European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The aim of this study was to describe the characteristics and long-term outcome for patients suffering from acute chest pain in relation to whether or not they were transported to hospital by ambulance. All patients with acute chest pain who were admitted over a 21-month period to the emergency department at Sahlgrenska Hospital in Göteborg with symptoms of acute chest pain were included in the study. Consecutive patients were prospectively registered and followed with regard to mortality and morbidity over 5 years. ⋯ It is concluded that among patients admitted to the emergency department with acute chest pain, those transported by ambulance had a much higher mortality during the subsequent 5 years than those who were not transported by ambulance. This was not entirely explained by observed differences at baseline. This information should be considered when ambulance organizations are being constructed.
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Spontaneous pneumomediastinum is a rare condition and a most uncommon complication of sporting activity. We describe a case of spontaneous pneumomediastinum in a 17-year-old boy while playing football with no history of blunt trauma to the chest. The patient presented with symptoms and signs suggestive of an oesophageal perforation. The importance of correct investigations and subsequent management are discussed.
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An 11-year-old boy known to have asthma was referred to our intensive care unit (ICU) with progressive respiratory distress. He was sedated, paralysed, and intubated approximately 3 hours after arrival and nebulization with salbutamol and ipratropium was continued on the ventilator. ⋯ Computerized tomography scan revealed no signs of generalized cerebral oedema. Local contamination with ipratropium was most likely to be the cause of pupil dilatation, which could have occurred during connecting and disconnecting the nebulization system or through contaminated hands.
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The admission of a large number of victims in a hospital after a mass casualty incident can easily lead to chaos and disruption of the hospital's regular organization. To ensure that this chaos does not continue, a correct way of registration and continuous overview of registered patients can be very helpful. The Emergency Hospital, which is part of the University Medical Centre Utrecht and the Central Military Hospital, was confronted several times with groups of patients who had to be admitted immediately. ⋯ The system also registers urgency classes and primary diagnoses. It appeared that fewer errors were made in comparison with manual registration, while more information was stored and easily retrievable. Pilot studies are being performed to extend the usefulness of this method in a prehospital environment.
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Outcome of major trauma in a Turkish university hospital: did integrated approach make a difference?
The aim of this study was to determine the effect of the institution in an in-hospital integrated approach to trauma on the mortality of severely injured patients in a university hospital in Turkey. We examined the effects of several risk factors, namely physiological parameters, anatomical findings, and the timeliness of therapeutic approaches, on the mortality of major trauma patients before and after the institution of integrated trauma care. The investigated risk factors were injury severity score (ISS), revised trauma score (RTS), anatomical localization of the injury, the type of injury, prehospital time, emergency room time, and referral from another hospital. ⋯ A significant improvement was seen in the Z-statistics between the two periods. Z value increased from -2.47 to 0.55. In-hospital integrated approach to trauma made major improvements in the care of the patients with severe injuries, especially those with significant airway, ventilation and circulation problems.