European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Recent data, focused on the inability to transfer emergency patients to inpatient beds, has shown this to be the single most important factor contributing to overcrowding. Our Emergency Department (ED) was reorganized in the year 2000 based on the optimization of patients' flow. In this model, the emergency team had to refer patients to units fitting best to their condition with minimal delays. ⋯ A short time of stay in the ED is compatible with both a good diagnosis and a good orientation of ED patients requiring admission for specialized care.
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Case Reports
Severe metformin intoxication treated with prolonged haemodialyses and plasma exchange.
Biguanides pose a significant risk of morbidity, mortality and permanent sequelae secondary to prolonged periods of hypoglycaemia. ⋯ For the maximum elimination of metformin, extended haemodialysis is required and the treatment of the accompanying metabolic acidosis with bicarbonate is important for the effectiveness of the treatment. Patients benefit much more from the treatment of combined haemodialysis with plasma exchange.
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Comparative Study
Comparison of the Full Outline of Unresponsiveness Score Coma Scale and the Glasgow Coma Scale in an emergency setting population.
The Glasgow Coma Scale (GCS) is the most widely used tool for the evaluation of the level of consciousness. The Full Outline of Unresponsiveness (FOUR) Score is a new coma Scale that was developed considering the limitations of the GCS, and has been found to be useful in an intensive care setting. We aimed to compare FOUR Score and GCS in the emergency setting. ⋯ The new coma Scale, FOUR Score, is not superior to the GCS. However, the combination of the eye and motor components of FOUR Score is a valuable tool that can be used instead of either the FOUR Score or GCS.
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Documenting the quality of emergency dispatch centres handling of emergency calls regarding intoxicated unconscious patients. ⋯ On the basis of the interviews and the survey, cases were handled according to guidelines. The log recordings, however, disclosed deviation from the protocol. Alcohol intoxication was associated with higher rate of deviation from the protocol compared with other intoxications.
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Comparative Study
Performance of the Wells and Revised Geneva scores for predicting pulmonary embolism.
The objective of the study was to compare two scoring methods to predict the risk of pulmonary embolism (PE) as diagnosed with computed tomography angiography (CTA) and/or CT venography (CTV). ⋯ The Wells rule seems to be more accurate among both inpatients and emergency department patients. The Revised Geneva score can be used in emergency department patients with high reliability.