European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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High velocity impact by handlebar is a rare cause of abdominal wall hernia following blunt trauma. We report a case of bicycle handlebar induced traumatic hernia with jejunal perforation. This case demonstrates that presentation of a traumatic hernia can be delayed and that computed tomographic scanning is useful in confirming the diagnosis. Surgical exploration with primary repair of the defect is the definitive treatment in cases of traumatic hernia.
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This paper reviews the experience of penetrating chest trauma over a 3-year period in one UK emergency department. ⋯ Penetrating chest trauma contributes significantly to our trauma workload with a high proportion of patients sustaining life-threatening injuries requiring immediate intervention. Significant prehospital delays occur. Overall mortality of 4.2% is comparable with that of a major American case series. Further education and protocol development is required to ensure that prehospital and emergency department management of these patients reflects the latest evidence-based guidelines.
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A 21-year-old man presented to the emergency department in St James's Hospital by ambulance. He was found collapsed at home by his uncle. He was complaining of severe pain and swelling to his left lower limb, with reduced sensation to his left foot. ⋯ If there is any evidence of compartment syndrome, urgent fasciotomy is required. Electrolyte imbalances should be corrected, unless very mildly abnormal. We have learned from our experience with this case that a high index of suspicion and thereby early recognition is crucial to prevent complications in intravenous drug users presenting with unusual symptoms and signs.
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The use of ketamine for pediatric sedation in the Emergency Department for painful procedures has become increasingly popular. Ketamine is a safe and effective sedative for diagnostic or therapeutic procedures in the Emergency Department. Sedation with this dissociative agent produces a rapid onset action, potent analgesia, adequate sedation, amnesia and minimal side effects. We report a case of prolonged sedation and airway complications after administration of an inadvertent intramuscular ketamine overdose in a healthy child.
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Multicenter Study Clinical Trial
Evaluation of an international emergency medicine intervention in Tuscany.
To measure the effectiveness of a 9-month emergency medicine 'train the trainers' program in Tuscany, Italy. ⋯ When measured by written examinations, oral examinations and physician self-assessment, a train the trainers program, designed as part of an international emergency medicine collaboration, was efficacious.