ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The objective of this study was to evaluate the validity in Belgium of the National Triage Scale for judgement of the urgency of a patient's condition and making a case-mix description of the patient profiles in the different urgency categories. The study is of a descriptive retrospective and descriptive correlational design and was carried out in the emergency department at the University Hospital Gasthuisberg in Leuven, Belgium. The urgency of patients arriving at the emergency department was evaluated during one randomly selected shift a day over 12 weeks in 1997 by one of the four triage-educated nurses, using an instrument based on the National Triage Scale. Patient identification and outcome parameters were retrieved from the existing computer system. The data were mainly analysed using the Ridit analysis. Overall 3650 patients were evaluated: Category 1, 4.19%; Category 2, 24.44%; Category 3, 39.32%; Category 4, 27.97%; Category 5, 4.08%. Any similarity between sentinel diagnoses as well as between the admission percentages in this pilot study and the reference from Australia (Z = 0.827;p > 0.05) was noted. Different aspects influenced the triage nurses while determining the degree of urgency. Urgency categories profiles revealed a significant effect of age (Kruskall–Wallis = 530.5;p = 0.000). Higher categories of urgency resulted in a higher degree of admission (t(df = 3640) = 643.45;p = 0.000). It is concluded that a resemblance between the pilot study and the reference confirms the predictive validity of the scale used. Patient profiles in the different urgency categories give a description of the emergency department population.

ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Intravenous magnesium sulphate (MgSO4) has been tried in the emergency department treatment of asthma since the mid-1980s, but published reports vary as to its efficacy. The literature suggests that it may be effective in the more severely ill asthmatic. We evaluated i.v. MgSO4in adult asthmatics having a moderate to severe exacerbation. The study was performed in a convenience sample of adult asthmatics between the ages of 18 and 55 presenting to the emergency department with a peak expiratory flow (PEF) of <100 l/min or <25% of predicted flow. Patients received either 2.0 grams of MgSO4or placebo in a randomized, double-blind fashion. All patients received inhaled bronchodilators and i.v. steroids. Outcome variables were: improvement in PEF, subjective respiratory distress as measured by the Borg dyspnoea scale (BDS) and hospital admission. The first visits of 42 patients presenting with acute asthma exacerbations were evaluated, 18 receiving MgSO4and 24 receiving placebo. Thet = 60 peak flow in the MgSO4group was 174 l/min versus 212 l/min in placebo,p = 0.04. Controlling for age, heart rate, initial PEF and initial BDS in ordinal logistic regression, thet = 60 Borg scale of subjective dyspnoea had an odds ratio of 1.54 in favour of more dyspnoea in MgSO4(95% C.I., 0.36–6.67;p = 0.56). Five of 18 patients (28%) receiving MgSO4were admitted compared with 5 of 24 (21%) receiving placebo (p = 0.72). In moderately severe adult asthmatics, 2.0 grams of MgSO4i.v. resulted in less improvement in peak expiratory flow compared with placebo. MgSO4did not appear to decrease subjective dyspnoea or the hospital admission rate. This evidence does not support the use of MgSO4in the treatment of acute asthma.

ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

We present a retrospective review of Hantavirus infection in the emergency department. Thirteen cases of Hantavirus infections with renal syndrome from July 1989 to August 1999 were analysed. The diagnosis was confirmed by detection of Hantavirus antibodies in all cases. Fever, chills and headaches were universally present. Intense back pain was associated in 77% of the patients. Thrombocytopenia, abnormal urinalysis, hypertransaminasaemia, increased lactate dehydrogenase were the principal biological patterns. All these parameters returned to their normal level, and all the patients recovered a normal renal function without sequels. The management is supportive. Only one patient in our series had to be dialysed. Hantavirus disease should be included in the differential diagnosis of acute renal failure with thrombocytopenia, particularly in patients with suspected exposure in known endemic areas. The differential diagnosis of any perplexing case of undifferentiated febrile illness with acute renal failure and thrombocytopenia should include Hantavirus infection.

ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) commonly present to the emergency department for treatment. Some of them, despite appropriate therapy become more dyspnoeic with increasing acute respiratory failure. The requirement for intubation and mechanical ventilation is for these patients often associated with a prolonged and complicated intensive care unit stay and has been associated with morbidity and mortality rates in excess. Non-invasive ventilation (NIV) emerged recently as a means of reducing those complications. NIV can be a safe and effective means of augmenting ventilation and decreasing inspiratory work in many patients with acute exacerbation of COPD. NIV is generally started in the intensive care unit. Except for a few negative studies, the overall compending studies seem to be in favour of the utilization of NIV in cases of exacerbation of COPD patients. There are few published data on the question whether NIV could or should be started earlier and initiated in the emergency department. It seems that NIV treatment could be an effective addition to standard treatment especially for acute exacerbation of COPD. A more extensive and routine use of non-invasive ventilation in the emergency department requires further study.

ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Biphasic-flow induced ventilation (BiFIV) is a variable time-cycled tracheal gas insufflation mode, using a specific multiluminal endotracheal tube. Some recent studies have reported efficiency of this new ventilatory mode in experimentalin vitroandin vivosettings. We hypothesized that this ventilatory mode could be able to deliver simultaneous efficient ventilation for several animals, using a single ventilator prototype. The study was performed in three groups of three domestic pigs with a normal lung compliance. Each pig was initially anaesthetized, intubated with the specific endotracheal tube, and ventilated with a conventional ventilatory device. The animals were then simultaneously ventilated under BiFIV, using a single ventilator prototype, for each group of three animals. Physiological parameters and arterial blood gases were recorded at each study phase. All animals but one survived the experiment. We did not observe any significant differences in arterial gas exchange, under both ventilatory modes. Oxygenation was as efficient for each three animals ventilated under BiFIV, using a single ventilator device, as under conventional ventilation, using three separate ventilators (PaO2 = 112 ± 17 mmHg under conventional ventilation versus 115 ± 16 mmHg under BiFIV). In conclusion, variable time-cycled tracheal gas insufflation may allow an efficient multiple ventilation on several animals, using a single multiple output ventilatory device, in a normal lung animal model. If validated on subsequent pathological models, it could thus be interesting in laboratory and/or mass casualty situations.

ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The principles of the management of upper cervical injuries remain controversial. The specific anatomical conditions render upper cervical injuries more problematic than lower cervical injuries. Here we present and discuss our experiences with upper cervical injury, comparing them with other treatment modalities. The 24 patients admitted to our department with upper cervical injury were treated surgically or conservatively according to their neurological and radiological status. Five patients were treated surgically due to neurological abnormality associated with compression to neural structures observed in computerized tomography/magnetic resonance imaging (CT/MRI). Patients with no neural compression were managed conservatively, with the Philadelphia collar. All patients showed stable fracture healing and experienced no additional clinical disability on follow-up after a minimum of 3 months, except one who died due to cardiac and respiratory failure. Regardless of the type of injury, indication for surgery in many cases of upper cervical injury is neurological abnormality associated with radiologically observed neural compression. It is our belief that, in the absence of both neurological abnormality and compression to neural structures observed in CT/MRI, treatment with the Philadelphia collar alone is safe, cost-effective and easily applicable for many cases of upper cervical injury.

ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Survival of patients with traumatic rupture of the thoracic aorta (TRTA) depends on early surgical repair. Six cases of TRTA were treated at our institution in 7 years. Time to diagnosis was 1.5, 3, 4, 36, 91 and 140 hours (mean = 46 hours). Diagnosis was made by computed tomography in one and by angiography in five cases. Time from arrival to treatment was 3, 9, 5, 46, 117 and 152 hours (mean = 55 hours). All six patients were treated by clamp and suture technique, with a mean cross clamp time of 48 minutes. Significant delay in diagnosis and treatment occurred in three patients. The reasons for delay were unrecognized signs for TRTA on the initial chest X‐ray, a false‐negative result of transoesophageal echography and not considering the diagnosis of TRTA. The diagnosis of TRTA requires a high index of suspicion and should always be considered in victims of high impact trauma.

ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The aim of this study was to determine various times related to the ambulance activities of Ankara Emergency Aid and Rescue Services (EARS) and if necessary contribute to the improvement of them. A descriptive study was planned to determine various times related to the ambulance activities of Ankara EARS. The data was collected by one of the researchers. The study was conducted between 1 October 1995 and 30 September 1996. The variables of the study were: delay time, response time, time at the scene (scene time), round trip time, transport time and total run time of Ankara EARS ambulance activities. Ankara EARS Emergency Call Registry Forms (5638 forms) were evaluated for the above stated variables. The computer program EPI-INFO 5.0 was used in the study. The median response time of Ankara EARS was found to be 9 minutes. In the research year, the median delay time was 2 minutes. Median arrival to patient contact time of Ankara EARS was 2 minutes. Median time at the scene was 7 minutes. Median round trip time of the system was 44 minutes. The median time to arrive at the scene from the ambulance station was 8 minutes. The median transport time was 10 minutes. The median total run time was 30 minutes. As the median response time was found to be 9 minutes it is concluded that there should be more ambulance vehicles to improve this time of Ankara EARS. Due to financial problems, times were recorded manually by the ambulance crew and dispatchers of Ankara EARS. If digital and electronic recording systems are used, these times might be more precise.

ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Knife-inflicted, deeply penetrating head and neck trauma is an uncommon life-threatening injury and a challenging problem. An examination of the neurovascular and systemic physical status is a first requirement and the decision as to which approach to adopt for the removal of the blade is of critical importance. Here we report a rare case of a pre-auricular stab wound with the knife blade deeply lodged in the extracranial infratemporal fossa. Radiological investigations showed that the knife blade had entered from the temporomandibular joint and become lodged through the anterior margin of foremen magnum below the petrosal bone. Minimal left vocal cord paresis, left palatal weakness and a slight deviation of the tongue towards the left side were observed. The other neurological and systemic physical evaluations were normal. Simple withdrawal of the blade in the operating room did not cause serious neurovascular injury. Here we discuss and compare the expanded exposure of anatomical structures for blade removal and simple withdrawal in similar injuries.

ISSN:0969-9546    

出版商:OVID    

年代:2001

数据来源: OVID