J Emerg Med
-
Ghana's first Emergency Medicine residency and nursing training programs were initiated in 2009 and 2010, respectively, at Komfo Anokye Teaching Hospital in the city of Kumasi in association with Kwame Nkrumah University of Science and Technology and the Universities of Michigan and Utah. In addition, the National Ambulance Service was commissioned initially in 2004 and has developed to include both prehospital transport services in all regions of the country and Emergency Medical Technician training. Over a decade of domestic and international partnership has focused on making improvements in emergency care at a variety of institutional levels, culminating in the establishment of comprehensive emergency care training programs. ⋯ This work represents a significant move toward in-country development of sustainable, interdisciplinary, team-based emergency provider training programs designed to retain skilled health care workers in Ghana and may serve as a model for similar developing nations.
-
Pregnancy after hysterectomy is an extremely rare event. However, if not diagnosed and managed properly, it may result in life-threatening consequences. ⋯ The possibility of pregnancy should be considered in the differential diagnosis of abdominal pain in women with intact ovaries despite a history of hysterectomy. A pregnancy test should be a part of the diagnostic work-up of these patients when they present in the emergency department.
-
Acute paraquat poisoning has a high mortality rate. Several prognostic factors have been proposed to predict the mortality risk of paraquat-poisoned patients. However, these prognostic factors are complex and some require a laboratory. Corrected QT (QTc) has been used as a prognostic factor in several clinical conditions, such as acute organophosphate poisoning. In addition, the measurement can be obtained in a reasonable amount of time. ⋯ QTc prolongation is a useful prognostic factor for predicting death in acute paraquat-poisoned patients. Cardiovascular collapse may occur in some paraquat-poisoned patients. Physicians can use QTc as an indicator of a patient's severity of poisoning and mortality risk.
-
The benefits of low-carbohydrate, high-protein diets, such as the Dukan Diet©, are well documented, whereas reported adverse effects are rare in literature. Such diets mimic starvation states in that they promote the breakdown of fat and the production of ketones secondary to fatty acid metabolism. In fact, one measure of the effectiveness of such diets is the presence of ketosis. To our knowledge, there have been no reported cases of ketoacidosis resulting from the Dukan Diet. ⋯ Although rare, ketoacidosis secondary to a low-carbohydrate, high-protein diet can have serious complications if untreated. Clinical suspicion should arise in any patient presenting with intractable nausea and vomiting after starting a diet such as the Dukan Diet. Early recognition and intervention is essential to quicken patient recovery and outpatient management.
-
Resuscitation of any critically ill patient is aimed at restoration of oxygen delivery to maintain aerobic metabolism. Thus, "endpoints" of resuscitation have been sought after as a measure of evaluating the adequacy of resuscitation. This review article describes the most commonly used endpoints, central venous oxygen saturation (ScvO2) and lactate, and provides a clinically useful paradigm for utilizing these endpoints during resuscitation of critically ill patients in the emergency department (ED). ⋯ ScvO2 and lactate are useful endpoints of resuscitation, and when used together, provide a metabolic framework for guiding targeted therapy for critically ill patients in the ED with shock.