European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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A 25-year-old woman presented with chest pain. Electrocardiogram (ECG) on admission was normal. When she had recurrent chest pain a second ECG showed marked ST elevation in the anteroseptal leads. ⋯ The case illustrates several important points. Inquiring about risk factors in patients with chest pain should include a question about abnormal clotting. It is important to exclude significant pathology in patients who may appear 'histrionic': inspection of a patient's belongings and collateral history may be invaluable.
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We conducted a prospective study of 152 adult patients presenting to an emergency department with chest pain or symptoms suggestive of acute myocardial infarction (AMI) to evaluate the first electrocardiogram (ECG), creatine kinase (CK)-MB and Troponin-T Rapid Assay (TnT) alone or in combination with chest pain in the initial diagnosis of AMI. A provisional diagnosis was made after the history, physical examination and the first ECG reading. Blood specimens were taken for TnT, CK and CK-MB mass. ⋯ A combination of the first ECG, CK-MB mass and TnT had a negative predictive value (NPV) of 87.9% (95% CI, 80.0-95.8). The first ECG was the most sensitive test while the combination of chest pain, ECG, cardiac enzymes and TnT gave the best results in the initial diagnosis of AMI. If the first ECG, CK-MB mass and TnT are all negative, the probability of having an AMI is 12%.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, open, single blind, randomized study comparing four analgesics in the treatment of peripheral injury in the emergency department.
The efficacy of four analgesics, distinct concerning analgesic power and mechanism of action, was evaluated for pain relief in patients suffering from single peripheral injury. Patients were randomly allocated to receive either propacetamol (the pro-drug of paracetamol) 20 mg/kg i.v., piritramide 0.25 mg/kg i.m., tramadol 1 mg/kg i.v. or diclofenac 1 mg/kg i.v. Pain scores were measured by the patient using the visual analogue scale (VAS) and by an observer using a 4-point verbal rating scale (VRS). ⋯ VRS score analysis showed a similar trend although significances differed. In the piritramide group significantly more side effects were noted than in the other groups (p < 0.05). We conclude that intravenous propacetamol, tramadol and diclofenac are equally efficacious for emergency analgesic treatment of single peripheral trauma.
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Rupturing of the liver due to delivery is an uncommon but severe birth trauma. Although described in the preterm neonate with very low birthweight or after complicated delivery, we present a case of capsular liver haemorrhage in a term newborn with normal birthweight after a seemingly uncomplicated delivery. ⋯ Since shock was not amenable to fluid replacement therapy, the haemorrhage had to be managed surgically. Even without evidence of birth trauma, intra-abdominal bleeding must always be suspected in a newborn with suddenly prevailing shock and unexpected anaemia.