EMresearch.ch

Schaller, B. B., Exadaktylos, A. K., Andres, R. H., and Bonel, H. M. “A New Full Body Low-Dose X-Ray Technique Is An Alternative To Conventional "Shunt Series" In Patients With Ventriculoperitoneal Shunt Dysfunction”. Am J Emerg Med 25, no. 6: 702-3. doi:10.1016/j.ajem.2007.03.009.

Tags: *Ventriculoperitoneal Shunt, Humans, Hydrocephalus/therapy, Radiation Dosage, Radiography/*methods.

Schwarz, N., Nohl, F., Dang, L., Hohl, U., Mattle, H. P., von Bredow, F., and Schiemann, U. “[Acute Headache In A Case Of Cerebral Cavernomas]”. Praxis (Bern 1994) 96, no. 19: 775-8. doi:10.1024/1661-8157.96.19.775.

Abstract: We report a case of a 52-year-old female patient with known cerebral cavernomas and acute headache. A cranial CT scan excluded an intracranial bleeding. Cavernomas are rare vascular malformations of the venous blood system (synon. cavernous angiomas) with a slow blood flow. Clinical manifestation is presented between an age of 30-50 years with mostly unspecific neurological symptoms like headache, nausea, vomiting and dizziness, but also epileptic seizures and bleedings may occur. In general, therapy is symptomatic. In cases of seizures, however, anticonvulsive treatment is indicated. Operation can be discussed for peripheral localized cavernomas with bleeding or for refractory seizures. If antiplatelet or anticoagulation therapy is necessary due to other diseases (coronary heart disease, atrial fibrillation, thrombosis, pulmonary embolism), cerebral cavernomas are not considered as an absolute contraindication. The risk for an ischemic stroke under atrial fibrillation (5-20%), for example, is higher than the risk for bleeding of a cerebral cavernoma under anticoagulation therapy.

Tags: Acute Disease, Brain Neoplasms/*diagnosis, Brain/pathology, Diagnosis, Differential, Emergency Service, Hospital, Female, Headache/*etiology, Hemangioma, Cavernous/*diagnosis, Humans, Magnetic Resonance Imaging, Meningeal Neoplasms/*diagnosis, Meningioma/*diagnosis, Middle Aged, Migraine Disorders/diagnosis, Neoplasms, Multiple Primary/*diagnosis, Switzerland, Tension-Type Headache/diagnosis.

Franz, T., Hasler, R. M., Benneker, L., Zimmermann, H., Siebenrock, K. A., and Exadaktylos, A. K. “Severe Spinal Injuries In Alpine Skiing And Snowboarding: A 6-Year Review Of A Tertiary Trauma Centre For The Bernese Alps Ski Resorts, Switzerland”. Br J Sports Med 42, no. 1: 55-8. doi:10.1136/bjsm.2007.038166.

Abstract: OBJECTIVE: To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe spinal injuries related to alpine skiing and snowboarding. STUDY DESIGN: A six-year review of all adult patients with severe spinal injuries sustained from alpine skiing or snowboarding. SETTING: Tertiary trauma centre in Bern, Switzerland. PATIENTS AND METHODS: All adult patients (over 16 years of age) admitted to a tertiary trauma centre from 1 July 2000, through 30 June 2006, were reviewed using a computerised database. From these records, a total of 728 patients injured from snow sports were identified. Severe spinal injuries (defined as spinal fractures, subluxations, dislocations or concomitant spinal cord injuries) were found in 73 patients (17 female, 56 male). The clinical features of these patients were reviewed with respect to epidemiological factors, mechanism of injury, fracture pattern, and neurological status. RESULTS: The majority of severe spinal injuries (n = 63) were related to skiing. Fatal central-nervous injuries and transient or persistent neurological symptoms occurred in 28 patients (23 skiers, 5 snowboarders). None of the snowboarders suffered from persistent neurological sequelae. Snowboarders with severe spinal injuries (n = 10) were all male (p<0.05), and were significantly younger than skiers (p<0.001). The most commonly affected site was the lumbar spine. However, 39 patients (53.4%) suffered from injury pattern at two or more levels. CONCLUSIONS: With advances in technology and slope maintenance, skiers and snowboarders progress to higher skill levels and faster speeds more rapidly than ever before. Great efforts have been focused on reducing extremity injuries in snow sports, but until recently very little attention has been given to spinal injury prevention on the slopes. Suggestions for injury prevention include the use of spine protectors, participation on appropriate runs for ability level, proper fit and adjustment of equipment, and taking lessons with the goal of increasing ability and learning hill etiquette.

Tags: Accident Prevention/methods, Adolescent, Adult, Age Factors, Aged, Female, Humans, Injury Severity Score, Male, Middle Aged, Protective Devices, Retrospective Studies, Risk Factors, Sex Factors, Skiing/*injuries, Spinal Injuries/*epidemiology/prevention & control, Switzerland/epidemiology.

Daeppen, J. B., Gaume, J., Bady, P., Yersin, B., Calmes, J. M., Givel, J. C., and Gmel, G. “Brief Alcohol Intervention And Alcohol Assessment Do Not Influence Alcohol Use In Injured Patients Treated In The Emergency Department: A Randomized Controlled Clinical Trial”. Addiction 102, no. 8: 1224-33. doi:10.1111/j.1360-0443.2007.01869.x.

Abstract: AIMS: To evaluate the effectiveness of brief alcohol intervention (BAI) in reducing alcohol use among hazardous drinkers treated in the emergency department (ED) after an injury; in addition it tests whether assessment of alcohol use without BAI is sufficient to reduce hazardous drinking. DESIGN: Randomized controlled clinical trial with 12-month follow-up conducted between January 2003 and June 2005. SETTING: Urban academic emergency department (ED) of the Lausanne University Hospital, Lausanne, Switzerland. PARTICIPANTS: A total of 5136 consecutive patients attending ED after an injury completed a seven-item general and a three-item alcohol screen and 1472 (28.7%) were positive for hazardous drinking according to the National Institute on Alcohol Abuse and Addiction definition; of these 987 (67.1%) were randomized into a BAI group (n = 310) or a control group with screening and assessment (n = 342) or a control group with screening only (n = 335) and then a total of 770 patients (78.0%) completed the 12-month follow-up procedures. INTERVENTION: A single 10-15-minute session of standardized BAI conducted by a trained research assistant. MEASUREMENTS: Percentage of participants who have changed to low-risk drinking at follow-up. FINDINGS: Data obtained at 12 months indicated that similar proportions were low-risk drinkers in BAI versus control groups with and without assessment (35.6%, 34.0%, 37.0%, respectively, P = 0.71). Data also indicated similar reductions in drinking frequency, quantity, binge drinking frequency and Alcohol Use Disorders Identification Test (AUDIT) scores across groups. All groups reported similar numbers of days hospitalized and numbers of medical consults in the last 12 months. A model including age groups, gender, AUDIT and injury severity scores indicated that BAI had no influence on the main alcohol use outcome. CONCLUSIONS: This study provides the evidence that a 10-15-minute BAI does not decrease alcohol use and health resource utilization in hazardous drinkers treated in the ED, and demonstrates that commonly found decreases in hazardous alcohol use in control groups cannot be attributed to the baseline alcohol assessment.

Tags: Adolescent, Adult, Age Factors, Aged, Alcohol Drinking/adverse effects/epidemiology/*prevention & control, Emergency Service, Hospital, Female, Follow-Up Studies, Humans, Interviews as Topic/*methods, Male, Middle Aged, Switzerland/epidemiology, Wounds and Injuries/epidemiology/etiology/*prevention & control.

Tamches, E., Buclin, T., Hugli, O., Decosterd, I., Blanc, C., Mouhsine, E., Givel, J. C., and Yersin, B. “Acute Pain In Adults Admitted To The Emergency Room: Development And Implementation Of Abbreviated Guidelines”. Swiss Med Wkly 137, no. 15-16: 223-7. doi:10.4414/smw.2007.11663.

Abstract: AIM: Although acute pain is frequently reported by patients admitted to the emergency room, it is often insufficiently evaluated by physicians and is thus undertreated. With the aim of improving the care of adult patients with acute pain, we developed and implemented abbreviated clinical practice guidelines (CG) for the staff of nurses and physicians in our hospital's emergency room. METHODS: Our algorithm is based upon the practices described in the international literature and uses a simultaneous approach of treating acute pain in a rapid and efficacious manner along with diagnostic and therapeutic procedures. RESULTS: Pain was assessed using either a visual analogue scale (VAS) or a numerical rating scale (NRS) at ER admission and again during the hospital stay. Patients were treated with paracetamol and/or NSAID (VAS/NRS <4) or intravenous morphine (VAS/NRS > or =04). The algorithm also outlines a specific approach for patients with headaches to minimise the risks inherent to a non-specific treatment. In addition, our algorithm addresses the treatment of paroxysmal pain in patients with chronic pain as well as acute pain in drug addicts. It also outlines measures for pain prevention prior to minor diagnostic or therapeutic procedures. CONCLUSIONS: Based on published guidelines, an abbreviated clinical algorithm (AA) was developed and its simple format permitted a widespread implementation. In contrast to international guidelines, our algorithm favours giving nursing staff responsibility for decision making aspects of pain assessment and treatment in emergency room patients.

Tags: *Algorithms, *Decision Trees, *Emergency Service, Hospital, Acetaminophen/therapeutic use, Acute Disease, Analgesics, Non-Narcotic/therapeutic use, Analgesics, Opioid/therapeutic use, Humans, Morphine/therapeutic use, Pain Measurement, Pain/*drug therapy, Practice Guidelines as Topic, Substance-Related Disorders/diagnosis, Switzerland.

Maile, S., and Slongo, T. “Atlantoaxial Rotatory Subluxation: Realignment And Discharge Within 48 H”. Eur J Emerg Med 14, no. 3: 167-9. doi:10.1097/MEJ.0b013e328014081c.

Abstract: Atlantoaxial rotatory fixation is a rare disorder in which the atlas gets fixed in a position normally achieved during rotation. Patients present with painful torticollis and a typical 'cock robin' position of the head: rotation, slight flexion and head tilting contralateral to the direction of rotation. During childhood, laxity of the ligamentous apparatus and joint cups allows a wider range of motion and rotation within these joints. Traumatic effects contribute to subluxation at relevant degree (Fiedling type 2 and higher) for which skeletal traction is necessary. Duration of skeletal traction can be reduced to a minimum (24 h), as seen in this patient, when diagnosis is set as early as possible.

Tags: Atlanto-Axial Joint/diagnostic imaging/*injuries, Child, Preschool, Humans, Joint Dislocations/*diagnostic imaging/therapy, Male, Spinal Injuries/*diagnostic imaging/therapy, Time Factors, Tomography, Spiral Computed, Torticollis/*diagnostic imaging/therapy, Traction.

Decosterd, I., Hugli, O., Tamches, E., Blanc, C., Mouhsine, E., Givel, J. C., Yersin, B., and Buclin, T. “Oligoanalgesia In The Emergency Department: Short-Term Beneficial Effects Of An Education Program On Acute Pain”. Ann Emerg Med 50, no. 4: 462-71. doi:10.1016/j.annemergmed.2007.01.019.

Abstract: STUDY OBJECTIVE: Acute pain is the most frequent complaint in emergency department (ED) admissions, but its management is often neglected, placing patients at risk of oligoanalgesia. We evaluate the effect of the implementation of guidelines for pain management in ED patients with pain at admission or anytime during their stay in our ED. METHODS: This prospective pre-post intervention cohort study included data collection both before and after guideline implementation. Consecutive adult patients admitted with acute pain from any cause or with pain at any time after admission were enrolled. The quality of pain management was evaluated according to information in the ED medical records by using a standardized collection form, and its impact on patients was recorded with a questionnaire at discharge. RESULTS: Two hundred forty-nine and 192 patients were included during pre- and postintervention periods. Pain was documented in 61% and 76% of nurse and physician notes, respectively, versus 78% and 85% after the intervention (difference 17%/9%; 95% confidence interval [CI] 8% to 26%/2% to 17%, respectively). Administration of analgesia increased from 40% to 63% (difference 23%; 95% CI 13% to 32%) and of morphine from 10% to 27% (difference 17%; 95% CI 10% to 24%). Mean doses of intravenous morphine increased from 2.4 mg (95% CI 1.9 to 2.9 mg) to 4.6 mg (95% CI 3.9 to 5.3 mg); administration of nonsteroidal antiinflammatory drugs and acetaminophen increased as well. There was a greater reduction of visual analogue scale score after intervention: 2.1 cm (95% CI 1.7 to 2.4 cm) versus 2.9 cm (95% CI 2.5 to 3.3 cm), which was associated with improved patient satisfaction. CONCLUSION: Education program and guidelines implementation for pain management lead to improved pain management, analgesia, and patient satisfaction in the ED.

Tags: *Education, Medical, Continuing, *Guideline Adherence, Acute Disease, Adult, Analgesia/standards/*statistics & numerical data, Data Collection, Emergency Service, Hospital, Hospitals, Teaching, Humans, Pain/*drug therapy, Patient Satisfaction, Practice Guidelines as Topic, Prospective Studies, Switzerland.

Henning, P., Brenner, B., Brunner, K., and Zimmermann, H. “Hemodynamic Instability Following An Avulsion Of The Corona Mortis Artery Secondary To A Benign Pubic Ramus Fracture”. J Trauma 62, no. 6: E14-7. doi:10.1097/01.ta.0000210355.44804.24.

Tags: *Embolization, Therapeutic, Aged, 80 and over, Arteries/*injuries, Female, Fractures, Bone/*complications/physiopathology, Hemorrhage/etiology/physiopathology/*therapy, Humans, Pubic Bone/*injuries.

Grosse, A. B., Grosse, C. A., Steinbach, L. S., Zimmermann, H., and Anderson, S. “Imaging Findings Of Avalanche Victims”. Skeletal Radiol 36, no. 6: 515-21. doi:10.1007/s00256-006-0259-1.

Abstract: OBJECTIVE: Skiing and hiking outside the boundaries remains an attractive wilderness activity despite the danger of avalanches. Avalanches occur on a relatively frequent basis and may be devastating. Musculoskeletal radiologists should be acquainted with these injuries. DESIGN AND PATIENTS: Fourteen avalanche victims (11 men and 3 women; age range 17-59 years, mean age 37.4 years) were air transported to a high-grade trauma centre over a period of 2 years. RESULTS: Radiographs, CT and MR images were prospectively evaluated by two observers in consensus. Musculoskeletal findings (61%) were more frequent than extraskeletal findings (39%). Fractures were most commonly seen (36.6%), involving the spine (14.6%) more frequently than the extremities (9.8%). Blunt abdominal and thoracic trauma were the most frequent extraskeletal findings. CONCLUSION: A wide spectrum of injuries can be found in avalanche victims, ranging from extremity fractures to massive polytrauma. Asphyxia remains the main cause of death along with hypoxic brain injury and hypothermia.

Tags: *Disasters, *Mountaineering, *Snow, Adolescent, Adult, Diagnosis, Differential, Female, Humans, Injury Severity Score, Magnetic Resonance Imaging, Male, Middle Aged, Prospective Studies, Switzerland, Tomography, X-Ray Computed, Wounds and Injuries/*diagnosis.

Mettler, J., Simcock, M., Sendi, P., Widmer, A. F., Bingisser, R., Battegay, M., Fluckiger, U., and Bassetti, S. “Empirical Use Of Antibiotics And Adjustment Of Empirical Antibiotic Therapies In A University Hospital: A Prospective Observational Study”. Bmc Infect Dis 7: 21. doi:10.1186/1471-2334-7-21.

Abstract: BACKGROUND: Several strategies to optimise the use of antibiotics have been developed. Most of these interventions can be classified as educational or restrictive. Restrictive measures are considered to be more effective, but the enforcement of these measures may be difficult and lead to conflicts with prescribers. Any intervention should be aimed at targets with the highest impact on antibiotic prescribing. The aim of the present study was to assess the adequacy of empirical and adjusted antibiotic therapies in a Swiss university hospital where no antibiotic use restrictions are enforced, and to identify risk factors for inadequate treatment and targets for intervention. METHODS: A prospective observational study was performed during 9 months. All patients admitted through the emergency department who received an antibiotic therapy within 24 hours of admission were included. Data on demographic characteristics, diagnoses, comorbidities, systemic inflammatory response syndrome (SIRS) parameters, microbiological tests, and administered antibiotics were collected prospectively. Antibiotic therapy was considered adequate if spectrum, dose, application modus, and duration of therapy were appropriate according to local recommendations or published guidelines. RESULTS: 2943 admitted patients were evaluated. Of these, 572 (19.4%) received antibiotics within 24 hours and 539 (94%) were analysed in detail. Empirical antibiotic therapy was inadequate in 121 patients (22%). Initial therapy was adjusted in 168 patients (31%). This adjusted antibiotic therapy was inadequate in 46 patients (27%). The main reason for inadequacy was the use of antibiotics with unnecessarily broad spectrum (24% of inadequate empirical, and 52% of inadequate adjusted therapies). In 26% of patients with inadequate adjusted therapy, antibiotics used were either ineffective against isolated pathogenic bacteria or antibiotic therapy was continued despite negative results of microbiological investigations. CONCLUSION: The rate of inadequate antibiotic therapies was similar to the rates reported from other institutions despite the absence of a restrictive antibiotic policy. Surprisingly, adjusted antibiotic therapies were more frequently inappropriate than empirical therapies. Interventions aiming at improving antibiotic prescribing should focus on both initial empirical therapy and streamlining and adjustment of therapy once microbiological results become available.

Tags: Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents/*administration & dosage, Bacterial Infections/drug therapy/microbiology, Drug Therapy/methods/standards/statistics & numerical data, Female, Guideline Adherence, Hospitals, University, Humans, Male, Middle Aged, Observation, Prospective Studies, Risk Factors.

Benneker, L. M., Bonel, H. M., Zumstein, M. A., and Exadaktylos, A. K. “A Novel Multiple-Trauma Ct-Scanning Protocol Using Patient Repositioning May Increase Risks Of Iatrogenic Injuries”. Emerg Radiol 13, no. 6: 349-51; author reply 353. doi:10.1007/s10140-007-0577-1.

Tags: Accidental Falls, Adult, Brachial Plexus/*diagnostic imaging/*injuries, Diagnostic Errors, Emergency Medical Services, Female, Humans, Iatrogenic Disease, Multiple Trauma/*diagnostic imaging, Posture, Tomography, X-Ray Computed/*adverse effects.

Muller, B., Harbarth, S., Stolz, D., Bingisser, R., Mueller, C., Leuppi, J., Nusbaumer, C., Tamm, M., and Christ-Crain, M. “Diagnostic And Prognostic Accuracy Of Clinical And Laboratory Parameters In Community-Acquired Pneumonia”. Bmc Infect Dis 7: 10. doi:10.1186/1471-2334-7-10.

Abstract: BACKGROUND: Community-acquired pneumonia (CAP) is the most frequent infection-related cause of death. The reference standard to diagnose CAP is a new infiltrate on chest radiograph in the presence of recently acquired respiratory signs and symptoms. This study aims to evaluate the diagnostic and prognostic accuracy of clinical signs and symptoms and laboratory biomarkers for CAP. METHODS: 545 patients with suspected lower respiratory tract infection, admitted to the emergency department of a university hospital were included in a pre-planned post-hoc analysis of two controlled intervention trials. Baseline assessment included history, clinical examination, radiography and measurements of procalcitonin (PCT), highly sensitive C-reactive protein (hsCRP) and leukocyte count. RESULTS: Of the 545 patients, 373 had CAP, 132 other respiratory tract infections, and 40 other final diagnoses. The AUC of a clinical model including standard clinical signs and symptoms (i.e. fever, cough, sputum production, abnormal chest auscultation and dyspnea) to diagnose CAP was 0.79 [95% CI, 0.75-0.83]. This AUC was significantly improved by including PCT and hsCRP (0.92 [0.89-0.94]; p < 0.001). PCT had a higher diagnostic accuracy (AUC, 0.88 [0.84-0.93]) in differentiating CAP from other diagnoses, as compared to hsCRP (AUC, 0.76 [0.69-0.83]; p < 0.001) and total leukocyte count (AUC, 0.69 [0.62-0.77]; p < 0.001). To predict bacteremia, PCT had a higher AUC (0.85 [0.80-0.91]) as compared to hsCRP (p = 0.01), leukocyte count (p = 0.002) and elevated body temperature (p < 0.001). PCT, in contrast to hsCRP and leukocyte count, increased with increasing severity of CAP, as assessed by the pneumonia severity index (p < 0.001). CONCLUSION: PCT, and to a lesser degree hsCRP, improve the accuracy of currently recommended approaches for the diagnosis of CAP, thereby complementing clinical signs and symptoms. PCT is useful in the severity assessment of CAP.

Tags: *Cause of Death, Adult, Aged, Analysis of Variance, Biomarkers/analysis, C-Reactive Protein/*analysis, Calcitonin Gene-Related Peptide, Calcitonin/*blood, Cohort Studies, Community-Acquired Infections/diagnosis/mortality/therapy, Diagnostic Tests, Routine, Early Diagnosis, Female, Health Care Surveys, Humans, Leukocyte Count, Male, Medical Records, Middle Aged, Pneumonia, Bacterial/*diagnosis/*mortality/therapy, Prognosis, Protein Precursors/*blood, Radiography, Thoracic, Respiratory Tract Infections/diagnosis/mortality/therapy, Risk Assessment, ROC Curve, Statistics, Nonparametric, Survival Analysis, Switzerland.

Katz, E., Metzger, J. T., Sierro, C., Mischler, C., Fishman, D., and Kappenberg, L. “[Sudden Cardiac Death: Epidemiology And Modern Therapy]”. Rev Med Suisse 3, no. 96: 302-7. https://www.ncbi.nlm.nih.gov/pubmed/17319402.

Abstract: Sudden Cardiac Death (SCD) has become an important public health challenge in the Western World. In Switzerland near 10,000 people suffer each year from SCD. The survival from SCD to hospital discharge is discouraging (near 5%). Large majority of events occur unexpectedly in the out-of-hospital environment and are not predicted with great accuracy by risk profiling. Because the majority of SCD occur by the mechanism of ventricular fibrillation, community-based defibrillation strategies have emerged as one approach to SCD problem. Newer strategies of defibrillation designed to respond faster to out-of-hospital cardiac arrest, including public access defibrillation, as well as aggressive primary and secondary prevention of coronary artery disease appears as the best approach for successful management of SCD.

Tags: Death, Sudden, Cardiac/*epidemiology/etiology/prevention & control, Defibrillators, Humans, Public Health, Risk Factors.

Russmann, S., Dowlatshahi, E. A., Printzen, G., Habicht, S., Reichen, J., and Zimmermann, H. “Prevalence And Associated Factors Of Viral Hepatitis And Transferrin Elevations In 5036 Patients Admitted To The Emergency Room Of A Swiss University Hospital: Cross-Sectional Study”. Bmc Gastroenterol 7: 5. doi:10.1186/1471-230X-7-5.

Abstract: BACKGROUND: The epidemiology of liver disease in patients admitted to emergency rooms is largely unknown. The current study aimed to measure the prevalence of viral hepatitis B and C infection and pathological laboratory values of liver disease in such a population, and to study factors associated with these measurements. METHODS: Cross-sectional study in patients admitted to the emergency room of a university hospital. No formal exclusion criteria. Determination of anti-HBs, anti-HCV, transferrin saturation, alanine aminotransferase, and obtaining answers from a study-specific questionnaire. RESULTS: The study included 5'036 patients, representing a 14.9% sample of the target population during the study period. Prevalence of anti-HBc and anti-HCV was 6.7% (95%CI 6.0% to 7.4%) and 2.7% (2.3% to 3.2%), respectively. Factors independently associated with positive anti-HBc were intravenous drug abuse (OR 18.3; 11.3 to 29.7), foreign country of birth (3.4; 2.6 to 4.4), non-white ethnicity (2.7; 1.9 to 3.8) and age > or =60 (2.0; 1.5 to 2.8). Positive anti-HCV was associated with intravenous drug abuse (78.9; 43.4 to 143.6), blood transfusion (1.7; 1.1 to 2.8) and abdominal pain (2.7; 1.5 to 4.8). 75% of all participants were not vaccinated against hepatitis B or did not know their vaccination status. Among anti-HCV positive patients only 49% knew about their infection and 51% reported regular alcohol consumption. Transferrin saturation was elevated in 3.3% and was associated with fatigue (prevalence ratio 1.9; 1.2 to 2.8). CONCLUSION: Emergency rooms should be considered as targets for public health programs that encourage vaccination, patient education and screening of high-risk patients for liver disease with subsequent referral for treatment if indicated.

Tags: *Emergency Service, Hospital, Adult, Cross-Sectional Studies, Female, Hepatitis B Antibodies/blood, Hepatitis B/blood/*epidemiology, Hepatitis C Antibodies/blood, Hepatitis C/blood/*epidemiology, Hospitals, University, Humans, Liver Function Tests, Male, Middle Aged, Prevalence, Switzerland, Transferrin/*metabolism.

Reigner, P., Carron, P. N., Ribordy, V., and Yersin, B. “[Terrorism And Turning To Physicians: Management Of A Mass Casualty Situation]”. Rev Med Suisse 2, no. 91: 2876-9. doi:10.53738/revmed.2006.2.91.2876.

Tags: *Physician's Role, *Terrorism, Humans, Triage/*organization & administration.

Stolz, D., Christ-Crain, M., Bingisser, R., Leuppi, J., Miedinger, D., Muller, C., Huber, P., Muller, B., and Tamm, M. “Antibiotic Treatment Of Exacerbations Of Copd: A Randomized, Controlled Trial Comparing Procalcitonin-Guidance With Standard Therapy”. Chest 131, no. 1: 9-19. doi:10.1378/chest.06-1500.

Abstract: BACKGROUND: Therapy with antibiotics influences recovery only in selected cases of COPD exacerbations. We evaluated the efficacy and safety of procalcitonin guidance compared to standard therapy with antibiotic prescriptions in patients experiencing exacerbations of COPD. METHODS: A total of 208 consecutive patients requiring hospitalization for COPD exacerbation were randomized at the index exacerbation to procalcitonin-guided or standard antibiotic therapy. Patients receiving procalcitonin-guided therapy were treated with antibiotics according to serum procalcitonin levels; standard-therapy patients received antibiotics according to the attending physician. The primary outcome was the antibiotic exposure at the index exacerbation and the subsequent antibiotic requirement for COPD exacerbation within 6 months. Secondary outcomes were clinical recovery, symptom scores, length of hospitalization, ICU stay, death, lung function, exacerbation rate, and time to next exacerbation. RESULTS: At the index exacerbation, procalcitonin guidance reduced antibiotic prescription (40% vs 72%, respectively; p < 0.0001) and antibiotic exposure (relative risk [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; p < 0.0001) compared to standard therapy. Moreover, procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months (RR, 0.76; 95% CI, 0.64 to 0.92; p = 0.004). Clinical outcome and improvement in FEV(1) at 14 days and 6 months did not differ between groups. Within 6 months, the exacerbation rate (0.62 vs 0.64, respectively), the rehospitalization rate (0.21 vs 0.24, respectively), and mean (+/- SD) time to the next exacerbation (70.0 +/- 46.1 vs 70.4 +/- 51.9 days, respectively; p = 0.523) were similar in both groups. CONCLUSIONS: Procalcitonin guidance for exacerbations of COPD offers a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-to-treat of 3.

Tags: Acute Disease, Adult, Anti-Bacterial Agents/*therapeutic use, Bacterial Infections/*blood/*drug therapy, Calcitonin Gene-Related Peptide, Calcitonin/*blood, Chi-Square Distribution, Female, Humans, Male, Middle Aged, Protein Precursors/*blood, Pulmonary Disease, Chronic Obstructive/*blood/*drug therapy/physiopathology, Respiratory Tract Infections/*blood/*drug therapy, Spirometry, Statistics, Nonparametric, Treatment Outcome.

Grosgurin, Olivier, Plojoux, Jérôme, and Sarasin, François P. “How To Reduce Reperfusion Time In St Elevation Myocardial Infarction?; [Comment Réduire Le Délai De Reperfusion Dans L'infarctus Du Myocarde Avec Sus-Décalage Du Segment St?]”. Revue Medicale Suisse 3, no. 121: 1817-1819. https://www.scopus.com/pages/publications/34548666999?origin=resultslist.

Abstract: For patients with ST elevation myocardial infarction (STEMI), most hospitals do not achieve recommended reperfusion time delay. The goal of this article is to discuss the several strategies allowing to reduce delay to reperfusion (e.g., pre-hospital ECG, early activation of catheterisation laboratory), in order to help each institution to develop its own protocol.

Tags: article, electrocardiogram, Electrocardiography, Emergency Medical Services, heart catheterization, heart infarction, heart muscle reperfusion, high risk patient, human, Humans, mortality, Myocardial Infarction, Myocardial Reperfusion, ST elevation myocardial infarction, symptomatology, Time Factors.

Salathé, Cécile, and Sarasin, François P. “Initial Management Of Acute Heart Failure In The Emergency Department; [Insuffisance Cardiaque Aiguë Décompensée: Prise En Charge Initiale Aux Urgences]”. Revue Medicale Suisse 3, no. 121: 1822-1825. https://www.scopus.com/pages/publications/34548674246?origin=resultslist.

Abstract: Acute decompensated heart failure is one of the most leading diseases among elderly patients presenting in the emergency department with a chief complaint of dyspnea. Initial management is crucial for the patient's outcome. In this article we propose a review of diagnosis, treatment, stratification and orientation of patients admitted to emergency department with acute heart failure in light of recent recommendations.

Tags: Acute Disease, acute heart failure, clinical feature, diuretic agent, dopamine, dyspnea, Emergency Service, Hospital, emergency ward, heart arrhythmia, Heart Failure, Congestive, heart muscle ischemia, hospital admission, human, Humans, mortality, nesiritide, nitric acid derivative, outcome assessment, patient satisfaction, review, treatment indication, vasoactive agent, vasodilator agent.

Vermeulen, Bernard, and Carron, Pierre-Nicolas. “The Importance Of Teamwork Concepts When Training In Emergency Medicine; [Importance Du Concept De Travail D'équipe Dans La Formation En Médecine D'urgence]”. Revue Medicale Suisse 3, no. 121: 1813-1816. https://www.scopus.com/pages/publications/34548687058?origin=resultslist.

Abstract: The study of dynamics in relation to performing in small groups has increased pedagogic knowledge about teamwork. The successful management of patients with life-threatening pathologies depends highly from a succession of teams with a specific mission as: the call centre 144, Paramedics, the ED, the Operating Theatre and the Intensive care. To enable each team to operate successfully, it is essential to coordinate their qualifications and synergism. This can be efficiently attained by simulating real situations and by following protocols dedicated to teamwork. Emergency Medicine, which is on the brink of acquiring its proper curriculum, must adopt this concept to integrate knowledge and know-how, and the art of being and doing. At this stage, the Emergency Physician will have the competence which will enable him to be a real «team leader».

Tags: article, competence, curriculum, Emergency Medicine, Humans, Leadership, Patient Care Team.

Schreyer, Nicolas, D'Ambrogio, Aris, and Demartines, Nicolas. “Acute Abdominal Pain: What About Analgesia; [Le Syndrome Douloureux Abdominal (Sda) Aux Urgences: Quelle Analgésie?]”. Revue Medicale Suisse 3, no. 117: 1647-1650. https://www.scopus.com/pages/publications/34548482228?origin=resultslist.

Abstract: Acute abdominal pain tends not to be treated by surgeons and emergency physicians. However, literature has become clear that analgesics are effective and do not disturb clinical examination, diagnostic process and do not delay surgery. Thus, early treatment of acute abdominal pain is recommended, in the absence of scientific evidence, protocols must be established by each institution and validated by quality process.

Tags: Abdomen, Acute, Abdominal Pain, Acute Disease, Analgesics, Clinical Protocols, Diagnosis, Differential, Humans, Quality Assurance, Health Care.

Vetter, M., Aeschbacher, B., Schönfelder, A., and Rupp, P. “Das Tako-Tsubo-Syndrom - Eine Passagere Linksventrikuläre Kardiopathie Unklarer Ätiologie”. Der Notarzt 23, no. 2: 56-63. doi:10.1055/s-2006-952018.

Abstract: In this study we present the case of a 69-year-old female patient admitted to hospital with unstable angina pectoris, pathological ECG and secondary increase of troponin. Coronary angiography showed no significant stenosis of the coronary artery. Left ventriculography and heart echo revealed abnormal apical wall movement which had almost disappeared again two days after onset of symptoms. The patient's symptoms and diagnostic findings fufill the criteria for the Tako-Tsubo syndrome, which is a rare, transitory left ventricular cardiomyopathy of obscure etiology. We provide an overview of current literature and a possible therapeutic approach. In the case of female patients over 60 years of age presenting with symptoms of angina pectoris, unsuspicious angiography and typical echocardiographic findings, this rare syndrome should also be considered. Prognosis is favorable. Differential diagnostics should include coronary spasms and Prinzmetal angina. © Georg Thieme Verlag KG Stuttgart.

Tags: aged, angiocardiography, Apical dyskinesia, article, cardiomyopathy, case report, clinical feature, Coronary angiography, coronary artery spasm, Coronary spasms, differential diagnosis, electrocardiogram, female, heart left ventricle failure, heart ventriculography, human, Left bundle-branch block, Prinzmetal angina pectoris, tako tsubo syndrome, Tako-Tsubo cardiomyopathy, troponin, unstable angina pectoris.

Stangl, R., and Rupp, P. “Therapeutische Optionen Und Handlungsstrategien Bei Der Akutmanifestation Des Tachykarden Vorhofflimmerns”. Der Notarzt 23, no. 3: 101-104. doi:10.1055/s-2007-970846.

Tags: acupuncture, antiarrhythmic agent, cardioversion, clinical feature, electrocardiogram, health care policy, heart atrium fibrillation, human, practice guideline, short survey, tachycardia.

Stangl, Robert, Pietsch, C., and Rupp, P. “Successful Resuscitation In Sudden Unexpected Cardiac Arrest: Typical Ecg Changes In Brugada Syndrome Are Often Masked; [Erfolgreiche Reanimation Bei Plötzlichem, Unerwartetem Kreislaufstillstand: Typische Ekg-Veränderungen Beim Brugada-Syndrom Sind Häufig Maskiert]”. Notfall Und Hausarztmedizin 33, no. 2: 100-101. https://www.scopus.com/pages/publications/33947580164?origin=resultslist.

Rupp, P., and Stangl, R. “Akute Rhythmusstörungen - Fallbeispiel 40”. Der Notarzt 23, no. 5: 174-175. doi:10.1055/s-2007-971030.

Tags: article, beta adrenergic receptor blocking agent, case report, digitalis, electrocardiography, heart arrhythmia, hemodynamics, human, patient mobility, tachycardia, verapamil.

Rupp, P., and Stangl, R. “Risikostratifizierung Und Ressourcenorientierte Zuweisungsstrategien Bei Patienten Mit Akutem Koronarsyndrom (Acs) Im Notarztdienst”. Der Notarzt 23, no. 5: 155-160. doi:10.1055/s-2007-970905.

Abstract: Since the prevalence of acute coronary syndromes is still growing, a valid tool for risk stratification in the setting of emergency medical services is essentially. The synopsis from anamnestic data, physical examination and 12-lead ECG, estimates the total risk. Based on a pre-hospital triage-protocol, the decision about the subsequent clinical treatment can be made more reasonable. Low-risk-patients can be admitted to the next hospital with an internal division. Medium-risk patients should obtain ICU-Care. High-risk-patients must be admitted to a facility which performs PCI immediately. © Georg Thieme Verlag KG Stuttgart.

Tags: Acute coronary syndrome, angina pectoris, article, biochemistry, differential diagnosis, electrocardiography, emergency health service, health care planning, human, intensive care, percutaneous coronary intervention, physical examination, prevalence, risk assessment, Risk stratification, Strategy.

Rupp, P., and Stangl, R. “Akute Rhythmusstörungen - Fallbeispiel 39”. Der Notarzt 23, no. 1: 24-26. doi:10.1055/s-2006-951938.

Tags: adult, anamnesis, article, case report, clinical feature, electrocardiography, extrasystole, heart arrhythmia, heart stimulation, human, obesity, QRS complex, tachycardia.

Pietsch, C., and Rupp, P. “Ein Zucken Im Rechten Arm …”. Der Notarzt 23, no. 4: 135-136. doi:10.1055/s-2007-970812.

Abstract: A young pregnant woman is found with elevated blood pressure in her living room. She is brought to the nearest hospital. Arriving there a general myoclonic seizure occurs. © Georg Thieme Verlag KG Stuttgart.

Tags: article, case report, dihydralazine, Eclampsia, female, HELLP syndrome, human, Hypertension in pregnancy, magnesium salt, maternal hypertension, myoclonus seizure, nifedipine, preeclampsia, pregnancy, risk factor, symptomatology, Treatment, Urapidil.

Pietsch, C., and Rupp, P. “Vaginale Blutung - Seltenes Krankheitsbild Im Notarztdienst”. Der Notarzt 23, no. 6: 208-210. doi:10.1055/s-2007-970807.

Abstract: Gynecological emergencies a rare in the prehospital emergency physician services. Reported is the Case of a woman with vaginal bleeding ending in hemorrhagic shock. © Georg Thieme Verlag KG Stuttgart.

Tags: clinical feature, emergency care, emergency physician, Gynaecological emergencies, hemorrhagic shock, human, Myoma, review, Shock, uterus myoma, vagina bleeding, Vaginal bleeding.

Hohenstein, C., and Fleischmann, T. “Patientensicherheit Im Hochrisikobereich”. Der Notarzt 23, no. 1: 1-6. doi:10.1055/s-2006-939998.

Abstract: Patient safety in combination with their optimal treatment plays a more and more important role in our medical system. Devices for diagnosis and treatment in the field of prehospital emergency medicine underlie a constant and fast technical development. The increasing complex tasks in the prehospital field require high cognitive skills and a high specialization as well as qualification from emergency physicians. At the same time, an appropriate risk management is mandatory in order to maintain the optimal diagnostic and therapeutic regime for the patients. An anonymous Critical Incident Reporting System (CIRS), which derived from the aviation and already served well for the development of safety systems, is well suited for identification of critical incidents in the field of prehospital emergency medicine. Emergency physicians in their work with high risk patients can take advantage from this anonymous reporting system, as anaesthesiologists already profited from it previously. © Georg Thieme Verlag KG Stuttgart.

Tags: article, clinical practice, Critical incident reporting system, Critical incidents, diagnostic procedure, emergency care, emergency physician, health care personnel, health care system, incidence, medical instrumentation, Patient safety, Prehospital emergency medicine, Risk management, skill.

Bingisser, R., Gratzl, O., and Scheidegger, D. “Schnittstelle Notaufnahme”. Notfall + Rettungsmedizin 10, no. 3: 171-174. doi:10.1007/s10049-007-0893-8.

Abstract: The emergency department at the University Hospital in Basel is managed as an interdisciplinary "emergency department." The Basel Model in use is briefly explained. Ethical questions, in particular the question of suspending treatment, should be discussed early in the interdisciplinary team. Since the goal of medical care in the preclinical phase is mostly to enable rapid transfer to a suitable target hospital, the opportunity to pose these questions often first arises in the resuscitation room of the emergency department. Additional information relevant to decision making can be taken into consideration such as the putative wishes of the patient as well as the prognosis. The different standards in the preclinical and clinical phases can lead to conflicts in the emergency department. Communication between the team leader and the rescue squad, but also with colleagues in other disciplines, can be decisive. © Springer Medizin Verlag 2007.

Tags: Clinical emergency medicine, Ethics, Interdisciplinary emergency department, Preclinical emergency medicine.

Swiss Emergency Research collection

2007

2006