European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
Review Practice Guideline Guideline
Guidelines for the management of severe head injury. Brain Trauma Foundation.
-
Eighteen patients with small intestine or mesenteric injury following blunt abdominal trauma were operated over a 34-month period. Early diagnosis and surgery, less than 6 hours after admission, was achieved in 10 patients (56%), seven of whom had haemorrhagic shock and had positive diagnostic peritoneal lavage or ultrasonography on admission. Three haemodynamically stable patients had a diagnostic abdominal computed tomography. ⋯ Delayed diagnosis is often related to isolation of intestinal and mesenteric injury and results in increased morbidity and hospital stay. Every attempt should be made to reach a diagnosis within six hours of admission to the trauma unit. A management algorithm is proposed.
-
Embolization of small foreign body particles from peripheral veins to the heart or lungs is an uncommon occurrence and, once released into the circulation, localization and retrieval may be difficult. We present a case of accidental separation and embolization of a 28 mm long distal portion of a polytetrafluoroethylene intravenous cannula that was sited in a superficial right wrist vein. ⋯ It was then accurately located in the cephalic vein using contiguous axial computed tomography with reconstructions, and was easily retrieved under local anaesthesia. A management approach to this uncommon but potentially serious problem is suggested.
-
This paper reviews the nature and the frequency of adverse events in the everyday functioning of a French trauma emergency unit, and evaluates the feasibility of their detection by the means of a daily record review. A senior surgeon identified the adverse events by reviewing the complete record with a minimal 6-months follow-up for every patient attending the emergency unit during a 10-week period. To test the reliability of this review, a blind re-review of all records corresponding to the detected adverse events, mixed with an equal number of controls, was carried out by two independent experts. ⋯ The re-review evaluated the positive predictive value of the initial review to be 97.5% and its negative predictive value to be 96%. It is concluded that the review of the initial record by a single senior is effective in detecting the adverse events. Prevention of two-thirds of them could be possible by the implementation and monitoring of protocols.
-
We present a case of benign paradoxical vocal cord adduction' presenting to the emergency department as acute stridor. This patient received direct laryngoscopy at initial presentation documenting inspiratory vocal cord adduction. ⋯ Successful treatment has included relaxation, sedatives and speech therapy to abort the acute attack and prevent further recurrence. As direct flexible laryngoscopy is more readily available in the emergency department, goals for the future are more rapid diagnosis and appropriate treatment of this benign syndrome.