European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Intravenous urography (IVU) is a useful radiographic study in the detection of renal and ureteral calculi. However, it is time consuming, expensive, and exposes the patient to i.v. contrast and radiation. To determine the impact of utilizing IVU less for the detection of renal calculi, criteria for ordering IVU in the emergency department (ED) were evaluated, and patients with high probability of positive IVU were identified. ⋯ The combined objective findings of acute flank pain and haematuria are sensitive, and prior history is specific in identifying patients with renal calculi. Degree of haematuria was not useful in predicting renal calculi. By utilizing the criteria of acute flank pain and haematuria as a decision aid, 66% of all IVUs ordered could have been avoided.
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A 55-year-old man developed acute respiratory failure, pulmonary hypertension and left heart failure due to acute myocardial infarction. Nitric oxide (NO) inhalation improved arterial oxygenation, decreased pulmonary arterial pressure and increased cardiac output (CO), but combined use of dobutamine with NO produced increases in pulmonary arterial pressure and pulmonary capillary wedge pressure (PCWP). In this patient, amrinone decreased pulmonary arterial pressure and PCWP, and increased PaO2/FiO2 effectively while increasing CO. Combined use of inhaled NO and intravenous amrinone may have beneficial effects for a patient with acute respiratory and cardiac failure.
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Hypothermia is an important threat in trauma patients. The prevention of accidental hypothermia requires a thermal steady state. ⋯ To simulate possible strategies to prevent hypothermia in the trauma patient the mathematical solution needs to be extended to describe situations where steady state does not exist. From these simulations it can be concluded that infusion heating devices are mandatory in patients with high fluid requirements.
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Randomized Controlled Trial Comparative Study Clinical Trial
The influence of the mode of emergency ambulance transportation on the emergency patient's outcome.
Emergency transport by an ambulance can cause considerable psychical and physical stress for patients. We determined the haemodynamic and endocrinological values of 54 healthy volunteers subjected to one high speed emergency transport and one smooth transport. There were significant differences in all measurements: heart rate (p < or = 0.001), blood pressure, cortisol (p < or = 0.01), prolactin, somatotropine and ACTH between the two modes of transportation. We hypothesize that the additional stress of high speed ambulance transport particularly in patients with acute cardiac disease may result in additional morbidity.
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We report the case of a 30-year-old male, heroin dependent, receiving methadone treatment, who, while staying at home, ingested 50 mg of naltrexone. He immediately developed serious withdrawal symptoms and was admitted to the hospital. In the emergency department the drugs given to counteract the agitation were ineffective, and the patient developed respiratory distress. ⋯ Afterwards he did not attend his scheduled outpatient follow-up visits. Treatment with propofol is effective in the case of a patient with a serious withdrawal syndrome secondary to naltrexone overdose during methadone therapy. Despite the actual possibility of getting through the withdrawal symptoms the patient failed to return for follow-up visits, which might be related to a lack of motivation.