European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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This paper reports on a fatal intoxication by oral ingestion of the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D). At admission, the victim was unconscious. His condition deteroriated rapidly with blood loss from his mouth and nose. ⋯ The identity of the toxic xenobiotic was revealed by gas chromatography-mass spectrometry. Analytical quantification of the herbicide was performed by acid extraction prior to gas chromatographic examination using electron capture detection. His blood level of 2,4-D was 192 mg l-1.
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Comparative Study Clinical Trial
A comparison of the prognostic value of neuron-specific enolase serum levels and somatosensory evoked potentials in 13 reanimated patients.
Thirteen patients resuscitated after circulatory arrest due to cardiopulmonary aetiologies were studied with regard to survival and outcome. Exclusion criteria were known central nervous system disorders or death secondary to cerebrovascular accident. The serum level of neuron-specific enolase (NSE), presumably a reliable marker of neuronal death, was measured by enzyme immunoassay in peripheral blood samples over the course of 4 days at 12 h intervals. ⋯ In conclusion, pathological SSEPs and increased NSE levels are of comparable prognostic value. They may well be complementary investigations. The neuron-bound enzyme NSE is a biochemical marker which varies with the extent of neuronal damage, while absence of the cortical potentials may indicate neurophysiological loss of function.
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We report the case of a 32-year-old male who presented to the emergency department with left-sided chest pain associated with burning epigastric discomfort and radiation to the back. Similar symptoms had prompted his visit to another emergency department 1 week earlier. He was discharged from that institution after a negative upper gastrointestinal series. ⋯ Aortic dissection is rarely seen in young, healthy individuals. Atypical clinical representations are reviewed. The emergency department work-up of aortic dissection is discussed.
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Comparative Study
Clinical status before and during cardiopulmonary resuscitation versus outcome in two consecutive databases. Belgian CPCR Study Group.
The outcome of out-of-hospital cardiac arrest is very much determined by uncontrollable precardiopulmonary resuscitation (CPR) conditions. Two consecutively registered databases containing variables related to pre-arrest, arrest and CPR are similarly analysed to produce and validate a simple clinical algorithm for acute decision making during CPR. ⋯ The simultaneous and persistent absence of ventricular fibrillation, gasping and light-reactive pupils after arrival of the second tier was strongly associated with a poor outcome. Unresponsiveness of these variables to a full and optimal trial of advanced life support can in itself be considered as an index for irreversible myocardial and neurological damage.
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All prehospital resuscitations performed by emergency physicians in the city of Bochum, Germany, were recorded and evaluated prospectively from 1 August 1989 to 30 September 1990. Initially successful cardiopulmonary resuscitation (CPR) was achieved in 33.8% (alive at admission), and definitive success in 10.4% (discharged alive). Of the patients who presented with cardiac arrest before the arrival of the emergency physician, 28.4% could be resuscitated initially and 7.6% survived definitively. ⋯ This decrease, however did not improve either the initial or the definitive success of CPR. From these results we conclude that further improvement of prehospital resuscitation can only be achieved to a small extent by reducing the call to arrival time of ambulances staffed with emergency physicians. Improvement is more likely to be seen when immediate resuscitation is performed by bystanders present at the scene.