ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In January 1991, an image transfer unit was developed and installed in the neurosurgical department of the University in Mainz. The system provides an image transfer of patient data via fibreoptic cable networks (VBN), ISDN, and public telephone line. In the following 4 years, 432 consultations were recorded. Nine departments were linked within this system. They provided an emergency out-patient department for primary treatment and radiology. The lack of a neurosurgical department in these clinics was made up for by the image transfer system. In these rural medical departments, tele consultation improves the care of daily routine neurosurgical cases, as well as in emergency cases. There is also a decrease of costs due to tele consultation. The image transfer via simple public telephone line was sufficient.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Verapamil overdose, because of its frequency and severity, represents a significant problem for the emergency physician. With recent search recommending specific therapies for verapamil toxicity, aids to rapid diagnosis hold promise for decreasing morbidity and mortality from overdose of all calcium channel blockers. At this time, diagnosis of verapamil toxicity depends primarily on patient history and identification of cardiac dysrhythmias. This study attempts to improve the diagnostic armamentarium available for verapamil poisoning by analysing cardiac conduction problems seen in a canine model of verapamil toxicity, with the goal of identifying clinically useful dysrhythmia patterns. In 43 verapamil-toxic animals, junctional rhythm without organized atrial activity was the most frequently identified rhythm (55.6%). The next most commonly seen rhythms were tertiary atrioventricular (AV) block (16.3%) and idioventricular rhythm (11.6%); other animals manifested low grade AV block. Of interest, prominent U waves were noted in 25.6% of animals. While these results are subject to the limitations inherent in the use of an animal model, the data generated provide potentially useful patterns of dysrhythmia which may be encountered in humans with verapamil toxicity.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This paper studies the use of an ambulance service in the case of psychiatric emergency referrals. A cross-sectional design was used to compare the patients brought in by an ambulance with all other psychiatric emergency referrals. The sociodemographic and clinical characteristics as well as the referral pattern of both groups of patients are compared. Results show that an important proportion of patients brought in by an ambulance can be described as high risk referrals. However, for another group of referrals the ambulance is used for other reasons. The possibility of using alternative social services in these cases are discussed.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The aim of this study was to observe cerebral and systemic oxygen extraction after human cardiac arrest with return of spontaneous circulation. Eight adult patients after non-traumatic, cardiac arrest were included. Cerebral and systemic oxygen extraction ratios were measured together with haemodynamic variables beginning 2 hours after cardiac arrest and every 4 hours thereafter until 24 hours. Between 2 and 12 hours after cardiac arrest cerebral oxygen extraction values ranged from very low over normal to very high. In the further course these values were reduced until 24 hours in six patients. Two patients who were still alive after 6 months, both severely mentally disabled, had a higher cerebral oxygen extraction ratios in comparison with non-survivors. Systemic oxygen extraction seemed to vary more than the cerebral oxygen extraction. The two long-term survivors had normal to supranormal values from 8 to 24 hours. In conclusion cerebral oxygen extraction was higher in long-term cardiac arrest survivors than in non-survivors between 12 and 24 hours after the event. Further, a better quality of neurological recovery was associated with higher cerebral oxygen extraction. Systemic oxygen extraction was also impaired, but to a lesser extent, especially in long-term survivors.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

It is well known that in a case of cardiac arrest a fast intervention is essential for the survival of the victim. All research on resuscitation therefore contains some reference to intervention times. In the past it was difficult to compare the results of different studies. This problem has however been overcome by the publication of the Utstein Guidelines, as these guidelines emphasize on a correct and complete time registration with uniform definitions of the different time intervals. As the Belgian Cardio-Pulmonary-Cerebral Resuscitation Study Group tries to collect all these time intervals we are able to present the complete performance of the interventions for cardiac arrest of five registration centres and to identify weak points in our &chain of survival&.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This paper describes the rate of re-admission and the characteristics of patients who were readmitted after having been discharged directly from the emergency department at Sahlgrenska Hospital when they presented with acute chest pain or other symptoms suggestive of acute myocardial infarction. A total of 1463 patients were admitted and directly discharged during the 15 month recruitment period, of whom 222 (15%) were re-admitted at least once and 72 (5%) were re-admitted more than once during the subsequent 6 to 21 months. However, among patients not being re-admitted, 63% reported recurrency of symptoms one year after discharge. Re-admitted patients differed from those who were not re-admitted by: being older (p <0.001); they more frequently had a history of cardiovascular diseases (p <0.001); they more frequently had a pathological electrocardiogram (p <0.001); and they were more frequently judged to have angina pectoris (p <0.001). Among re-admitted patients, about half were hospitalized but only 10% developed AMI. In conclusion, among patients who were discharged directly from the emergency department with acute chest pain, 15% were re-admitted with similar symptoms only. A minority, however, developed acute myocardial infarction. A high proportion of patients not being re-admitted had recurrency of symptoms.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

To evaluate the symptoms, the associated lesions, the treatment and the outcome of patients with blunt carotid injury (BCD, we reviewed the records of all patients admitted to our intensive care unit with head trauma between May 1991 and May 1995. A patient's assessment included the commonly used severity scores and cranial computed tomography (CT). Other diagnostic investigations were performed according to the clinical setting. Four patients (2 males, 2 females, age 29±13 years) out of 145 were diagnosed to have BCI. At admission, the Glasgow Coma Scale (GCS) was s 12 in all patients, and was associated with hemiparesis in three of them; the fourth became paretic 48 hours later. No pathological elements were demonstrated at the initial CT scan, whilst subsequent examinations showed signs of ischaemia after a variable interval from admission. In every patient the radiologic investigations demonstrated a thrombotic obstruction of the internal carotid artery (ICA), associated with an intimal dissection in two cases. Three patients were discharged with only minor neurologic symptoms. The fourth patient was referred to our ICU after the development of a massive hemispheric infarction, and died 3 days after admission.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A survey of patients with maxillofacial injuries (MFI) was carried out in a triaged cohort of multiply injured patients (n =802) evacuated from accident scenes by the helicopter emergency medical service (HEMS). Despite intubation at accident scenes, some patients required further airway protection on arrival at hospital. One hundred and ninety-six patients (24.5%) had Mil and 90 (11.2%) were classified as severe with ISS of facial region >2 or more severe (ISS up to 16, median 4). The latter group were commonly found to be associated with other severe injuries (median ISS of 36) leading to death in 41 patients (5.1% of the total). Out of the 196 multiply injured patients with MFI, 57 (29%) had diagnostic peritoneal lavage for suspected haemorrhage, 27 (14%) subsequently underwent laparotomy. Six (3%) had thoracotomies and 29 (15%) had chest drains inserted. Seventeen (9%) had emergency craniotomies and 14 (7%) required intracranial pressure monitoring. Orthopaedic injuries were most commonly associated with MFI and 91 patients (46%) underwent surgical interventions. The purpose of the present study was primarily to establish a database for MFI patients with multiple injuries. The longer term objective being to gain evidence for early definitive management of these complicated cases rather than the more traditional expectant policies. In our view delayed management of MFI can rarely correct all the consequent facial deformities.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In an open study relating psychiatric emergencies in a general hospital, the authors observe that only in 30% of cases does the reason for emergency referral of patients by their general practitioner involve the concept of danger. In view of the results of this study, it would seem beneficial, if one wishes to reduce the number of psychiatric admissions, to improve the training of general practitioners in general psychiatry and in the treatment of mood disorders in particular.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID