European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The need to consider the problem of acute toxic injury in the prehospital context emphasized by the recent use of highly toxic agents of warfare in terrorist attacks. Toxic agents differ widely in their nature but may be considered to have four distinct properties: toxicity, latency, persistency and transmissibility. Toxicity and latency determine the onset and pathophysiology of the poisoning and therefore the clinical management. ⋯ This approach, however, although essential for the safety of medical responders may not be in the best interests of the patient who may be in a life-threatening situation within a contaminated zone (CONZONE). Toxic injury may require more rapid help than traumatic injury; moreover, traumatic and toxic injury may co-exist, as in the case of explosion with toxic emission. The special skills required are defined in the TOXALS programme and must now become a standard part of the training and practice of prehospital care medical care.
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The unique physiologic and medical consequences of blast injuries are often unrecognized and frequently poorly understood. The medical consequences, including pulmonary, gastrointestinal and auditory injury, have a defined and unique set of physiologic sequelae. Understanding the mechanism of injury, treatment issues and the potential long-term morbidity of primary blast injuries will enhance survival.
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The Great Hanshin earthquake on 17 January 1995 caused a complete disruption of both the communications and transportation systems which, as a result, severely hampered a prompt and timely system response. The survival rate of the extricated victims was 80.4% on the first day, and 1892 victims were extricated with an overall survival rate of 40%. ⋯ Crush syndrome was the most prominent medical syndrome necessitating critical care after the Kobe earthquake. The Japanese Association for Acute Medicine has since made eight new proposals for emergency medicine during mass-disasters that will hopefully improve the survival of patients in any future disasters.
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For optimal treatment of burns an understanding of the pathophysiological changes occurring locally and systemically after injury is necessary. Accurate estimation of burn size and depth as well as early treatment is essential. Knowledge of the circumstances of the accident and experience in diagnosing physical signs are required in terms of the need for intubation, treatment of poisoning and the occurrence of other trauma.
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Review Case Reports
Early electrocardiographic signs in acute massive pulmonary embolism.
As a result of the increasing accuracy in diagnosing acute pulmonary embolism by isotopic ventilation-perfusion scintigraphy and pulmonary arterial angiography, the electrocardiographic changes associated with acute cor pulmonale are being abandoned as a diagnostic tool for this life-threatening disease. Nevertheless, certain electrocardiographic findings can raise the suspicion of pulmonary embolism. ⋯ In this case report we emphasize the importance of the electrocardiographic findings which forwarded the diagnosis of pulmonary embolism. Hence the necessary invasive diagnostic and therapeutic measures, i.e. pulmonary arterial angiography and thrombolytic therapy, can be taken immediately after admission to the emergency department.