European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Case Reports Comparative Study
Diagnostic uses for thoracic electrical bioimpedance in the emergency department: clinical case series.
Differentiation of the central haemodynamic state is often critical during acute resuscitation. A clinical case series is presented in which the use of thoracic electrical bioimpedance (TEB) was pivotal in the diagnostic determination of the pathophysiology. This new technology allows the emergency physician to rapidly determine cardiac output, total peripheral resistance and myocardial contractility. The inexpensive and non-invasive nature of the TEB measurement makes cardiac output determination a potential 'sixth' vital sign for the evaluation of the emergent patient.
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The outcome of out-of-hospital cardiac arrest (CA) following cardiopulmonary resuscitation (CPR) initiated by dispatcher-provided telephone instructions (T-CPR) in the area of Gothenburg, Sweden was studied. During a period of 27 months, 475 cases categorized by the dispatchers at the Emergency Co-ordination and Dispatch Centre as being suspected CA were offered T-CPR and were included in one of the following groups: (1) T-CPR completed (caller without previous CPR training); (2) T-CPR completed (caller with previous CPR training); (3) T-CPR started, but not completed; (4) T-CPR declined by caller due to previous CPR training; (5) T-CPR declined by caller due to other reasons; or, (6) T-CPR not offered. Of the patients, 473 could be followed up and of them 427 fulfilled the criteria for CA on ambulance arrival. ⋯ More efforts and research are needed, however, to increase the percentages of callers completing CPR. The impact of T-CPR on survival might be limited. Indeed, the comparison of 'resuscitable' patients in whom T-CPR played an important role in supporting bystanders (i.e. groups 1 and 2) with 'resuscitable' patients in whom T-CPR was not performed (i.e. groups 3, 5 and 6) suggests an increase in survival from 6% (groups 3, 5 and 6) to 9% (groups 1 and 2).
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In The Netherlands a serious effort is underway to improving the performance of the emergency medical care system by functionally integrating ambulance services and hospitals into a comprehensive care network. Ambulance services are actively stimulated to join regional bodies offering adequate resources to deal with a whole range of incidents from day-to-day accidents to large-scale disasters. At the same time the development of a network of 'Accident and Emergency' hospitals is being promoted. ⋯ Regional ambulance bodies and 'A&E-network' will be geographically attuned into an integral EMC-system, supervised by an EMC-officer assigned by the local authorities that constitute the regional authority. The Dutch government has initiated a project to streamline and monitor the developments. The project has proved to be a stimulating example of effective collaboration between the government and various involved professional disciplines.
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The Thunderdome-party was a mass gathering of 14000 young people. Many of them were under influence of drugs (amphetamine and ecstasy (MDMA)). ⋯ The benefit of a prehospital medical team at the event is illustrated by the description of the population treated on-site. Toxicological screening of blood and urine was not necessary to safely treat drug intoxication during the Thunderdome-party.
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To evaluate the rate of diagnostic errors leading to preventable deaths among patients admitted to our intensive care unit (ICU), we retrospectively reviewed the medical and autopsy records of all patients who died in the ICU between 1 January 1991 and 31 December 1993. Excluded were patients with traumatic injuries, cerebrovascular accidents and primary cardiac arrest. According to their length of stay (LOS) in the ICU, patients were subdivided into Group A (LOS 0-24 hours), Group B (LOS > 24 hours-14 days), and Group C (LOS > 14 days). ⋯ Type 2 errors were 18% in Group A, 34% in Group B, and 30% in Group C. Fully correct diagnoses or Type 3 errors were present in 77% of patients in Group A, 62% of patients in Group B, and 61% of patients in Group C. Clinical errors of any type were not related with the LOS in the ICU or in the hospital, age and the number of underlying chronic diseases.