European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
The National Emergency X-ray Utilisation Study (NEXUS) criteria and the Canadian cervical spine rules are validated clinical decision-making tools used to facilitate selective cervical spine (C-spine) radiography. The NEXUS criteria are frequently used, as the Canadian cervical spine rules have been noted to be difficult to learn, remember and implement. We present a series of significant C-spine injury in three elderly patients who would not have warranted C-spine imaging using the NEXUS criteria. ⋯ Plain film imaging was initially performed as each patient had a reduced range of movement. Significant odontoid peg injury was confirmed on subsequent computed tomography/MRI imaging for all patients. Despite previous validation studies of the NEXUS criteria in the elderly population, we would urge caution in using the NEXUS criteria alone in determining radiography of the C-spine in the elderly.
-
Angioedema is characterized by localized swelling of subcutaneous tissues or mucosa of the upper respiratory or gastrointestinal tract. Laryngeal involvement may threaten airway patency and can be fatal if not addressed promptly. ⋯ In the emergency department, it is essential not only that acute angioedema is identified as quickly as possible but also that the likely working diagnosis is established so that the most effective treatment may be administered to resolve potentially life-threatening swelling. In this paper, we present an overview of the various types of angioedema, and offer a practical diagnostic and therapeutic approach to their management.
-
The aim of this study was to determine the prevalence and prognostic value of troponin elevation at emergency department (ED) presentation in patients admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). A retrospective cohort study of ED patients with acute exacerbations of COPD who were admitted to hospital and in whom troponin was assayed at ED presentation. Other data collected included demographics, clinical characteristics, test results, and outcome. ⋯ Seventy-eight patients had elevated troponin of greater than 99th centile (31%, 95% CI 26-37%). Factors independently associated with mortality were troponin elevation [odds ratio (OR) 8.3, 95% CI 1.58-43.7], pH less than 7.2 (OR 12.7, 95% CI 1.86-86.4), and requirement for noninvasive ventilation (OR 8.09, 95% CI 1.61-40.8). In conclusion, troponin elevation is associated with increased in-hospital mortality in ED patients with acute exacerbation of COPD.
-
The aim of the study was to evaluate the prevalence and the risk factors of ventilation-associated pneumonia (VAP) for out-of-hospital or in the emergency department intubated patients. This was a retrospective descriptive study. All intubated adults subsequently admitted to the ICU over 1-year period were included. ⋯ Death rate was 17% and was not significantly higher for patients with VAP (P=0.9; 95% CI 0.32-4.95%). Emergency care workers should be aware of the potential 20% occurrence of VAP when they intubate and ventilate a patient. Preventive strategies, which have been proven effective in ICUs, should be implemented in the emergency setting.