Herman Delooz

Quality and efficiency of bystander CPR

Abstract Incorrectly performed bystander CPR might compromise survival of the cardiac arrest patient. We therefore evaluated the outcome in 3306 out-of-hospital primary cardiac arrests of which 885 received bystander CPR. bystanders performed CPR correctly in 52%, incorrectly in 11%, 31% performed only external chest compressions (ECC) and 6% only mouth-to-mouth ventilation (MMV). The initial ECG in cases without bystander CPR was ventricular fibrillation in 28% (95% confidence interval: 27–30%); 45% (41–50%) and 39% (29–48%), respectively when bystander CPR was performed correctly or incorrectly; 43% (37–49%) when only ECC was applied and 22% (11–33%) when only MMV was practiced. Long term survival, defined as being awake 14 days after CPR, was 16% (13–19%) in patients with correct bystander CPR; 10% (7–14%) and 2% (0–9%), respectively when only ECC or only MMV was performed; 7% (6–8%) when no bystander was involved; 4% (0–8%) when bystander CPR was performed incorrectly. Bystander CPR might have a beneficial effect on survival by maintaining the heart in ventricular fibrillation by ECC. A negative effect of badly performed bystander CPR was not observed compared to cases which had not received bystander CPR.

A Nurse-Led Interdisciplinary Intervention Program for Delirium in Elderly Hip-Fracture Patients

OBJECTIVES: To develop and test the effect of a nurse‐led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip‐fracture patients.

PREDICTIVE VALUE OF GLASGOW COMA SCORE FOR AWAKENING AFTER OUT-OF-HOSPITAL CARDIAC ARREST

The Glasgow coma score (GCS) during days 1-6 after cardiac arrest was used to predict neurological outcome in 360 resuscitated victims of out-of-hospital cardiac arrest. A predictive rule based on the best GCS of 216 patients resuscitated in 1983-84 (prediction group) was constructed, and its predictive power was tested on 133 patients treated in 1985 (test group). Neurological outcome was correctly predicted 2 days after cardiac arrest in 80% of the prediction group, with a best GCS of 10 or above and 4 or below as cutoff points. For patients with a best GCS of 5-9, prediction of outcome was possible 6 days after cardiac arrest, with a best GCS of 8 during the first 6 days as the single cutoff point. The rule was then validated in the test group: the sensitivity was 96%; the specificity 86%; the negative predictive value 97%; and the positive predictive value 77%. These data suggest that this simple GCS-based rule can be helpful in predicting outcome in patients resuscitated after out-of-hospital cardiac arrest, but confirmation of these data is required in a prospective study in a larger number of patients.

Chest pain in the emergency department: the broad spectrum of causes.

We performed a prospective study to describe the broad spectrum of causes of chest pain in patients presenting to the emergency department and to compare the diagnoses in referred patients, self-referred patients and patients rushed in by ambulance. The final diagnosis in a consecutive case series of 578 chest pain patients was established after discharge from the hospital. The underlying disorders were grouped into cardiac, respiratory, gastro-oesophageal disorders, musculoskeletal pathology, somatization disorders, other diseases and unknown. For comparison of the frequencies of the disease categories the Chi-squared test was used. Out of 578 patients, 161 (27.9%) were self-referred, 369 (63.8%) were referred by the general practitioner and 48 (8.3%) were rushed in by ambulance. Cardiac diseases represented 51.7% of the cases, myocardial infarction and unstable angina 19% and 12.8% respectively. Cardiac diseases were statistically significantly less common in self-referred patients (p <0.0005). Pulmonary diseases encompassed 14.2% of the population, followed by somatization disorders (9.2%), musculoskeletal pathology (7.1%) and other causes (4.3%). In 11.1% of the cases no definite final diagnosis could be established. Somatization disorders were significantly more frequent in self-referred and ambulance patients. Cardiac and pulmonary problems are the most frequent underlying disorders in acute chest pain patients in the emergency department. Somatization disorders and musculoskeletal pathology represented respectively 19.1% and 14.8% of the non-cardiac causes. The referral pattern influenced significantly the distribution of the disease categories with more cardiac and less psychiatric disorders in referred patients.

Systematic triage in the emergency department using the Australian National Triage Scale: a pilot project.

The objective of this study was to evaluate the validity in Belgium of the National Triage Scale for judgement of the urgency of a patients 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.

Fatal intentional poisoning cases admitted to the University Hospitals of Leuven, Belgium from 1993 to 1996.

Between January 1993 and July 1996, a total of 2827 intentional cases of poisoning were registered in the University Hospitals of Leuven, Belgium. Ten of these cases were fatal. This study was set up to evaluate the substances involved, the circumstances, the features and the characteristics of the patients who died due to intentional poisoning. The male to female ratio of these fatal cases was 9 : 1. The median age was 43 years. Two groups of substances were revealed to be associated with fatal outcome. The first group consisted of chemicals (seven lethal cases): cholinesterase inhibitors (n =3), methanol (n =2) and paraquat (n =2). The second group consisted of benzodiazepines (three lethal cases). In the cases of poisoning with chemicals, death was directly related to product toxicity and the severity of the poisoning, whilst with benzodiazepines, which are considered to be relatively safe drugs even when taken in overdose, there was a clear relationship between a fatal outcome and a delay between ingestion and medical support. Product toxicity, complications and a delay in medical support may be considered as predictors for the effectiveness and efficacy of treatment and may influence which medical treatments need to be administered.

The effect of helmets on the incidence and severity of head and cervical spine injuries in motorcycle and moped accident victims: a prospective analysis based on emergency department and trauma centre data

The aim of this prospective study was to quantify the anatomic severity of head and cervical spine injuries in hospital admitted victims of motorcycle and moped accidents in relation to helmet use and controlled for non-head injuries (i.e. kinetic impact). Two hundred and twenty-three patients entered the study group, of which 152 were motorcyclists and 71 were moped riders. Our results reveal that helmets do prevent head injury in motorcycle and moped accidents, especially in those crashes involving relatively low kinetic energy transfers. Helmet use does not lead to an increase of the incidence or severity of cervical spine injury. As a result compulsory helmet laws should not be limited to motorcyclists but also focus on all moped riders and probably also bicyclists. This study illustrates that emergency departments can provide important epidemiological information for injury control purposes. However, the epidemiological use of emergency department data and hospital data in general requires cautiousness. Confounding is a common problem which should be dealt with during analysis.

The European Master Program in Disaster Medicine

Objectives To present and evaluate the European Master in Disaster Medicine (EMDM) as a unique education and training model for all those involved in the medical preparedness and response in disaster situations at local, national and international levels. Methods The EMDM is composed of a self-directed study based on problem-based e-learning, a live-in course with interactive exercises and debates, a thesis related to a topic of disaster medicine or disaster management, and a final on-line examination provided on the Internet. Results The European Certificate in Disaster Medicine started in 2000 and was upgraded to a level two European Master in 2002. To date, 76 students from 27 nationalities have participated in the EMDM. A summative evaluation shows that the great number and variety of practical exercises and interactive debates during the residential course, the problem-oriented simulation exercises, and the discussion forum on the EMDM website are highly valued by the students. Conclusion The problem...

The use of buffers

Metabolic acidosis can be caused by increased production of organic acids, by decreased excretion of hydrogen ions due to renal dysfunction, by loss of base or by increased intake of acid [14]. Buffers are present in all body compartments, but in varying quantities and in varying attainability [17]. Furthermore the buffering capacity of different cellular structures is not identical [12]. The brain occupies a special place as far as buffering is concerned, for only carbon dioxide crosses freely the blood-brain barrier [8]. The administration of sodium bicarbonate will exert an immediate buffering effect in the blood, but will, by producing carbon dioxide, initially cause a paradoxical drop of the pH of the cerebro-spinal fluid [151. As far as the general rules for the use of buffers are concerned, three questions need to be asked: 1. When to use a buffer solution? 2. Which buffer to use? 3. How much of the buffer solution should be administered?

Harris or axis ring: an aid in diagnosing low (type 3) odontoid fractures

OBJECTIVE To present our experience of diagnosing fractures of the odontoid process on lateral radiographs of the cervical spine that show the Harris (axis) ring. DESIGN Retrospective study. SETTING Teaching hospital, Belgium. SUBJECTS 12 patients with multiple injuries, including cervical spine, 8 of them unconscious or uncooperative. INTERVENTIONS Cross table lateral view of the cervical spine. MAIN OUTCOME MEASURE Identification of otherwise hidden type 3 axial fractures. RESULTS Diagnosis of low odontoid fractures in all cases. CONCLUSION The Harris ring is disrupted in low odontoid fractures and intact in fractures of the odontoid process. Awareness of this sign will allow diagnosis of otherwise hidden axial fractures.