European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Methaemoglobinemia is a disorder in which the haemoglobin molecule is functionally altered and prevented from carrying oxygen. A variety of aetiologies including genetic, dietary, idiopathic and toxicological sources may cause methaemoglobinemia. Symptoms vary from mild headache to coma or death, and may not correlate with measured methaemoglobin concentrations. ⋯ A 23-year-old girl who arrived in the emergency department in a state of confusion with intense cyanosis. The night before she had drunk water with ice defiled by ammonium nitrate, poured from a broken pack of instant ice. The absence of improvement after the administration of oxygen and the 'chocolate brown' colour of the arterial blood gave us the most important clue in suspecting the diagnosis of methaemoglobinemia.
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Multicenter Study Comparative Study
Upper gastrointestinal haemorrhage in Emergency Departments in France: causes and management.
Little is known about the epidemiology of acute upper gastrointestinal haemorrhage hospitalized in Emergency Departments. Most of the studies concerning digestive bleeding have been carried out by Gastroenterology Departments. This multicentre study included consecutive patients with acute upper gastrointestinal haemorrhage hospitalized after an initial management at Emergency Departments in France, to describe the initial medical management and to determine the causes of acute upper gastrointestinal haemorrhage. We also studied the relationship between the use of non-steroidal anti-inflammatory drugs or aspirin and the occurrence of an acute upper gastrointestinal haemorrhage by a case-control comparison. ⋯ Hospitalized acute upper gastrointestinal haemorrhage in Emergency Departments in France is more often caused by cirrhosis than in other countries. Decreasing the delay between the first signs of bleeding and arrival at the Emergency Department is the main challenge in the management of acute upper gastrointestinal haemorrhage.
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Laryngotracheal foreign bodies, although less common than bronchial foreign bodies, are potentially more dangerous. We report a 10-year-old girl with Down syndrome with asthma bronchiale symptoms, which was later found to be the result of a thin bone lamella impacted in her larynx. There was no clear history of foreign body aspiration. ⋯ The foreign body was removed via direct laryngoscopy. It was a white and thin bone lamella with sharp edges, measuring 28 x 19 x 2 mm. We thought the case was worth presenting because of its rare location, the size of the foreign body, and the long duration before the final diagnosis was made.
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Diaphragmatic rupture is an uncommon and frequently missed complication in blunt thoraco-abdominal trauma. Symptoms usually become apparent in a delayed phase, up to years after the trauma. ⋯ We only found two cases in the literature. We present here two other cases from our practice, with a review on the literature on post-traumatic diaphragmatic hernias.
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To obtain information about patient, staff and organization characteristics of Emergency Departments in the Netherlands, and evaluate the changes between 1996 and 1999. ⋯ Almost all hospitals in the Netherlands reported an increase in the number of patients visiting the Emergency Department, especially in the number of self-referred patients. A majority of the Emergency Departments are now staffed by emergency physicians instead of surgical residents. Developing specific training programmes for emergency physicians should be a priority for the Netherlands in the future.