European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Ultrasound (US) has been used for in-hospital evaluation of the trauma victim for many years. The outcome in severely injured patients remains heavily influenced by initial life support and early care, as time plays a major role. Development of handheld, battery-powered, low-weight US machines has created the possibility of bringing US to the prehospital setting, thus gaining a potential for early diagnosis and treatment. ⋯ Several studies in this review showed that prehospital US is feasible and that the procedure is highly reliable in detection of haemoperitoneum or haemopericardium compared with the low accuracy of physical examination and haemodynamic measurements. An early diagnosis will provide the prehospital physician with the knowledge to prioritize the relevant initial treatment and to choose the closest appropriate hospital and transportation form. There is currently no evidence in the literature that prehospital US of the abdomen or thorax improves treatment of trauma patients.
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During the last few years, a growing number of studies have shown the accuracy of lung ultrasound in the diagnosis of pulmonary diseases. The latest developments in lung ultrasound are not because of technological advance, but are based on new applications and discovering the meanings of sonographic artifacts. ⋯ The bedside sonographic recognition of pulmonary diseases practically guides management and reduces the amount of negative radiologic image testings. This review describes some innovative practical applications of B-mode lung ultrasound in the diagnosis of alveolar consolidations and interstitial syndrome in the emergency department.
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Review
Hypokalemic periodic paralysis: a case series, review of the literature and update of management.
The objective of this study was to present a case series of patients with hypokalemic periodic paralysis. We described all patients with diagnosis of hypokalemic periodic paralysis admitted to the Al Ain Hospital (UAE) during the year 2006. Seventeen patients, all males and mostly Asians, were presented to the Al Ain Hospital over a 12-month period. ⋯ In conclusion, clinicians should have a high index of suspicion, especially among Asians presenting with flaccid paralysis and hypokalemia. The main steps in the management include exclusion of other causes of hypokalemia, potassium replacement, hydration and close monitoring of the cardiac rhythm and serum potassium levels. When possible, the underlying cause must be adequately addressed to prevent the persistence or recurrence of paralysis.
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To question the existing practice to observe the victims of scorpion sting in the emergency department at least for 6 h. ⋯ Serious toxicity after scorpion sting in Israel and some of neighboring countries is rare, and always presents within 1 h from the sting. Thus, prolonged observation can be reserved for a high-risk population and patients with serious toxicity on admission.
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Spider bites are an uncommon presenting complaint to Irish emergency services. We describe the case report of a patient diagnosed with a spider bite, thought due to an Australian (White-Tailed) spider unintentionally imported in a traveller's luggage. Her lesions were consistent with those caused by White-Tailed Spiders, and her clinical course and management is described. ⋯ The ascription of various clinical effects to particular spiders is problematic because of poor case definition and a lack of confirmed scientific evidence. However, spider bite enquiries are now the single most common reason for calls to Australian poisons centres. The diagnosis and treatment of spider bites is discussed with reference to the use of antibiotics, steroids and antivenoms, as featured in the recent literature.