Assuntos
Parada Cardíaca , Hipotermia , Humanos , Ordens quanto à Conduta (Ética Médica) , ReaquecimentoAssuntos
Reanimação Cardiopulmonar/métodos , Eletrocardiografia , Parada Cardíaca/etiologia , Frequência Cardíaca/fisiologia , Fibrilação Ventricular/complicações , Idoso , Evolução Fatal , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Humanos , Masculino , Fibrilação Ventricular/fisiopatologiaRESUMO
Suicide is a major cause of premature deaths worldwide and belongs to the top priority public health issues. While suicide attempt is the most important risk factor for completed suicide, intervention for suicide attempters (SA) have produced mixed results. Since an important proportion of SA request medical care, emergency units (EU) are an opportune setting to implement such interventions. This exploratory study evaluated the feasibility and acceptability of a multicomponent intervention for SA admitted to an EU. The intervention consisted of coordination by a case manager of a joint crisis plan (JCP), an early meeting with relatives and the existing care network, as well as phone contacts during 3 months after suicide attempt. Among 107 SA admitted to the emergency unit during the study period, 51 could not be included for logistical reason, 22 were excluded, and intervention was offered to 34. Of these, 15 refused the intervention, which was thus piloted with 19 SA. First-time attempters most frequently declined the intervention. Feasibility and acceptability of phone contacts and case manager were good, while JCPs and meetings were difficult to implement and perceived as less acceptable. Refusal pattern questions the global acceptability and is discussed: JCPs and meetings will have to be modified in order to improve their feasibility and acceptability, especially among first-time attempters.
Assuntos
Psicotrópicos/efeitos adversos , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto , Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/fisiopatologia , Serviços Médicos de Emergência/métodos , Humanos , Masculino , Psicotrópicos/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/fisiopatologiaRESUMO
In 2006, a medico-legal consultation service devoted to adult victims of interpersonal violence was set up at the Lausanne University Hospital Centre, Switzerland: the Violence Medical Unit. Most patients are referred to the consultation by the Emergency Department. They are received by forensic nurses for support, forensic examination (in order to establish medical report) and community orientation. Between 2007 and 2009, among community violence, aggressions by security agents of nightclubs on clients have increased from 6% to 10%. Most of the victims are young men who had drunk alcohol before the assault. 25.7% presented one or several fractures, all of them in the head area. These findings raise questions about the ability of security agents of nightclubs to deal adequately with obviously risky situations and ensure client security.
Assuntos
Ocupações , Violência/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Licença Médica , Suíça/epidemiologia , Armas/estatística & dados numéricos , Ferimentos e Lesões/economiaRESUMO
Standardized clinical examination can obviate the need for osteoarticular radiographs for trauma. This paper summarizes a number of decision rules that allow clinical exclusion of significant fracture of the cervical spine, elbow, knee or ankle, making radiographs unnecessary. These criteria were all derived from large cohort studies (Nexus, Ottawa, CCS, etc..., and have been prospectively validated. The rigorous use of these criteria in daily practice improves treatment times and costs with no adverse effect on treatment quality.