Nederlands tijdschrift voor geneeskunde
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Carotid sinus massage for diagnosis and termination of supraventricular tachycardia (SVT) is still a widely used vagal manoeuvre in the A&E department. However, itsefficacy is limited (termination of the SVT in approximately 20%) and carotid sinus massage may be complicated by (potentially devastating) neurologic complications in 0.2-1% of the patients. ⋯ Carotid sinus massage remains an important diagnostic method in patients with unexplained syncope in whom, based on the clinical history, carotid sinus hypersensitivity is suspected. It should be avoided in patients with previous TIA or stroke within the past 3 months, or those with carotid bruits, except if carotid Doppler studies have excluded significant stenosis (≥ 70%).
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Since the introduction of the electronic e-cigarette a few years ago, its use has greatly increased. The liquid formulations used in these e-cigarettes contain nicotine in high concentrations; ingestion of these liquids can be fatal. ⋯ Nicotine e-liquids are highly concentrated. Intentional ingestion can lead to toxic levels of nicotine which are associated with cardiac arrhythmias or arrest. Because even a few millilitres can be lethal, nicotine intoxication due to e-liquid ingestion should be considered potentially life-threatening.
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To determine the degree of agreement between delirium experts on the diagnosis of delirium based on exactly the same information, and to assess the sensitivity of delirium screening methods used by clinical nurses. ⋯ There was considerable disagreement between the classifications of individual delirium experts, based on exactly the same information, indicating the difficulty of the diagnosis. Furthermore, the sensitivity of the delirium screening tools used by the clinical nurses was poor. Further research should focus on the development of objective methods for recognising delirium.
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Ned Tijdschr Geneeskd · Jan 2017
Review Case Reports[Food bolus obstruction of the oesophagus or ingestion of a foreign body; what should you do?]
A food bolus obstruction of the oesophagus and foreign body ingestion are frequently encountered in common clinical practice. There is currently no guideline in the Netherlands for management of these problems. We present two cases to illustrate how these can be managed in line with European and American guidelines. ⋯ Endoscopic removal was not possible, and a fourth laparotomy was performed to remove the fork. Food bolus obstruction is a gastroenterological emergency that warrants swift endoscopic removal. In cases of ingestion of a foreign body, the characteristics of the object must be taken into account when determining timing of endoscopic removal.
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Up to thirty years ago, in the Netherlands the word 'stervensbegeleiding' [literally, dying-guidance] was used to refer to care for people in the last days of life. After Cicely Saunders had developed a multidisciplinary and multidimensional approach for care for the dying, the wording changed, until the word 'palliative care' was adopted. This care gradually developed from care for the dying to care for all people with life-threatening illness, as illustrated in the WHO definition. ⋯ However, answering the surprise question does not inform us about palliative care needs. Nevertheless, when people enter the dying phase, a fundamental change in the nature of care is needed. The word 'stervensbegeleiding' marks this change of care.