European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Verapamil overdose, because of its frequency and severity, represents a significant problem for the emergency physician. With recent search recommending specific therapies for verapamil toxicity, aids to rapid diagnosis hold promise for decreasing morbidity and mortality from overdose of all calcium channel blockers. At this time, diagnosis of verapamil toxicity depends primarily on patient history and identification of cardiac dysrhythmias. ⋯ The next most commonly seen rhythms were tertiary atrioventricular (AV) block (16.3%) and idioventricular rhythm (11.6%); other animals manifested low grade AV block. Of interest, prominent U waves were noted in 25.6% of animals. While these results are subject to the limitations inherent in the use of an animal model, the data generated provide potentially useful patterns of dysrhythmia which may be encountered in humans with verapamil toxicity.
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A survey of patients with maxillofacial injuries (MFI) was carried out in a triaged cohort of multiply injured patients (n = 802) evacuated from accident scenes by the helicopter emergency medical service (HEMS). Despite intubation at accident scenes, some patients required further airway protection on arrival at hospital. One hundred and ninety-six patients (24.5%) had MFI and 90 (11.2%) were classified as severe with ISS of facial region > 2 or more severe (ISS up to 16, median 4). ⋯ The purpose of the present study was primarily to establish a database for MFI patients with multiple injuries. The longer term objective being to gain evidence for early definitive management of these complicated cases rather than the more traditional expectant policies. In our view delayed management of MFI can rarely correct all the consequent facial deformities.
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In an open study relating psychiatric emergencies in a general hospital, the authors observe that only in 30% of cases does the reason for emergency referral of patients by their general practitioner involve the concept of danger. In view of the results of this study, it would seem beneficial, if one wishes to reduce the number of psychiatric admissions, to improve the training of general practitioners in general psychiatry and in the treatment of mood disorders in particular.
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We report the case of a patient who co-ingested a tricyclic antidepressant (2500 mg of doxepin) and a neuroleptic drug (3500 mg of prothipendyl). Following overdose either agent can affect the central nervous and cardiovascular systems, inducing arrhythmias, conduction disturbances and hypotension. ⋯ The clinical features and management of this combined intoxication are discussed. Treatment with sodium bicarbonate readily corrected a potentially life-threatening cardiac arrhythmia and is therefore suggested to be imperative in the treatment of these cases.
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It is well known that in a case of cardiac arrest a fast intervention is essential for the survival of the victim. All research on resuscitation therefore contains some reference to intervention times. ⋯ This problem has however been overcome by the publication of the Utstein Guidelines, as these guidelines emphasize on a correct and complete time registration with uniform definitions of the different time intervals. As the Belgian Cardio-Pulmonary-Cerebral Resuscitation Study Group tries to collect all these time intervals we are able to present the complete performance of the interventions for cardiac arrest of five registration centres and to identify weak points in our 'chain of survival'.