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Background Analysis of in-hospital mortality after serious adverse events (SAE's) in our hospital showed the need for more frequent observation in medical and surgical wards. We hypothesized that the incidence of SAE's could be decreased by introducing a standard nurse observation protocol. Aim To investigate the effect of a standard nurse observation protocol implementing the Modified Early Warning Score (MEWS) and a color graphic observation chart. Methods Pre- and post-intervention study by analysis of patients records for a 5-day period after Intensive Care Unit (ICU) discharge to 14 medical and surgical wards before (n = 530) and after (n = 509) the intervention. Results For the total study population the mean Patient Observation Frequency Per Nursing Shift (POFPNS) during the 5-day period after ICU discharge increased from .9993 (95% C.I. .9637–1.0350) in the pre-intervention period to 1.0732 (95% C.I. 1.0362–1.1101) (p = .005) in the post-intervention period. There was an increased risk of a SAE in patients with MEWS 4 or higher in the present nursing shift (HR 8.25; 95% C.I. 2.88–23.62) and the previous nursing shift (HR 12.83;95% C.I. 4.45–36.99). There was an absolute risk reduction for SAE's within 120 h after ICU discharge of 2.2% (95% C.I. −0.4–4.67%) from 5.7% to 3.5%. Conclusion The intervention had a positive impact on the observation frequency. MEWS had a predictive value for SAE's in patients after ICU discharge. The drop in SAE's was substantial but did not reach statistical significance.

Thrombotic disease of the vertebrobasilar circulation is associated with a poor prognosis. It may occur in trauma patients, especially those with neck injuries and even several months after the initial insult. We report on the case of a young polytrauma patient, victim of a traffic accident, with associated cervical and thoracic spinal injuries resulting in paraplegia. Consciousness was not impaired initially, but during transfer to our hospital he became suddenly unconscious. An occluded basilar artery was found on angiography, but unfortunately we were unable to reopen the vessel with thrombolytic therapy. This case again proves that lesions of the vertebro-basilar system must always be suspected in neck injuries. Even after minor whiplash injuries, fatal basilar thrombosis may occur. A review of all reported cases of traumatic basilar artery thrombosis is given and the use of thrombolytic therapy is discussed.

The only way to rescue ischaemic tissue is to re-instate the oxygen supply to the tissue. However reperfusion of the ischaemic area not only oxygenates the tissue but also initiates a cascade of processes, which may in some cases result in temporary dysfunction of the myocardium. In order to devise protective measures, it is essential to understand the mechanisms and the triggers of this reperfusion phenomenon. In this review we will mainly focus on the inflammatory response caused by reperfusion. We will cover the different steps of polymorphonuclear leukocyte activation and will briefly discuss the molecular biology of the receptors involved. The currently used pharmacological medications in acute cardiology will be reviewed and in particular their actions on polymorphonuclear leukocyte activation, adhesion and degranulation. This review is a compilation of the current knowledge in the field and the therapeutic progress in the prevention of reperfusion injury made today.

The risk of complications of cardiopulmonary resuscitation (CPR) does not outweigh the benefit of a successful restoration of a spontaneous circulation. Despite the frequent occurrence of gastric distension (caused by air entering the stomach because of too forceful and/or too quick rescue breathing), there are few reports of massive gastric distension causing gastric rupture and pneumoperitoneum after CPR. We reviewed all 67 case reports of gastric perforation that have been reported after CPR. Although uncommon, this review stresses the need to consider this potentially lethal complication after initial successful resuscitation.

Amniotic fluid embolism (AFE) is a relatively rare condition usually occurring during or shortly after pregnancy and is catastrophic in most cases. The classical description is a sudden onset of dyspnoea, cyanosis and hypotension out of proportion to the blood loss, followed quickly by cardiorespiratory arrest. Up to 20% of patients will have seizures and up to 40% will have consumptive coagulopathy. If the patient survives the initial phase, a non-cardiogenic pulmonary oedema will follow in up to 70% of all cases. We report on two cases of severe and near fatal amniotic fluid embolism during pregnancy. Surgical trauma, caused by a blow in the stomach and a surgical intervention, was considered to be the aetiology.

Adults seem to be more vulnerable than children to tracheal lacerations. Tracheal lacerations have been described particularly after surgical procedures and penetrating trauma, but they may also result from minor blunt trauma. We report the case of a 7-year-old boy who sustained a posterior tracheal wall laceration after a direct frontal fall on a wooden strut. We also review the literature on posterior wall tracheal laceration as an isolated feature after blunt cervical trauma in children, the diagnostic features and management options.

Kawasaki disease (KD) is an uncommon cause of sudden death in young adults in Europe. Angiographically, the disease is characterized by coronary artery aneurysms which can be fully obstructed by acute thrombosis or by progression of the disease. If diagnosis of KD is made, immediate investigation should be made to determine whether ischemia is occurring and if so, to establish optimal time for revascularisation or cardiac transplantation. We describe an 18-year-old Caucasian male who was not previously known to have KD and who suffered from an acute myocardial infarction complicated by ventricular fibrillation, caused by acute thrombosis of a coronary artery aneurysm.