Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
Practice Guideline[Practice guideline 'Pharmaceutical pain treatment during labour'; the woman's request is sufficient indication].
The basic principle of the practice guideline 'Pharmaceutical pain treatment during labour' is that during labour every woman can have adequate pain treatment at her request. Most women experience severe pain during labour, but retrospective satisfaction also depends on the support of care-givers and on the extent to which the woman was involved in decisions relating to her situation. A number of medical indications require good pain management. ⋯ Pethidine is far less effective. Recommended organisational changes include structured provision of information on pharmaceutical pain management in the 30th week of pregnancy, to be developed by midwives, obstetricians and anaesthetists. Other recommended changes include referral to another hospital for the treatment of choice, development of local protocols across primary and secondary care with agreements about out-patient referral to the anaesthetist, structured daily contact between obstetricians and anaesthetists, the time lapse between the request for pain treatment and the administration of the treatment, and the site of administration and monitoring.
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Two men presented at the Accident & Emergency Department with lower urinary tract symptoms. The first patient was a 76-year-old male with reddish urine and lower abdominal pain. A CT-scan revealed a tumorous mass related to the bladder. ⋯ Voiding problems can arise when the haematoma extends into the prevesical (Retzius) space that is anatomically related to the rectus sheath. A haematoma of the rectus sheath is difficult to diagnose. Current insights show that conservative treatment is generally sufficient.
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Three patients, men aged 30, 33 and 32 years respectively, died in police custody in Amsterdam, the Netherlands. According to autopsy reports, all patients died from excited delirium syndrome induced by cocaine use. Excited delirium is a state of mental and physiological hyperarousal commonly associated with the use of cocaine. ⋯ Medical and police staff should aim to reduce confrontation. When patients are too agitated to cooperate, benzodiazepines should be used for sedation of the patient. Beta blockers and antipsychotic medication should not be administered, as these medications can exacerbate the fatal cardiac effects seen in excited delirium.
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The first exemption to the comprehensive ban on smoking in public places in the Netherlands was made on 14 May 2009. The exemption was based on a technicality in the wording of the law, and could potentially lead to further exemptions to the smoking ban being made. The authors argue that focusing solely on the wording is a sidetrack in the main discussion. ⋯ That is exactly what smoking in public places does. They also argue that other legislative measures comparable to the smoking ban are already in effect. In conclusion, the ban on smoking in public places does not remove the right to smoke, but serves to create a healthier social environment for everyone.
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Two patients were involved in a high-energy trauma that resulted in an unstable pelvic fracture. The first patient, a 51-year-old woman, was trapped between two boats. At our hospital she received a traumatic pelvic orthotic device (T-POD), followed by angiography with embolisation. ⋯ These cases illustrate the variety of possible treatments for patients with unstable pelvic fractures. Choice of treatment depends on the character of the attending injuries and the haemodynamic situation. Fast consultation should take place with a hospital experienced in the initial care and treatment of unstable pelvic fractures.