European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Clinical Trial Controlled Clinical Trial
Transcutaneous PO2 measurement in compound fractures.
The transcutaneous assessment of tissue oxygenation has become a useful method for evaluating microcirculatory disorders in different diseases. In this clinical experimental pilot study, the impact of compound fractures on tissue oxygenation was examined. Using a special probe placed directly into the muscle, tissue oxygenation was measured at the site of tissue injury as well as at one non-injured site within the same fractured extremity. ⋯ After day 4 until the end of the study (day 10) a complete return to normal values was noted at both sites. In conclusion, it is most likely that, due to a change of microcirculation within the fractured extremity, the injured site is temporarily oversaturated by oxygen and this is associated with low oxygenation at the non-injured site on the same extremity. As the microcirculatory status may be important in making decisions about trauma surgery (e.g. whether or not to amputate), transcutaneous oxygen measurement is a practical and useful method in trauma care.
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The very early handling of patients with suspected acute myocardial infarction (AMI) is of critical importance to the outcome. The aim of this study was to relate the dispatcher's initial suspicion of AMI, among patients who call for an ambulance due to chest pain, to the subsequent diagnosis and outcome. All patients who called for an ambulance in Gothenburg due to acute chest pain during a 2-month period were included in the study. ⋯ Among patients with at least a strong suspicion of AMI, 29% subsequently developed infarcation, compared with 18% among patients with a moderate suspicion of AMI and 15% among patients with only a vague or no suspicion (p < 0.001). However, the priority level was similar in patients with and without a life-threatening condition, and the mortality rate remained similar in patients with a strong suspicion and those without a strong suspicion of AMI. Thus, among patients who called for an ambulance due to acute chest pain there was a direct relationship between the dispatcher's suspicion of AMI and the subsequent diagnosis, but the mortality rate was similar in the different groups.
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In the Netherlands, neonatal intensive care is provided in 10 neonatal intensive care centres. Although antenatal transport is preferred, each year more than 1000 newborns are transported to the centres, in the majority of cases by ambulance. Transport by helicopter became available in 1987. ⋯ The transports carried out from 1987 to 1989 were recalculated with regard to duration and cost, assuming they were carried out by ambulance instead of by helicopter: for the babies, the mean transport time by helicopter was 75% less than the calculated mean transport time by ambulance. However, the financial costs per transport were on average Dutch florins (DFL) 3000 higher by helicopter than by ambulance. In the Netherlands, the use of a helicopter for neonatal transport reduces the transport time, but doubles the costs.
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Case Reports
Post-traumatic transverse dissection of the caudal thoracic aorta diagnosed by transoesophageal echocardiography.
Transverse dissection of the distal aorta is a rather rare complication of spinal trauma. Transoesophageal echocardiography (TEE) appears to have a supplementary value in diagnosing post-traumatic transverse dissection of the caudal thoracic aorta. We present a case where the advantages and additional value of TEE are particularly apparent.
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When treating stroke as a medical emergency, more uncommon causes should be carefully and promptly considered, since timing may be crucial not only to any neuroprotective and particularly thrombolytic therapy but also to the management of an underlying life-threatening disease. This issue is illustrated in the report of an apparently extremely rare case in which an infarction in the territory of the middle cerebral artery was the presenting symptom of acute promyelocytic leukaemia with associated disseminated intravascular coagulation, which we believe highlights the imperative need of immediate haematological tests on all acute stroke patients.