulation and on rapid exclusion of easily correctable conditions, e.g. hypoglycaemia. Common causes of coma are considered and the diagnostic evaluation of these children is discussed. A case of a toddler in coma is discussed from the perspective of the accident and emergency department to illustrate the management of these challenging but uncommon patients.
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The use of recreational drugs in society is becoming a widespread problem increasing the workload of all the emergency services. Gamma hydroxybutyric acid (GHB) is one of these, a drug used primarily for its euphoric effect. ⋯ The presentation, clinical features and management of these cases are described. All health care personnel involved in the emergency setting need to know of its existence, toxic effects and initial management with particular reference to airway control and possible assisted ventilation.