European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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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'.
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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.
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Traumatic cervical spine injuries can result in severe disability or death unless promptly diagnosed and treated. Advanced trauma life support guidelines recommend that three-view cervical spine X-rays should be obtained routinely in all blunt trauma patients. In this retrospective study, we evaluated whether cervical spine X-rays are indeed necessary in all such patients. ⋯ On the other hand, none of the patients without neck pain and tenderness were found to have cervical spine injury. We conclude that pain and/or tenderness in the neck area are valid criteria with regard to the timely diagnosis of cervical spine injuries, and that routine cervical spine X-rays may be unnecessary for those blunt trauma patients who are conscious, fully orientated, co-operative, non-intoxicated, exhibit no neurological deficits and who do not have neck pain or tenderness. Omitting cervical X-rays speeds up patient evaluation, protects the department staff from unnecessary exposure to ionizing radiation and mitigates treatment costs, while maintaining the quality of the healthcare provided.
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Sudden non-traumatic death in young people (< 30 years old) has been discussed both in systematic studies and anecdotal reports. After presenting three remarkable cases, a global survey of the incidence with special reference to the Belgian CPCR database, ethiopathogenesis and prognosis of sudden non-traumatic death in this specific age group is given. ⋯ The involvement of drugs or other toxins has to be excluded in the first place. Apart from transoesophageal echocardiography and coronary angiography, electrophysiological testing, serological exams, myocardial biopsy and magnetic resonance imaging should be considered.
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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).