Showing papers by "Bertrand Yersin published in 1990"

Right arm involvement and pain extension can help to differentiate coronary diseases from chest pain of other origin: a prospective emergency ward study of 278 consecutive patients admitted for chest pain.

Abstract: . In a prospective study of 278 consecutive patients admitted to an emergency ward for chest pain, the 115 clinical and paraclinical parameters available at the time of admission were evaluated by computer comparison with the final diagnoses. The most valuable items for making the diagnosis were classified according to their sensitivity, specificity and predictive value. Among the 278 patients, 100 individuals had myocardial infarctions (MI), 47 had unstable angina, 25 had stable angina and 106 patients had a non-coronary disease. The twelve most sensitive items for distinguishing MI from other conditions were the following: sudden onset of pain (70%): duration of more than 60 min (88%): constriction and squeezing (79%): oppression (75%): prior anginal attacks (61%): sex male (72%): age over 60 years (74%): abnormal heart auscultation (62%): abnormal electrocardiogram (ECG)(98%): segment (ST) disturbances (86%): increased glucose level (77%): CKMB fraction greater than 6% of total creatine kinase (CK) level (63%). Among the twelve most specific items, also with the best positive predictive value, irradiation in the right arm is of most importance: among the 51 patients with right arm involvement, 48 suffered from a coronary disease and 41 from a myocardial infarction. The largest extension of pain was reported in the latter group. It is concluded that chest pain with a wide irradiation involving the right arm strongly suggests that a myocardial infarction is ongoing.

Characteristics of 167 consecutive traffic accident victims with special reference to alcohol intoxication: A prospective emergency room study

Abstract: This prospective study examined the characteristics of 167 consecutive traffic accident victims admitted to the emergency room of a major Swiss hospital with particular attention to the presence of a detectable blood alcohol concentration (BAC). The majority of the study population were male (71%), 16–29 years of age (56%) and occupants of an automobile or motorcycle (70%). Most patients were injured during the daytime, with nighttime accidents increasing towards the end of the week. Seventy-five percent of the injured were drivers of the crash vehicle and the majority (56%) were involved in multi-vehicle accidents. Fifty-three percent of all injuries consisted of internal lesions and/or fractures with motorcyclists and pedestrians being the most severely injured. There was a 21% incidence of alcohol intoxication (BAC>=0.8 g/kg); 97% of intoxicated patients were male, of which 38% were 16–29 years of age. There was a distinct age-related alcohol intoxication pattern among males, with an intoxication rate of 20% in the 16–29 age range and 40% in the 30–75 age range. Alcohol-related accidents occurred predominantly in the nighttime and towards the end of the week, and victims of single-vehicle crashes were more likely to be intoxicated (28%) than those injured in multi-vehicle crashes (17%). Moped drivers exhibited the highest rate of intoxication (45%) followed by pedestrians (42%). Our study confirms the high prevalence of acute alcohol intoxication among traffic accident victims in Switzerland, a fact which needs to be considered by the treating medical care providers for the early detection and referral of alcohol-related problems, and which should be limited by effective preventive measures.