Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Jul 2006
Case Reports[Delirium in critically ill children in a paediatric intensive care unit].
Two critically ill girls, aged 2.3 years and 3.5 years respectively, developed delirium in the Paediatric Intensive Care Unit (PICU). The first child, admitted with meningococcal meningitis and septic shock with respiratory failure, suffered from hyperactive delirium which started 2 hours post-extubation. The second child, admitted due to an exacerbation of cystic fibrosis with the threat of respiratory failure, suffered from hypoactive delirium with regression, inconsolability, dyspraxia and dysphasia. ⋯ It should nevertheless be considered as a medical emergency, particularly in a PICU setting, and should be treated accordingly. Physicians are generally reluctant to consider psychopharmacological treatment of childhood delirium. Haloperidol is considered as the drug of choice, but risperidone can also be used successfully.
-
Ned Tijdschr Geneeskd · Jul 2006
Comment Review[Emergency procedures for taking care of the victims of bomb attacks: logistical and medical aspects].
In The Netherlands the threat of terrorist attacks also exist. Both doctors and hospitals alike should be prepared for such attacks both on the logistical as well as the medical level. Most terrorist attacks are carried out with explosives. ⋯ One especially important aspect of this is the sorting and selecting between victims who are likely to develop complex problems and who therefore need to receive aggressive treatment in a specially equipped centre and those patients for whom the nearest emergency department will suffice their needs. The triage should be repeated considering the possibility that initial estimates on these points may have been wrong. Epidemiological research should be carried out for each attack in order to make an inventory of the number of victims, the injuries incurred, the assessment of the effects of the medical help received and an assessment of the effectiveness of the total aid received.
-
Care for the polytraumatized patient in the pre-hospital phase has improved rapidly in recent years. This has resulted in more patients being alive on arrival at the hospital. The treatment of polytraumatized patients requires a different approach to that of regular trauma patients because they are threatened not only by the injuries themselves but also by the metabolic disruptions that follow. ⋯ The second phase consists of resuscitation on the Intensive Care Unit and the third phase aims at definitive repair of the sustained injuries. Despite the low level of evidence found in the literature, DCS seems to reduce mortality rates in polytraumatized patients. Therefore, when initiated correctly and at the right moment, it appears to be a promising technique.
-
Ned Tijdschr Geneeskd · Jul 2006
Case Reports[Diagnostic image (281). A girl with fever, a sore throat and a rash].
Scarlet fever was diagnosed in a girl with high fever, a sore throat and exanthema marginatum.
-
Ned Tijdschr Geneeskd · Jun 2006
Case Reports[Diagnostic image (279). A man with swelling and crusts on his lower legs and feet].
A 68-year-old man presented with painful swollen legs due to elephantiasis nostras verrucosa.