European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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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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During the years 1986 to 1990, an increasing number of cases of acute carbon monoxide (CO) poisoning were encountered in the Emergency Department Hacettepe University Hospital in Ankara, Turkey. Between January 1 and March 31, 1991, all the patients presenting with complaints compatible with CO poisoning were evaluated; the diagnosis was confirmed in 55 of the 5795 people who attended the Emergency Department during this period. In all cases the source of CO intoxication was determined. ⋯ One of them was discharged from the hospital with mild cerebral disability. Another patient developed an acute myocardial infarction. In all the cases in this series, the source of CO poisoning was identified as improper combustion of recently marketed steam coal in inadequately ventilated bucket stoves.
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This study was initiated to identify the incidence, risk factors and outcome predictors of patients admitted to hospital in the Netherlands because of accidental hypothermia. Information about these patients was available for study through the National Health Care Data Bank. Between 1987 and 1990, 612 accidental hypothermic patients were admitted: 185 hypothermic patients also suffered from submersion (HYPSUBS), but this was not the case in the remaining 427 patients (HYPNOTSUBS). ⋯ Almost half of the HYPNOTSUBS non-survivors died after more than 2 days. Because body temperature will have returned to normal by then, this must be the result of late complications. Most HYPSUB non-survivors died during the first 2 days, probably as a direct result of the submersion injury.
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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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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.