European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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In this study, we screened a total of 6723 consecutive patients with chest pain and ECG non-diagnostic for acute myocardial infarction (AMI) on presentation to the emergency department (ED). The aim of the study was to avoid missed AMI, improve safe early discharge and reduce inappropriate coronary care unit (CCU) admission. Chest pain patients were triaged using a clinical chest pain score and managed in a chest pain unit (CPU). ⋯ The remaining 34% of patients, with non-diagnostic or normal ECG, were managed in the CPU. In this group, 1487 patients (representing 22% of the overall study group) were found positive for CAD, two-thirds because of delayed ECG or serum markers of myocardial injury, and one-third by Echo, SPECT or ETT. In conclusion, CPU based management allowed 22% early detection of myocardial ischaemia and 78% early discharge from the ED avoiding inappropriate CCU admission and optimizing the use of urgent angiography.
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Acute intoxication by methylene chloride has primarily been reported from occupational settings. However, it may occur through domestic exposure, by the use of aerosol sprays, degreasers and paint removers. We describe an unusual case of an accidental domestic methylene chloride intoxication through the use of aerosol spray, resulting in an HbCO of 30%.