Emergency medicine journal : EMJ
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A short cut review was carried out to establish whether terlipressin or somatostatin is more effective at reducing acute bleeding in adults with known oesophageal varices. Altogether 170 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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This is the first case report of a ruptured aortic aneurysm presenting with acute right buttock pain. The patient was an 80 year old man. ⋯ Thus the present case is another unusual presentation of ruptured abdominal aortic aneurysm and highlights the importance of careful history taking and clinical examination. A high index of clinical suspicion of aneurysm rupture should be maintained in elderly patients presenting with a history of collapse.
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Salicylate self poisoning is potentially fatal. Plasma salicylate concentrations can be used to guide management when taken in the context of clinical features of toxicity and acid base status. Previous studies in the USA and Hong Kong have shown that routine measurement of plasma salicylate concentrations in all overdose patients is inappropriate, but there have been no previous studies in the UK. ⋯ History of salicylate ingestion has a high sensitivity and negative predictive value with respect to the detection of plasma salicylate concentrations. However, current practice indicates that insufficient information is obtained from patients about the clinical features of toxicity. Routine measurement of plasma salicylate concentrations is not required unless there is (a) a positive history of ingestion of salicylates or (b) a reduced level of consciousness or other reason limiting the validity of the history obtained, together with clinical features consistent with salicylate poisoning.
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Lactic acidosis is a recognised event in adult patients with status asthmaticus, particularly in the setting of intensive care. However, it has been infrequently studied in patients attending the emergency departments (ED). ⋯ This study confirmed previous observations that high lactate concentrations can develop during the first hours of inhaled beta agonist treatment. The presence of a previous hyperadrenergic state may predispose to the development of this condition. A significant improvement in lung function was associated with elevated lactate levels.
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The Diploma in Immediate Care of the Royal College of Surgeons of Edinburgh is increasingly recognised as a gold standard for immediate care practitioners, including doctors with a significant involvement in prehospital care, paramedics who wish to enhance their knowledge base or obtain the Diploma as an entry requirement for a post registration degree, and for nurses who have a recognised and developing role in the evolving emergency medical services. This paper provides information about the Diploma examination including eligibility, the syllabus and the components of the examination, and comments on the reason for failure and provides suggestions for training and education to enhance the candidate's opportunity of passing the examination.