European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review Case Reports
Heart failure with preserved ejection fraction: echocardiographic VALVE protocol for emergency physicians.
Heart failure with preserved ejection fraction, previously called diastolic heart failure, has been recognized to account for heart failure in about half the total population of patients with heart failure. These patients can present with the signs and symptoms of acute heart failure. ⋯ These findings can aid in the recognition of patients who present with heart failure with preserved ejection fraction. The authors will discuss a focused stepwise approach, namely the VALVE protocol, suitable for the fast-paced emergency department.
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There is an ongoing shortfall of organs for donation in the UK and worldwide. Strategies including donation after circulatory death (DCD), living donation and better identification of potential donors are attempting to increase the number of donors and donated organs. The number of DCD donors in the UK increased by 808% from 37 to 336 between 2001 and 2010 and this is continuing to increase. ⋯ The process of DCD varies between different countries and institutions. The outcome of DCD transplantation has been largely encouraging, particularly for kidneys. The increase in DCD has led to an appraisal of issues that may arise during the donation process; these include the Lazarus phenomenon, the dead donor rule, perimortem interventions, public opinion and conflict of interest for clinicians.
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The use of point-of-care ultrasound in the emergency department has expanded considerably in recent years, allowing enhanced evaluation of the patient with an emergent eye or vision complaint. The technique is simple and quick to perform, and can yield clinical information that may not be readily obtainable through physical or slit-lamp exams. ⋯ Optic nerve sheath diameter can be measured in patients with a suspected intracranial process as a surrogate for intracranial pressure, and may aid emergency diagnosis and management. This article reviews common emergency ophthalmic pathologies diagnosed with ultrasound in the emergency setting and a mnemonic for the use of bedside ocular ultrasound is proposed to aid in thoroughly scanning the eye and its surrounding structures.
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Patients who have undergone a total laryngectomy have altered anatomy and physiology. This results in unique and specific issues that must be recognized in order to ensure that this group of patients experience appropriate care. This article looks at the current literature and attempts to highlight specific areas of concern, so that emergency care providers can deliver an equally high standard of care to this patient group as they do to others. ⋯ The results were analyzed to identify the most relevant articles that meet our objective. Articles were then organized into the different subheadings used within the article and reviewed. The most up-to-date articles or those that were in the opinion of the authors the most appropriate to convey our objective were included in our review.
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Review Comparative Study
Are two penicillins better than one? A systematic review of oral flucloxacillin and penicillin V versus oral flucloxacillin alone for the emergency department treatment of cellulitis.
Flucloxacillin either alone or combined with penicillin V is still the first-line antibiotic drug of choice for the treatment of cellulitis in emergency departments (EDs) in Ireland. The rationale for this antibiotic regimen is their anti-staphylococcal and anti-streptococcal activity. ⋯ Despite its common use, there are no published randomized-controlled trials comparing flucloxacillin monotherapy with a combination of flucloxacillin and penicillin V in the ED management of cellulitis. We discuss existing European and North American prescribing rationale and current guidelines.