European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review
Hypokalemic periodic paralysis: a case series, review of the literature and update of management.
The objective of this study was to present a case series of patients with hypokalemic periodic paralysis. We described all patients with diagnosis of hypokalemic periodic paralysis admitted to the Al Ain Hospital (UAE) during the year 2006. Seventeen patients, all males and mostly Asians, were presented to the Al Ain Hospital over a 12-month period. ⋯ In conclusion, clinicians should have a high index of suspicion, especially among Asians presenting with flaccid paralysis and hypokalemia. The main steps in the management include exclusion of other causes of hypokalemia, potassium replacement, hydration and close monitoring of the cardiac rhythm and serum potassium levels. When possible, the underlying cause must be adequately addressed to prevent the persistence or recurrence of paralysis.
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To compare the diagnostic value of the Cincinnati Prehospital Stroke Scale, the Face Arm Speech Test, the Los Angeles Prehospital Stroke Screen and the Melbourne Ambulance Stroke Screen for identifying patients with an acute stroke in a prehospital setting in Belgium. ⋯ The results obtained in this study are comparable with earlier investigations. Given the limitations of the study, we could not identify the most adequate stroke scale. History items seem to be less relevant compared with clinical assessment. Further research is needed to determine the most adequate stroke scale.
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Case Reports
Complete recovery from aneurysmal subarachnoid hemorrhage associated with out-of-hospital cardiopulmonary arrest.
Out-of-hospital cardiopulmonary arrest (OHCPA) because of aneurysmal subarachnoid hemorrhage (SAH) is almost always fatal, because devastating SAH causes OHCPA and the brain damage is aggravated by OHCPA. We report a rare case of a 63-year-old female patient who survived SAH-induced ventricular fibrillation OHCPA without neurologic sequelae. Early brain computed tomography scans were needed for the diagnosis, as most of SAH seemingly disappeared within 7 h after the onset and was associated with acute coronary syndrome-like findings. This case shows that even less severe SAH can cause ventricular fibrillation OHCPA and takotsubo cardiomyopathy, and that early diagnosis and appropriate treatment following immediate, successful resuscitation may lead to a surprisingly favorable outcome.
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Clinical Trial
Initial ventilation through laryngeal tube instead of face mask in out-of-hospital cardiopulmonary arrest is effective and safe.
Bag-valve-mask ventilation is recommended as the initial airway management option for paramedics during cardiopulmonary resuscitation, although this technique requires considerable skill and is associated with the risk of stomach insufflation, regurgitation, and aspiration. The present two-phase study investigated the efficacy and safety of the laryngeal tube (LT-D) used by paramedics as the sole technique for ventilation in out-of-hospital cardiac arrest. ⋯ The LT-D is feasible and effective for airway management and ventilation when used by paramedics in out-of-hospital cardiopulmonary resuscitation and can be recommended as the sole technique in such situations.
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Multicenter Study
Emergencies related to cocaine use: a European multicentre study of expert interviews.
Illicit drug use can lead to acute reverse reactions leading to the admission to emergency departments. Cocaine-related emergencies have been monitored in the USA, but not in Europe so far. The study investigates patterns of cocaine emergencies in eight European cities in a multicentre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Rome, Vienna and Zurich. ⋯ Patterns of complaints among cocaine users are associated with the psychomotor-stimulant or cardiovascular effects of cocaine. Urine screens and referrals to the addiction services are infrequent. A closer link between the emergency departments and addiction services would help in guiding problematic drug users towards appropriate treatment at an earlier stage in the addiction process.