摘要:

This retrospective study was conducted to evaluate whether an observation unit (OU) attached to the emergency department (ED) of a tertiary care hospital in India is safe, is effective in minimizing hospitalization of acutely ill patients and is acceptable to the patients. Of 115 916 patients who attended the ED, 11130 (9.6%) were observed in the OU. The average period of observation was 7.74 h. Of the patients observed, 21.3% required hospitalization, while 78.5% were discharged after treatment. Twenty-four patients left the hospital against medical advice, and three patients died in the OU. It is concluded that an OU in the ED is safe in treating acutely ill patients, is effective in reducing substantially the number of patients requiring admission to the hospital, and is acceptable to the patients.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

All prehospital resuscitations performed by emergency physicians in the city of Bochum, Germany, were recorded and evaluated prospectively from 1 August 1989 to 30 September 1990. Initially successful cardiopulmonary resuscitation (CPR) was achieved in 33.8% (alive at admission), and definitive success in 10.4% (discharged alive). Of the patients who presented with cardiac arrest before the arrival of the emergency physician, 28.4% could be resuscitated initially and 7.6% survived definitively. In patients who suffered circulatory arrest on or after the arrival of the emergency physician, the initial success rate of CPR was 51.7%, and the definitive success rate 11.1%. Although the initial success rate was significantly more favourable, the definitive outcome did not differ statistically between these two.groups. Two time periods were compared. During the first period of 5 months only one base with two ambulances staffed with emergency physicians was available. During the second period of 9 months an additional base with a physician-staffed ambulance was established. This reorganization resulted in the reduced call to arrival time falling from 8.5 ± 2.4 min to 7.6 ± 2.4 min (univariate variance analysis:f=8.89, d.f.=1.31,p<0.01). This decrease, however did not improve either the initial or the definitive success of CPR. From these results we conclude that further improvement of prehospital resuscitation can only be achieved to a small extent by reducing the call to arrival time of ambulances staffed with emergency physicians. Improvement is more likely to be seen when immediate resuscitation is performed by bystanders present at the scene.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The role of barbiturate therapy in the development of pneumonia in head trauma patients in the intensive care unit of a university hospital was studied retrospectively. A total of 151 ventilated head trauma patients were included in the study. Intravenous thiopentone was administered to 75 patients (Group A), and 76 patients were managed without thiopentone therapy (Group B). Pneumonia was diagnosed when a new persistent pulmonary infiltrate appeared, with at least two of the following: (a) fever greater than 38°C, (b) a white blood cell count greater than 15 000/mm3, or (c) the presence of purulent bronchial secretions. On admission, there were no differences in the acute physiology and chronic health evaluation 2 revision (APACHE II) and Glasgow Coma Score between Groups A and B. Fifty-three per cent of the patients treated with thiopentone (Group A) developed pneumonia compared with 35% in Group B (odds ratio 1.85, 95% confidence interval 0.97-3.51). Gram-negative and Staphylococcus aureus organisms were the most frequently isolated in all cases. No differences in age, sex, APACHE II, Glasgow Coma Score, nutritional status or dexamethasone treatment were observed between the groups with and without pulmonary infection. In the multivariate analysis, prolonged mechanical ventilation before pneumonia and thiopentone treatment remained as the only independent risk factors for the appearance of pneumonia in head trauma patients (p=0.001 for both). Nevertheless, thiopentone did not increase the rate of mortality in patients with pneumonia. In conclusion, head trauma victims treated with thiopentone have a greater risk for the development of nosocomial pneumonia independent of mechanical ventilation.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The outcome of out-of-hospital cardiac arrest is very much determined by uncontrollable precardiopulmonary resuscitation (CPR) conditions. Two consecutively registered databases containing variables related to pre-arrest, arrest and CPR are similarly analysed to produce and validate a simple clinical algorithm for acute decision making during CPR. The outcome results in the two different time periods remained nearly unchanged. The simultaneous and persistent absence of ventricular fibrillation, gasping and light-reactive pupils after arrival of the second tier was strongly associated with a poor outcome. Unresponsiveness of these variables to a full and optimal trial of advanced life support can in itself be considered as an index for irreversible myocardial and neurological damage.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Thirteen patients resuscitated after circulatory arrest due to cardiopulmonary aetiologies were studied with regard to survival and outcome. Exclusion criteria were known central nervous system disorders or death secondary to cerebrovascular accident. The serum level of neuronspecific enolase (NSE), presumably a reliable marker of neuronal death, was measured by enzyme immunoassay in peripheral blood samples over the course of 4 days at 12 h intervals. On the first and third day post-resuscitation, median nerve somatosensory evoked potentials (SSEPs) were recorded and evaluated for the absence of the cortical potential - presently the standard approach for assessing prognosis in terms of post-resuscitation hypoxaemic brain damage. Absent cortical potentials were found in six patients with NSE levels above 140 µg I-1. Five of these patients died; one patient survived with loss of cortical functioning. Five patients had normal SSEP findings, and their NSE maximum levels were below 25µgl-1. All five patients survived without neurological deficits. One patient with a peak NSE level of 36 µg1-1on the second day developed a prolonged delirium (according to DSM III-R criteria) and one patient with a peak level of 76 µg I-1on the fourth day developed an acute respiratory distress syndrome; both patients had preserved cortical potentials. In conclusion, pathological SSEPs and increased NSE levels are of comparable prognostic value. They may well be complementary investigations. The neuron-bound enzyme NSE is a biochemical marker which varies with the extent of neuronal damage, while absence of the cortical potentials may indicate neurophysiological loss of function.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Hypothermia is a frequent event in trauma patients and appears to be related to post-traumatic organ dysfunction, although in elective surgery hypothermia is known to prevent ischaemia reperfusion injury. Retrospectively we have analysed data from 641 trauma patients treated in our institution between 1988 and 1993. On admission to hospital the core temperature (cT) was>34°]C in the majority (64%) of patients, followed by 23.6% with a cT<34°C and 12.4% with a cT<32°C. After 24 h 99% were warmed up to<34°C. Mortality was twice as high (53%) in patients with a cT<32°C compared with patients with a cT<34°C (28%). Analysis of correlations revealed that hypothermia was associated with a longer rescue time, more severe injuries of the limbs and central hypoxia. It also showed that hypothermia is not an independent prognostic factor for post-traumatic mortality. The different effect of hypothermia in trauma compared with elective surgery may be due to a lack of energy-storing phosphates like adenosine triphosphate (ATP). Further current investigations will identify the role of ATP in trauma-related hypothermia.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Multimodality evoked potentials (EPs), linear electroencephalograms and Glasgow Coma Scale (GCS) scores were recorded within 24 h of cardiac arrest in 62 patients who were comatose following cardiopulmonary resuscitation. The cardiac arrest had a cardiac cause in 35 patients and a non-cardiac cause in 27 patients. The Glasgow Outcome Scale (GOS) scores were established 6 months after resuscitation. The prognostic value of all the recorded variables was calculated in terms of sensitivity, specificity and accuracy. Spearman's rank test was also used for the determination of the correlation coefficients with GOS. EP recordings furnished no falsely pessimistic predictions, with a specificity of 100%. In other words, when EPs were altered, the prognosis was always poor. However, while all patients who regained consciousness had normal EPs, not all patients in whom EPs were recordable survived. The GCS score showed a higher sensitivity and correlation with GOS score than EPs, but it was associated with a high percentage of false positive results, and its specificity was only 67%. The combination of the GCS score with EPs may be a promising strategy to counterbalance the respective limits of these methods and to reduce the loss of information due to sedation and myorelaxation, which impede clinical examination but not EP results.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study was initiated to identify the incidence, risk factors and outcome predictors of patients admitted to hospital in the Netherlands because of accidental hypothermia. Information about these patients was available for study through the National Health Care Data Bank. Between 1987 and 1990, 612 accidental hypothermic patients were admitted: 185 hypothermic patients also suffered from submersion (HYPSUBS), but this was not the case in the remaining 427 patients (HYPNOTSUBS). Patients in the HYPNOTSUBS group were older (average age 55.2 years versus 38.9 years;p<0.001), remained longer in hospital (average 20.8 days versus 9.2 days;p<0.001) and had a higher death rate than those in the HYPSUBS group (16.9% versus 5.9%;p<0.001). In HYPNOTSUBS, increasing age correlated with increases in the length of hospital stay and death rate. This relationship was not found in HYPSUBS. Trauma was the major associated problem in both groups; these patients had the highest death rate (22.8% versus 16.7%; not significant). Death occurred within 2 days in 54% of HYPNOTSUBS nonsurvivors and 73% of HYPSUB non-survivors. HYPNOTSUBS admitted to university hospitals showed a lower death rate (5.9%) compared with HYPNOTSUBS admitted to non-university hospitals with less than 400 beds (13.4%) or more than 400 beds (21.7%). In contrast, the death rate in HYPSUB was higher in university hospitals (14.3%) than in non-university hospitals with less than 400 beds (5.2%) or more than 400 beds (3.6%). We observed that the incidence of accidental hypothermia is low at 1.1 per 100 000 inhabitants per year. We concluded that HYPNOTSUBS and HYPSUB are different groups of patients with respect to demographic data, risk factors and prognostic factors. Old age is an important unfavourable prognostic factor in HYPNOTSUB but not in HYPSUB. Hypothermia with trauma is an unfavourable combination in both groups. Almost half of the HYPNOTSUBS non-survivors died after more than 2 days. Because body temperature will have returned to normal by then, this must be the result of late complications. Most HYPSUB non-survivors died during the first 2 days, probably as a direct result of the submersion injury.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

During the last two decades the reported risk of overwhelming postsplenectomy infection (OPSI) has resulted in a conservative approach to splenic trauma, with the aim of splenic salvage. The appropriateness of this strategy is now questioned. The risk of OPSI varies with age and indication for splenectomy from less than 1% in adults to more than 4% in children. Pneumococcus is the causative agent in about 60% of cases. A prerequisite for splenic preservation procedures should be a haemodynamically stable patient without other intraabdominal injuries. The benefits derived from non-operative treatment of splenic salvage procedures may be overshadowed by the potential risk of transfusion-related bacterial and viral diseases. Polyvalent pneumococcal vaccines given early after splenectomy appear to reduce the incidence of OPSI substantially.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This paper reports on a fatal intoxication by oral ingestion of the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D). At admission, the victim was unconscious. His condition detonated rapidly with blood loss from his mouth and nose. Since the cause of this condition was not known, gastroscopy was performed and haemorrhagic mucosa was observed in the mouth, oesophagus and stomach. Gastric contents (removed by lavage), urine and blood were submitted for toxicological analysis. Unfortunately, within 3 h of admission (about 5 h following ingestion of the toxin) profound cardiogenic shock developed and the patient died. The identity of the toxic xenobiotic was revealed by gas chromatography-mass spectrometry. Analytical quantification of the herbicide was performed by acid extraction prior to gas chromatographic examination using electron capture detection. His blood level of 2,4-D was 192 mg I-1.

ISSN:0969-9546    

出版商:OVID    

年代:1995

数据来源: OVID