European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Status epilepticus (SE) is a common medical emergency. Two problems continue to militate against improved outcome in SE, namely, failure to recognize the wide spectrum of clinical presentation and failure to treat in an appropriately aggressive and timely manner. In this study, we aim to provide a clear understanding of the clinical presentation of SE, as well as providing an evidence-based review of the pathophysiological consequences of prolonged seizures, enabling the reader to adopt a rational approach to its management. We discuss current best practice for the management of SE as well as discussing alternative strategies, and briefly explore possible future therapeutic interventions.
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To report our experience with a guideline approach for the assessment of apparent life-threatening events (ALTE) at our paediatric emergency department (PED). ⋯ Most infants with a first episode of ALTE have normal physical examination. The absence of data suggesting underlying disease, after detailed history and examination, identifies a pool of infants who may be handled conservatively. This group may be monitored as outpatients after keeping them under watch for a short time at the emergency unit, thus avoiding unnecessary admissions. The low yield of laboratory tests in this group suggests that they could be safely omitted in most ALTE and restricted to cases with risk factors and/or whose progress at the observation unit is not satisfactory.
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Ultrasound at the bedside is being increasingly used by emergency physicians and others assessing the acutely ill and injured patient. Recent studies have described a sonographic sign, known as the 'sliding lung sign', which appears to hold promise in certain emergency situations including diagnosis of a pneumothorax and confirmation of endotracheal tube placement. This review article provides an introduction to the concept of the 'sliding lung sign' and gives an insight as to how it can be practically elicited and how it may potentially be used at the bedside in the emergency department.