European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
This paper describes the rate of re-admission and the characteristics of patients who were re-admitted after having been discharged directly from the emergency department at Sahlgrenska Hospital when they presented with acute chest pain or other symptoms suggestive of acute myocardial infarction. A total of 1463 patients were admitted and directly discharged during the 15 month recruitment period, of whom 222 (15%) were re-admitted at least once and 72 (5%) were re-admitted more than once during the subsequent 6 to 21 months. However, among patients not being re-admitted, 63% reported recurrency of symptoms one year after discharge. ⋯ In conclusion, among patients who were discharged directly from the emergency department with acute chest pain, 15% were re-admitted with similar symptoms only. A minority, however, developed acute myocardial infarction. A high proportion of patients not being re-admitted had recurrency of symptoms.
-
Dizziness is a common and vexing diagnostic problem in emergency departments. The term is rather undefinite and often misused, but can in practice be classified into four categories: fainting, disequilibrium, vertigo and miscellaneous syndromes. Vertigo is the most common category of dizziness. ⋯ Physicians working in emergency departments must be able to rapidly identify patients with potentially serious forms of vertigo, which could cause death or disability, and patients with mild conditions, that can be effectively treated. Previous studies and the experience of the authors have shown that reliable diagnostic hypotheses can be generated by taking a proper clinical history (focused on the onset and duration of the disease, the circumstances causing the vertigo and associated otological or neurological symptoms) and performing an accurate physical examination (evaluation of neurological defects and spontaneous or provoked nystagmus), supplemented by few laboratory tests and diagnostic procedures. Therapy of vertigo in emergency settings is mainly symptomatic and based on sedation and use of vestibulosuppressant drugs (antihistamines, phenothiazines).
-
The system of prehospital trauma care in the Netherlands is the subject of great concern. Although many improvements have been achieved in the last decade, there are still some deficits. Legislation concerning the minimal level of education for ambulance attendants was recently upgraded to 'registered nurse', a standard which must be achieved by 1997. ⋯ The deficits of the Dutch system of care related to the PHTLS/ATLS standard are pointed out, resulting in recommendations to improve the Dutch system. The requirements of the dispatcher are far inferior to the optimal situation, which, together with the lack of technical equipment, results in serious communication problems. The Dutch ambulance attendant education, in which in the present system the education level reaches 'registered nurse' in only 91% and specialized courses are not mandatory, should be upgraded to the PHTLS level of care.
-
The aim of this study was to assess the influence of prehospital advanced life support (PALS) on the survival of victims of severe trauma in our hospital. During a period of 24 months, 46 patients with severe trauma were admitted to our Emergency Department after receiving PALS; this included endotracheal intubation and ventilatory support (IVS) in 35 cases, and cardiopulmonary resuscitation (CPR) in 11. ⋯ The survival rate was 48% in patients with prehospital IVS rate and 18% in those receiving CPR. We conclude that PALS in severe trauma was able to save the lives of many patients at high risk of dying before reaching hospital.